Dear Editor
Helen Salisbury as always brings many useful insights, including Radio 4 giving prominence to an opinion re PSA testing contrary to current advice in the UK and USA. What I would like to debate though are guidelines and the risk that they may deskill and demotivate GPs, as well as being impossible to read and digest.
Take CSOM (chronic supportive otitis media) where the guidelines say GPs not to treat but refer where after a wait of many months first line treatment is likely to be topical or systemic antibiotics. NICE also recommends all people with heart failure are referred after an initial examination and biochemistry and where available an echo request. This may mean that as a profession we lose confidence and competence at managing this common condition and after a spell under secondary care people are discharged back to primary care.
My suggestion is that we are allowed to up-skill and for most people (excluding amyloid, primary valvular causes and rare things that one hope would have been shown on the echo) this is one of many things that could and possibly should be looked after in primary care, maybe with advice and guidance. Yes there will be GPs who will say there is no time for this, maybe. May I suggest we move safeguard training to be less frequent, and how many more lives would be saved if education re this replaced annual CPR updates. Many other examples exist – 3 day training for spirometry – so in reality it may not be easily available, fNO testing for asthma diagnosis as examples.
Guidelines seem to work in an ideal environment, not in the world of waiting lists and multimorbidity perhaps?
Re: Helen Salisbury: Opportunity costs and the time needed to treat