Blood tests can sometimes be helpful, but 99.9 percent of the time they are not. The results always require further investigation to assess their significance. Still, the common assumption prevails that they can reveal the cause of otherwise unexplained symptoms, and this is something that commercial companies are increasingly using (some would say exploiting).
In this case, the experience of a satisfied customer, as described on the UK-based company Numan’s website, is instructive. More fatigued than usual after a bout of covid, he paid £128 for Numan’s curiously named Fear Nothing Blood Test Plus, which measures 21 ‘biomarkers’, including blood sugar, cholesterol, liver, kidney and kidney function tests. thyroid.
Following the instructions, he duly mailed his blood samples for analysis, receiving the results by email three days later. They were, unsurprisingly, all in the normal range, except for marginally low levels of “sunlight” vitamin D and “good” HDL (high-density lipoprotein) cholesterol. Neither of them would have explained his fatigue, but he was pleased to have been alerted to a couple of medical issues he didn’t know he had. If he does, he does, as the clinical significance of such findings is highly uncertain.
“The rise of home screening is cause for concern,” noted family doctor Margaret McCartney in the British Medical Journal last week. The high probability that they generate false positives can lead to the medicalization of the healthy. It’s probably best to avoid it.
Cut management of GPs so they have more time for patients
The personal family doctor of childhood memory, “the same friendly face on the prescription pad,” may be on the way to extinction, as Miranda Levy reported in this newspaper last week. But all is not yet lost if our new Prime Minister seizes the newly proposed opportunity to cut the Gordian knot that has ensnared mainstream practice for the past two decades.
The huge difference between family medicine then and now is that, back then, GPs essentially spent all their time practicing medicine. Now, however, they have two additional jobs. They must collect and tabulate the volumes of data necessary to demonstrate that they have met their micromanaged “targets” of numbers of patients diagnosed and treated for a variety of conditions. This, in turn, requires taking on the burden of managing what has become, by necessity, a mid-sized company employing (as never before) legions of administrative staff, receptionists, health care assistants, care coordinators, cases etc in. It’s no wonder juggling these three workloads have become so stressed and difficult to access.
And so on until cutting the Gordian Knot, where the best solution to a complex problem is the simplest. On October 22, the House of Commons Health and Social Care Committee proposed that the immensely tedious and time-consuming goal that defines the Quality Results Framework be abolished. Freed from its suffocating embrace and the need to employ those legions of staff to care for him, family doctors would once again have the time and space to practice medicine. Who knows, it could happen.
Remedy for arches in the shoulder
Finally, my thanks to retired surgeon William Stebbings for the likely explanation for the episodes of abdominal discomfort, vomiting, and left shoulder pain that were mentioned last week. The crucial clue, he points out, is shoulder pain, which indicates involvement of the phrenic nerve that innervates both the shoulder and the diaphragm, which separates the thorax from the abdomen. Therefore, any stomach disorder that irritates the diaphragm can be experienced as shoulder pain. The disorder he suggests is probably an intermittent ‘gastric volvulus’ in which the stomach rotates on its axis thereby obstructing the passage of its contents into the duodenum (small intestine). This is easily fixed so it doesn’t happen with a stitch that fixes the stomach in position.
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