Breast implant fiasco
There are two things which the government has got completely wrong in its attempts to deal with concerns about PIP breast implants. It is fuelling anxiety rather than alleviating it and its notions of the responsibilities of private providers are muddled and incorrect.
Everybody knows that health treatment is only provided when clinically indicated. Never before has an indication for an operation been simply "the patient is worried". So it makes no sense at all to simultaneously say that PIP implants are safe but if a patient is worried they will be removed. Why remove something which isn't dangerous? This massively mixed message could hardly be more unhelpful. From everything I can see of the science so far there is no evidence that PIP implants present any higher risk than any other kind, in spite of being described in scarey terms such "industrial". Possibly they have a somewhat higher risk of rupture but that could be dealt with as and when and anyway the evidence is unclear. There is no clinical indication to go looking for problems when none are present, let alone to actually subject a patient to surgery on the grounds that rupture might possibly happen at some time in the future. But it's impossible to say convincingly to patients,"Don't worry, the implants are safe and nothing needs doing" if you simultaneously say, "But if you are worried, we'll take them out". What nonsense!
The other thing the government has got completely wrong is the notion that private providers have any kind of obligation, legal or moral, to do anything at all about this mess which is of the government's own making. If I get a procedure or operation done privately then I pay for it and that is that. Depending on what has been agreed, the private provider might or not have some kind of obligation to deal with complications of treatment which arise immediately. Or part of what I have purchased might include some kind of follow-up. But if I pay for a one-off procedure and the private provider delivers this competently and in good faith then their obligation to me is discharged. Or perhaps would be limited to providing at a later date some information about the treatment they have provided. I certainly could not expect to return years later, for example with a wobbly knee replacement, and expect them to give me another one for free. Still less could I expect this if in fact there was nothing at all wrong with me and no clinical indication for anything to be done. The private providers who are refusing to get involved in this insane process are in my view acting entirely properly. And people who know me will know I am no fan of private medicine.
The government and some senior doctors are making this situation much, much worse. I resent the fact that health resources and particularly NHS resources are going to be diverted towards what should have been a non-problem or at worst a minor problem because things have been exacerbated by the way public concerns have been handled. The NHS is already under pressure, clinical services are being cut. My patients with serious illness already complain about difficulty in getting to see their GPs. Now we see that the worried well are being advised to consult with their GPs with the prospect that this may lead on to completely unnecessary specialist consultations, investigations and ultimately surgery.
With Lansley, one always wonders how much is due to a secret agenda to dismantle the NHS and how much to simple incompetence. On this occasion I am prepared to give him the benefit of the doubt and say that this fiasco is probably occurring through a mixture of his own short-comings and the poor advice he has received. All the same, it's still pretty appalling.
Everybody knows that health treatment is only provided when clinically indicated. Never before has an indication for an operation been simply "the patient is worried". So it makes no sense at all to simultaneously say that PIP implants are safe but if a patient is worried they will be removed. Why remove something which isn't dangerous? This massively mixed message could hardly be more unhelpful. From everything I can see of the science so far there is no evidence that PIP implants present any higher risk than any other kind, in spite of being described in scarey terms such "industrial". Possibly they have a somewhat higher risk of rupture but that could be dealt with as and when and anyway the evidence is unclear. There is no clinical indication to go looking for problems when none are present, let alone to actually subject a patient to surgery on the grounds that rupture might possibly happen at some time in the future. But it's impossible to say convincingly to patients,"Don't worry, the implants are safe and nothing needs doing" if you simultaneously say, "But if you are worried, we'll take them out". What nonsense!
The other thing the government has got completely wrong is the notion that private providers have any kind of obligation, legal or moral, to do anything at all about this mess which is of the government's own making. If I get a procedure or operation done privately then I pay for it and that is that. Depending on what has been agreed, the private provider might or not have some kind of obligation to deal with complications of treatment which arise immediately. Or part of what I have purchased might include some kind of follow-up. But if I pay for a one-off procedure and the private provider delivers this competently and in good faith then their obligation to me is discharged. Or perhaps would be limited to providing at a later date some information about the treatment they have provided. I certainly could not expect to return years later, for example with a wobbly knee replacement, and expect them to give me another one for free. Still less could I expect this if in fact there was nothing at all wrong with me and no clinical indication for anything to be done. The private providers who are refusing to get involved in this insane process are in my view acting entirely properly. And people who know me will know I am no fan of private medicine.
The government and some senior doctors are making this situation much, much worse. I resent the fact that health resources and particularly NHS resources are going to be diverted towards what should have been a non-problem or at worst a minor problem because things have been exacerbated by the way public concerns have been handled. The NHS is already under pressure, clinical services are being cut. My patients with serious illness already complain about difficulty in getting to see their GPs. Now we see that the worried well are being advised to consult with their GPs with the prospect that this may lead on to completely unnecessary specialist consultations, investigations and ultimately surgery.
With Lansley, one always wonders how much is due to a secret agenda to dismantle the NHS and how much to simple incompetence. On this occasion I am prepared to give him the benefit of the doubt and say that this fiasco is probably occurring through a mixture of his own short-comings and the poor advice he has received. All the same, it's still pretty appalling.
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