Midnight BBC News 6/6/06. Workmates pay for Brain-scan.

Am I the only one who listens to the News on Radio Four at Midnight?

Surely the story came out elsewhere as well?

All the best from Fredrik

Dear Fredrik,

I sometimes catch the midnight news on R4, but I must confess that this story passed me by (other than from your thread), which is a shame since it is rather a wonderful and heartening one.

regards, Tam

I heard this too whilst on a long drive to the vets and think it's really positive - makes a really pleasant change

Heard it on radio 1 and radio 5 long before then. Is radio 4 always behind the times?

quote:

Originally posted by Fredrik_Fiske:

A guy was suddenly having terrible headaches, but was told it would take 11 weeks to have a brain-scan.

His work collegues then financed an immediate private scan, and he was opperated on within the NHS, having been told he would have died in a fortnight without the surgery.

A happy ending, but one that seems to point in the direction of some rather sad questions...

Fredrik

Indeed it does. Imagine being the person responsible for "allocating" the scans, knowing that they are a limited resource, and not everyone with "terrible headaches" can have one. Yet also knowing that delay in the rare case, with possibly no distinguishing presenting features, could result in a preventable death.
Immediate CT or MRI scans for everyone who presents with "terrible headaches" is neither affordable or desireable. How would you solve it?

It was also on the bbc website here. Maybe if he hadn't have had the scan the symptoms would have got a lot worse and they would have moved up the scan? As rockingdoc says they can't realistically give everyone with a head ache a scan, but it does sound pretty serious if friends/colleagues are prepared to stump up money for you for a scan.

It would be interesting to compare the number of supported MRI scanners per head of population in the UK compared with other countries in Europe.

I suspect that the person responsible for allocating scan time has a more difficult time because of the way that the health industry is funded and managed in the UK

and given that the scan was a survival issue - the local NHS trust should be stumping up to pay for the scan and so reimbursing the donors.

The news item does not indicate if the chap had to have to the operation privately because he had the diagnosis done privately.

Rockingdoc asks how the problem can be solved.

Well it could certainly be alleviated if they ran the bloody things 24/7 and not just on day shifts.

By the you can't wait for 'symptoms' to worsen. Any damage caused by the intra-cranial pressure is permanent and irreversible.

PS. denver has more MRI scanners than the UK

Bob,

Interesting that the solution lies in 'them' doing longer hours. Perhaps you would like to develop your theme, factoring in these considerations:

1. As one of 'them' I consider I do my bit in the daytime work required of me. Many of 'us' feel this way.

2. As I age, I am actually less able to do extended hours. The demographics of NHS staffing suggest I may be fairly representative of the whole.

3. I could trade daytime hours for other hours but then the daytime work goes undone.

If the NHS is to employ more people:

1. Where do they come from? Bear in mind they are volunteers and that the public are becoming progressively less of a pleasure to serve.

2. What happens to the jobs they would otherwise do? You can't run a business (and the UK is a business) on people selling each other beer, cutting each other's hair or providing each other with health care services.

3. How will you pay for them?

4. What will you forego to pay for them?

5. What ceiling will you set on the level of provision to be provided and how will you decide this level?

As I see it, the problem is one of scale. As an example, take Type 2 diabetes. Compared with 20 years ago, we are providing about twice the level of care (more treatment options) to about twice the numbers (rising prevalence) for about twice the length of time (improved survival), amounting overall to about 8x the earlier level of service provision. Repeat the maths for cardiovascular, respiratory, neurological disease et al. How will you meet these cases? Bear in mind that demand hasn't reached its plateau and that demand in other areas is not falling to compensate.

I await your blueprint for the future.

Cheers,

Fraser

Fraser - so how do other countries do it - the model used in the UK is not the only model to provide health care. Perhaps there are better ways - eg disconnect government and politics from the topic

And as for better MRI scanner coverage - how about training more people to provide second shift and perhaps more support.

quote:

Bear in mind they are volunteers

Well bugger me - I didn't realise we had a health service run by volunteers.

We get the health service we deserve in the UK. Underfunded, undervalued and underperforming as a consequence.

I would fund it through large increases in taxation. This would allow for 24 running of such services by employing more people. I would then be thrown out at the next general election because the population in the UK generally don't want to pay for decent services.

quote:

Originally posted by Rockingdoc:

quote:

Originally posted by Fredrik_Fiske:

...

A happy ending, but one that seems to point in the direction of some rather sad questions...

Fredrik

Indeed it does. Imagine being the person responsible for "allocating" the scans, knowing that they are a limited resource, and not everyone with "terrible headaches" can have one. Yet also knowing that delay in the rare case, with possibly no distinguishing presenting features, could result in a preventable death.
Immediate CT or MRI scans for everyone who presents with "terrible headaches" is neither affordable or desireable. How would you solve it?

Dear doc,


I said it raised questions, amd real ones at that, but I did not say that I had the answers!

Fiske for parliamen,t anyone? I thought not...

Fredrik

quote:

Originally posted by Fredrik_Fiske:
Fiske for parliamen,t anyone? I thought not...

