Tick Box Culture

[Pace]

Millions of elderly patients prescribed unnecessary pills because of 'tick-box culture', says expert | Mail Online (http://www.dailymail.co.uk/news/article-1159031/Millions-elderly-patients-prescribed-unnecessary-pills-tick-box-culture-says-expert.html)

Interesting read in the newpapers yesterday makes you think how many pilots are medicated for conditions which they dont really need medication for but because we are obsessed with numbers or things we can measure.

An example is hypertension. I know of one family who all have it but live into their mid nineties while I also know of a multiple heart byepass patient who has always had perfect blood pressure and a stroke victim who has always had low blood pressure.

Years ago acceptable blood pressure was 170/100 now anything higher than 140/90 and its a case of hit the panic buttons and medicate.

Maybe 10 years down the line and 140/90 will be looked at in horror?
Yet correct me if I am wrong but hypertension is a little understood phenomina. It can indicate ill health it can be normal.

And so goes all the other measurable items. Are we becoming a victim of tick box culture and needlessly medicating people to hit certain numbers we expect?

Pace

[gingernut]

In a very early time in my career, I was greeted by a man gripping his chest, in severe pain, clammy and near to death.

I gave him a shot of painkiller, phoned 999, and got the guy to hospital. Luckily, he lived.

Every Xmas, he'd turn up at the health centre with a bottle of Whisky, thanking me for saving his life. (although I didn't actually save his life, I took the whisky).


As my career developed, I found myself saying "sorry for your loss" to more and more young families, robbed of dad (&mum) through heart disease. I'd seen dad (or mum) many times previously, treating their sore throat, bad toe or chesty cough.

We (my colleagues and I), decided that we could do more to prevent families being robbed by this cruel disease.

It wasn't high tech, it wasn't that sexy, but it became more and more apparent, that if we controlled peoples blood pressure and cholesterol, told them off for smoking each time they came to the surgery, reminded them that eating the correct foods could benefit their health, then we could stop people dropping dead.

It was quite hard to decide what to concentrate on. We had to be sure that we improved our patients lifespan, before we poisoned them with chemicals. After all, these people were otherwise healthy- and we wanted to give them drugs which could potentially make their muscles ache, mess up their kidneys, and make them impotent. We had to make sure the interventions were based on robust trials. (we did).

I reckon, in the first year, that there were about 10 of our patients walking around because of our intervention. Extrapolate that to our region, and we could save 100 lives. Roll it out nationally, and the figure reaches thousands. (120,000 people die of heart disease yearly).

The Prof has a loud voice. He needs to look ath the evidence.

I reckon our low tech unsexy interventions have saved many a life.

Not one of 'em has bought me a bottle of whisky I'm afraid.:)

[obgraham]

There is some truth to what the good professor says. In particular, the practice of initiating preventive medical therapy in elderly patients. Most all the evidence of preventive efficacy is derived from younger patients, and is poorly studied in the older population.

In my field, the idea of an routine annual pap smear in women over 65 never made sense to me. Likewise for screening mammography.

And while I laud your efforts, gingernut, I don't see how you came up with the idea that you had saved the lives of 10 folks annually. How do you know? And maybe your barking abut smoking and exercise is what helped them, rather than the pills. We just don't know.

Besides: that whiskey'll kill you.

[gingernut]

Well this is the difficulty obsg.

The trials, whilst extremely robust in terms of design, (they are usually multicentre, RCT's involving large numbers), do tend to concentrate on quite a narrow population. (They are usually white middle aged men), and we are making some rather large assumptions when extrapolating to other populations, especially the elderly. (Although some of the later stuff does look at these.)

In a nutshell, I'm convinced that the evidence for the interventions is strong. Its actually stronger for the interventions around BP and lipid reduction, than it is for the lifestyle stuff. (there's more money in it, hence the trials get done), so I can be fairly sure that 10 people are walking about because of their implimentation.

The problem is, I'm not sure which 10 I'm going to save, and yes, I've got to poison a whole load of patients to save those 10.

There are three things which annoy me in life: Cheeky kids, warm beer, and drug company propagander, (oh 4 things, medicalising things which don't need to be medicalised), but I'm afraid, in this case, it's difficult to argue with the evidence.



