Comments on 0800 HANDYMAN: Fixing broken handymen

He didn't need to travel to Hungary. He could have...

2007-05-17T14:58:00.000+01:00

He didn't need to travel to Hungary. He could have had the scan done privately for £200 in the UK if he didn't want to wait. Try http://www.uk-radiology.co.uk

2007-05-17T13:12:00.000+01:00

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Actually the evidence that MRI helps fix early bac...

2007-05-11T10:32:00.000+01:00

Actually the evidence that MRI helps fix early back pain is not strong (see below)

A major study has been conducted to evaluate the role of Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans in the treatment of low back pain (LBP).

The findings of the trial carried out by the University of Aberdeen could lead health care professionals to question whether the cost of MRI and CT scans outweigh the benefits of their use in the management of many patients with this kind of back pain.

The five-year long study involved almost 800 patients from 14 NHS hospitals in Scotland and one in England. Its findings have just been published in the prestigious American journal Radiology.

Patients in the trial had been referred by their GP to a consultant orthopaedic surgeon or neurosurgeon because of symptomatic lumbar spine disorders. The specialist was uncertain of the need for imaging.

Participants were randomly allocated to two groups - one for early imaging (MRI or CT scan as soon as was practical) or delayed, selective imaging (no imaging unless a clear clinical indication developed).

The outcomes of patients were measured in a number of ways - see more background from study below.

The study found that the early use of imaging did not affect the management of patient's healthcare. Participants in the MRI/CT group were found to be marginally better than those who were not scanned.
However researchers do not believe it was a clinically important difference.

Professor Fiona Gilbert, Department of Radiology, School of Medicine at the University, is lead author of the report Does early imaging influence management and improve outcomes in patients with low back pain?

She said: "This large study suggests that MRI does not change clinicians' diagnosis or management of low back pain. It supports the premise that we should restrict MRI to those patients who are having surgery or an intervention where the level of the disc disease needs to be accurately shown."

Since most adults have an episode of back pain in their life we could easily spend huge sums unecessarily and unproductively on needless MRI.

See my comment on NHS Blog Doctor, who described this post as "irritatingly naïve":

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Ooops, was clearly far too hasty in posting about our handyman's "need" for an MRI scan. I of course have no idea whether he needed an MRI scan, or whether his British GP's diagnosis was better or worse than that of his Hungarian doctor. The point I had intended to make was simply that he found his NHS experience so exasperating that he felt he needed to go to a foreign country to get treatment. Whatever the reasons for him thinking that, it just doesn't seem right.

As a lapsed scientist (MA Oxon, Experimental Psychology) with an amateur interest in healthcare economics/policy I should have posted a little more carefully.

Ironically, the only blogs I read daily are yours, Ben Goldacre's and Freakonomics. So I am hugely flattered to be linked to, but highly embarrassed I didn't draft that post more thoughtfully.

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And in the past year 0800handyman handed over i...

2007-05-06T21:15:00.000+01:00
And in the past year 0800handyman handed over in excess of £300,000 in taxes (including payroll taxes, corporation tax, net VAT). You'd think there'd be enough in there to pay for a prompt MRI scan

Of course there would be, however I'm sure you understand that paying taxes is not the same as paying into a personal health insurance scheme. Of course we could just not have the NHS, which would presumably lower taxes, and have private insurance instead, and some would say that would be a better system overall.

Maybe it would be too, but there is no point complaining that the NHS doesn't do something that it was never intended to do. You are paying for public health, like it or not, you are not paying for your own personal treatment, and the treatment you are entitled to has nothing to do with the amount of tax you have (or have not)paid.

'his (Hungarian) doctor has diagnosed what is actu...

2007-05-05T12:39:00.000+01:00
'his (Hungarian) doctor has diagnosed what is actually wrong (which is, unsurprisingly, more than just "inflammation") and will fix him.'

Replace Hungarian doctor with Transylvanian crystal therapist and it really doesn't tell me any more.

I see people all the time returning from Europe, having seen a doctor while on holiday for a viral infection, and being prescribed on average around 4 drugs - generally two antibiotics, an opiate of some description, an adrenaline related drug to counteract the drowsiness of the opiate, a decongestant to counteract the cough suppression (ditto) and something to counteract the antibiotic-induced diarrhoea. They come to me because they're feeling sick (surprise!) and its really bad luck if they also have a rash, because they will have to avoid all these drugs in future as I have no idea which one has provoked their allergy. I just have to hope they never become ill enough to really need one of them. Oh, and a couple of weeks ago I diagnosed a cerebral bleed in a 32 year old woman who had been told by a french GP the previous week that she just had migraine (which doesn't usually cause intermittent unconsciousness) and that all she needed was...you guessed it...opiates! Pethidine in this case, plus a stonking dose of valium four times a day.

So how are we doing in the UK doctors versus the rest of Europe stakes?