Fiske for Culture Secretary, on the other hand - most certainly!

regards, Tam

Wouldn't he have to be in parliament to be Culture Secretary?

Dear Chris,

Maybe I should suck up to Blair, win the Lottery, and donate half to Labour funds, and become a Peer. The rest would be easy!

Fredrik

"so how do other countries do it"

In the US it's a matter of Healthcare for those who can afford it through health insurance...and next to nothing for those who can't! Not exactly an ideal situation.

quote:

"so how do other countries do it"

In a past life, I was a Public Health doc and undertook a survey of models of health care provision. I concluded that although there were four basic models, none works. The models (simplified,obviously) were:

(a) Grossly inadequate provision (e.g most of the world)

(b) Modestly inadequate but equitable provision (e.g. UK)

(c) Extravagant but inequitable provision (e.g. USA)

(d) Extravagant and equitable provision (e.g. France)

Feeling that nothing worked, I then considered factors common to all four. They seem to be:

(a) Humans develop faults too often

(b) Medicine is not, taken overall, that good in curative terms.

There are wonders of course (antibiotics, joint replacements etc.) but most medical intervention leaves the patient in a state of slow degradation. However, if you develop one of the great ills of Western Civilisation (heart disease, COPD, diabetes, cancer, Alzheimers and so on), the odds are still that you will die with it or of it.

As having one condition doesn't idemnify you against developing another, people in their newly-acquired state of slow degradation tend to develop co-morbidities.

I don't see a way round this.

Fraser

Fraser
What do you mean by 'none works'.
The WHO consider the French to have the best health provision in the world.

quote:

Originally posted by Fraser Hadden:
As having one condition doesn't idemnify you against developing another, people in their newly-acquired state of slow degradation tend to develop co-morbidities.
Fraser

Sound like life to me.

Life - it kills ya!!

If you had to do a risk assessment for life non of us would be born, after all mortality is inevitable.

quote:

Originally posted by bob mccluckie:
I would fund it through large increases in taxation.

Can't say I have no sympathy, after all the reason I voted Lib-Dem, at the election before the last, is that they were the one party who openly stated that, 'if you wanted a better health service you need to pay for it'.

Problem is that I am convinced that we are now paying too much in tax, to the detriment of our ability to compete.

To me one problem is that you could sink the GNP into the NHS and still have issues.

I believe that certain conditions should NOT be treated on the NHS; which is bound to get contentious. We need tackle some very difficult moral issues.

What would I NOT include?

IVF - We don't have a general population issue.
Sex changes.
Cosmetic surgery - unless linked to a major trauma (RTA etc)

Touch paper lit??

Martin

I think those that wish should be able to opt out the NHS and pay insurance for private.

Mr. Underhill,

It 's not as simple as that, is it? You wouldn' for instance, not buy a car on the grounds that it will eventually end up as scrap. You have to factor in the years of return on the investment.

Bob,

The French system offers a great level of provision but it:

(a) is vastly expensive

(b) results in hospital facilities underused much of the year

(c) is still unable to deal with peaks of demand

(d) tends to overtreat

I base this last claim on the now considerable numbers of French people I see and of English people who have needed to access French services.

As we've found from our own problems with hospital star ratings and league tables, there is no simple proxy measure for the quality of a service. If the WHO has a magic formula for factoring in outcomes rather than just measuring facilities and process, they are keeping very quiet about it.

Certainly judged by amount of health care provision. I wouldn't take issue with the WHO conclusion. But the French still fall short - and expensively.

Fraser

quote:

Originally posted by Fredrik_Fiske:
A guy was suddenly having terrible headaches, but was told it would take 11 weeks to have a brain-scan.
His work collegues then financed an immediate private scan, and he was opperated on within the NHS, having been told he would have died in a fortnight without the surgery.
A happy ending, but one that seems to point in the direction of some rather sad questions...
Fredrik

Dear Fredrik,

I suppose he had a warning subarachnoideal hemmorrhage and that he got surgery for an intracranial arterial aneurysm. Almost the only possible explanation in this case. A condition which may present itself in a typical way clinically when the hemorrhage is great, but also may present without specific signs when it is small. The interpretation of the so called warning hemorrhages i.e. small intermittent blood leakages signalling the imminent great catastrophy is especially difficult. But I don´t think, this story could have happened in Denmark. Incidentally I am being occupied with analysis of scans much of my working life, and to me it is obvious, that scans are asked for in my country, even if the suspicion of disease is rather small, and in these cases we respect the decision of the clinicians, considering the serious consequences of mistakes in this region. We often feel that we are overburdened with work, but perhaps our situation is better here than in the UK, so we have got a small capacity in reserve, I don´t know. My clinical impression is, that about 10% of the patients, which are scanned on this indication actually have got an aneurysm or hemorrhage.

Regards,

pe-zulu

How many MRI scanners are there in Denmark ?
and how many people live in Denmark

Thanks

I don´t know the actual number of MRI-scanners in Denmark as a whole, as it is still growing. But in my region we have at the moment five MR-scanners for about 500.000 inhabitants.

Pe-zulu
Wrong info. He had a brain tumour on his brain stem.