Thursday, 3 November 2011


The NHS is the largest employer in Europe and the 4th largest employer in the world. Yet it never ceases to amaze me that it doesn't measure whether it is achieving its prime purpose of making people better. It's good at measuring how many operations, outpatient appointments and CT scans it does but it doesn't measure whether patients leave the hospital in a better state than when they arrived.

Take my wife's shoulder. She had a spur on her sub acramial joint causing her pain. On a score of 1-10 she rated it at about a 6. For about 2 months after the op, it was a 9 and then gradually improved as the wound healed to a 6. At no point has it ever been better (pain wise) than just prior to her operation. i.e. it was a pointless operation. However, the highly respected surgeon noted that the procedure went well and will record this operaton as a success. It reminds me of a cartoon I once saw in which a surgeon commented "the operation was a success but unfortunately the patient died". Thankfully my wife didn't die, but you get the point; surgeons are often more interested in technical ability than patient outcome.

I accept that not all operations are successful, but I wonder how aware patients are of the health gain they should expect rather than just the risks of complications that accompanies the consent process. You would be excused for thinking that surgeons would be offering this impartial advice, but you'd be wrong, because surgeons like to cut and it's what they went to medical school for.

So what can be done? Well, personally I'd like to see patients offered before and after questionnaires that quantifies their health status. This isn't as hard as you think, and EQ-5D is a useful measure if you want to look ( All the questionnaires could then be collated centrally, entered on a database that enables comparisons of healthgain by surgeon for any given procedure. Now that would lead to an interesting discussion with your GP. Not only would we all as patients be better informed about whether we would prefer to wait for surgeon x in Andover rather than be seen by surgeon y in York, but we may also weigh up the odds and decide "nah - no thanks, I think I'll live with it". And if the NHS has to save £20bn by 2014, we do worse than to stop doing operations which don't benefit patients.

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