There does become a point, however, when the laws of diminishing returns occurs. And I take on board the thing about the elderly, more work needs to be done, although just because someone is 82, doesn't mean to say they shouldn't be allowed the care they deserve, if clinically beneficial.

Good health, ginge:)

[Whirlybird]

I've agreed for years that in general we over-medicate, but overall there is no simple answer to this for everyone. My feeling is that each individual needs to take more charge of his or her own health. I have friends who take whatever the doctor gives them, and half the time don't even know what it is! No way would I do that. I want the reasons, the thinking behind it, and where to find the research. Then I make the decision - it's my life, my attitude to risk, my medication and my possible side-effects. With the internet etc these days it's quite easy to do the research and to make up one's own mind. And don't tell me the elderly can't do that; unless they're going doo-lally, of course they can.

Doctors aren't gods and can only present the alternatives; it's up to us to decide what we do or don't want. And if my doctor doesn't agree with that, I'll go elsewhere.

Hmmm...I wonder if the above is why I haven't set foot in any surgery except that of my AME for more years than I can remember. ;)

[Pace]

Gingernut

The problem with a lot of these drugs is that what is heralded as wonderful one day is decried the next as awful.

I am not medically qualified and hence glean bits of information from various media sources like most of us.

Anti depressants were handed out like sweets but the science was lacking.
The science did not understand the complex reactions of seratonin. The tablets churned out to correct depression were like using a bulldozer to trim your garden. Now research is looking at other areas to treat to combat depression after common depression tablets brought up a whole whost of negative effects including suicides.

Correct me but BP is also not fully understood and while so determined raised BP it can be indicative of ill health it can also be normal in others.

The science is not complete and without specific medical problems medicating people elderly, young or pilots to hit numbers bothers me.

Pace

[gingernut]

I do sympathise. In effect, the decision to treat, often results in medicalising a patient who is fit and healthy.

I freely admit, we are often too keen to reach for the pad. When I trained to prescribe, I was told that the central agenda was for more precribers to get more medicines into more people.

I argue against this, in fact my role often, is to prevent medicines getting into patients. The depression argument is not far from the truth- I'm sure patients would fare better with a surfboard rather than a chemical.

But the evidence for this intervention is strong. Don't take my word for it, take a look at the studies yourself.

We can just give you the facts as we know them. The choices are yours.

[Old Smokey]

Gingernut, your heart, your ethics, and your concern for your fellow man are in the right place, there should be more like you:ok:

In effect, the decision to treat, often results in medicalising a patient who is fit and healthy.

Consider this -

My Grand-Father had a BP of 140/100 without medical intervention, and died at age 102 after a HARD day's work.

My Father has a BP of 140/100 without medical intervention, and continues to work as a builder at age 88, climbing roofs etc.

My "natural" BP is 140/100 without medical intervention, I do sedentary work (flying aeroplanes).

It seems that the genetic BP handed down to me through 3 generations is 140/100. My forebears lived/live long healthy working lives.

Now, for me, my "genetic" BP of 140/100 draws looks of SHOCK, HORROR from Aviation Medical Examiners, and I have been "sentenced" to using anti-hypertension medication to maintain a regular 120/80, which makes the wise men smile.

Is this a case of unnecessary / over-medication, or is it not? When I retire in 2 years I plan to flush the whole bleedin' lot.:ok:

I won't even start on my mother's side, they live longer!:ok:

Regards,

Old (but feeling young) Smokey

[gingernut]

Is this a case of unnecessary / over-medication, or is it not?

I'll tell you on your 110th birthday:ok:

[Pace]

Gingernut

Reminds me of the joke about the guy who went to his doctor. he said " So Doctor if I give up smoking, food, wine, women and song will I live longer?"

The Doctor said "I cannot promise you will live longer but i can promise that it will feel like it" :)

being drugged into a lethargic impotent do not excite myself sort of guy if I ever develop high BP doesnt sound much fun?

Now back to the Daily Mail to source some more medical groundbreaking bits of info for you :) You learn a lot in the Daily Mail :) The curse of the Doctors surgery or so I am told.

Pace

[Old Smokey]

I'm going to hold you to that Gingernut, you can push the wheel-chair.:ok:

After all, you'll be a mere sprightly 83 at the time!:E

Regards,

Old Smokey