Diagnosis and Budgeting

 I have attended several talks in the past few weeks on various topics but all of these seem to have had one thing in common; the fact that budgets and quotas play a huge part in the role of a doctor.

The first in this series of talks was a talk given to my school’s medical society by Dr Greg Rubin from Durham University about the early diagnosis of cancer, in particular the role of GPs in the process. He stated that a quarter of cases of cancer are diagnosed in A&E and also that in terms of survival rates after diagnosis, the UK looks pretty bad compared with other countries including Denmark, the USA and Australia. The UK currently has 28 cancer care networks but this doesn’t seem to be enough. We were able to ponder the importance of a multitude of factors influencing the chances of survival of a cancer patient but the winner was always going to be the time of diagnosis. So how can the NHS ensure that diagnosis takes place early enough?

A few factors were mentioned:

-The ability of patients to recall significant symptoms that are often unknown, such as a persistent cough. Failure to mention something that may seem trivial to a patient due to a lack of knowledge on the topic could mean a doctor misses a diagnosis, which could save a life. This highlights the importance of awareness of common symptoms of various cancers. It becomes slightly difficult, however, to fully educate the population when we consider that there is a fine line between education for the good of the population and education that could cause panic and be seen as scaremongering. For example, the last thing busy, overprescribed, understaffed hospitals need is Mrs Smith who has had a cough for two days and is convinced she has cancer walking into their emergency department demanding tests. We also need to think about the fact that education of an entire population is not going to be cheap and can the NHS afford all of the campaigns that would be necessary to publicise the unknown symptoms of less common cancers? Should cost come before the health and awareness of the population? Would it in fact save money to educate people and thus reduce the number of emergency cancer cases seen by catching it earlier?

-This brings us nicely to the second factor; the early diagnosis of cancer. Of course identifying cancer in patients early will increase their chances of survival. So what is involved in diagnosing cancer in a patient? I attended Mini Medical School at Newcastle University where the topic was ‘Diagnosis-art, science or hunch?’ and the diagnostic process was also touched upon in the lecture given by Dr Rubin. There are several steps to diagnosing a patient, most of which do not directly involve a doctor. Before the doctor even sees the patient, the patient has the appraisal phase, where they decide that they are ill and need treatment. This requires knowledge of what it means to be ill. Of course there is the medical model of illness, where one has a disease and is suffering from symptoms. Then there is the general state of health, both mental and physical whereby general wellbeing would be defined as healthy. So the patient decides that they are unhealthy but does not necessarily head straight to the GP but might first consult a friend, member of their family or self medicate, for example just take a paracetatmol. But this doesn’t work so they decide that they need to go to the doctor. They may not give the doctor all of the relevant information and are generally worried about the outcome of the appointment, so it's fair to say that the doctor has a difficult job ahead of them. Not only do they have the responsibility of this person's health being entrusted to them, they also have the healthcare systems rep to uphold, especially after incidents such as the MidStaffs enquiry. But added to all of that, they have budgets to stick to. Does this put them off taking potentially necessary tests? Would they take a test if they had unlimited money to do so? Would they refer more people to specialists if there wasn't a huge waiting list?

The main question we need to ask in these cases is is the quality of care restricted by a lack of resources? And the obvious answer is yes but more importantly, what can we do about it?