Saturday, September 24, 2011

The Downside of Paradise

‘I have just escaped from a physician and a fever, which confined me five days to bed … Here be also two physicians … I protested against both those assassins, but what can a helpless wretch do?’

The above excerpts are taken from a letter written by the poet Lord Byron in October 1810, written whilst he was touring the ancient ruins of Peloponnese in southern Greece. He had been suffering from a recurrent fever and shaking (rigors). Writing in this month’s edition of the Journal of the Royal Society of Medicine, Costas Tsiamis suggests that, from Byron’s own descriptions and a knowledge of the area in which he was travelling, it is quite likely that Byron was suffering from malaria. If so, he was fortunate to survive: not necessarily because of the dubious quality of his physicians, but because the disease was poorly understood and no effective treatments had then been identified.

However, two hundred years on, medical science has only brought limited advancement in the treatment of this mosquito-borne infection. According to a report from the World Health Organisation in 2010, 225 million cases of malaria are diagnosed every year and the disease kills almost 800,000 people; accounting for 2% of all worldwide deaths. Clearly, it is not a disease to be taken lightly. Nonetheless, each year thousands of holiday makers from the United Kingdom travel to exotic locations without a thought for the risks to their health; in the case of malaria, failing to take adequate courses of anti-malarial medication, and otherwise neglecting to enquire about vaccinations for other infectious diseases such as typhoid, polio, hepatitis A, yellow fever and rabies. Just because the destination of choice does not make the vaccinations compulsory for entry doesn’t mean you shouldn’t have them. If they are compulsory, it is to protect the inhabitants of the country you are travelling to, not because of that country’s concern for your well-being.

That said, exotic locations do not just bring risks of infection. With an increasing number of older adults taking time out to travel, insurance companies are seeing an astonishing increase in the level of medical expenses claims on travel insurance policies. Figures from the Association of British Insurers indicate that the cost of becoming ill whilst abroad rocketed to £275m in 2010, from a mere £74m in 2004, with the blame being firmly attached to those over 65 years of age.

Of course, holiday makers are not the only ones leaving our shores. Many of those in retirement go in search of greener grass (or at least lower taxes and better weather). Unfortunately, health care is not always of the same standard as in that provided by the NHS in the UK, or may only be available privately and for large fees. According to the British Insurance Brokers’ Association America is, not unexpectedly, the most expensive country for health care, whilst Greece is one of the cheapest. Surprisingly though, according to the Foreign and Commonwealth Office Britons are five times more likely to be hospitalised in Spain than in America.

There is little doubt that Lord Byron’s malaria affected his health for the rest of his life, and he died in 1824 at the age of 36. Of course, today he would be able to obtain advice on malaria prevention and travel vaccinations from physicians better qualified than his imagined ‘assassins’. Happily, your own experience of paradise can have a better outcome than Byron’s, but only with foresight and planning. Whether you are retiring abroad or merely taking a week’s holiday, it pays to discuss your plans with your GP well in advance.

(This article was first published in the Scunthorpe Telegraph, Thursday 1st September 2011)

Friday, September 16, 2011

Calling Expert Patients – Your NHS Needs You!

According to the Oxford English Dictionary, an expert is ‘a person who is very knowledgeable or skilful in a particular field.’ However, the American activist, Marian Wright Edelman, once said ‘Parents have become so convinced that educators know what is best for their children that they forget that they themselves are really the experts’.

Edelman may well have had a good point, as an analogy can be found when considering health care and patients. After all, who truly knows what it is like to live with a long term medical condition: the doctor, nurse or therapist with all their qualifications, or the patient, perhaps with nothing in the way of qualifications but with years of first-hand experience of the subject?

Speaking in an interview earlier this month, the chairwoman for the Royal College of General Practitioners, Dr Clare Gerada, emphasised that we are at time when ‘GP workload is exploding and its complexity is increasing’ (GP Magazine, 17 August 2011). At the same time, the number of whole-time equivalent GPs working in the NHS is falling. Inevitably, this means that the time GPs have for individual patients is under increasing pressure, with the end result that the nicety of long explanatory discussions about a patient’s long term condition is one of the first corners to be cut. Couple this with the fact that people are living longer (life expectancy is now 81.4 years for women and 77.5 years for men) and it becomes obvious that there is a problem.

Those are two of the reasons why NHS North Lincolnshire and the North Lincolnshire Council are trying to establish an Expert Patient Programme. As with all communities, North Lincolnshire has its share of patients with long-term (chronic) medical problems such as heart disease, asthma, diabetes, epilepsy, multiple sclerosis and arthritis. Such patients need assistance in learning about their conditions and how to live with them. The Expert Patient is an invaluable resource who can teach other patients, and assist in improving their confidence and skill in managing and living with their long-term conditions. In turn, the patient becomes less of a ‘patient’ and more of a ‘normal person who lives with a chronic condition’. Less time is spent in hospital or seeing GPs and life becomes more enjoyable, valuable and interesting.

The Prime Minister’s vision of the Big Society has been much derided of late. However, the Expert Patient Programme is one example of where the concept can truly work. That said, to be successful, volunteers with long-term medical conditions are most certainly needed. Such volunteers will need to complete a four day tutor-training course, after which they need to be prepared to deliver community-based self-management courses. All volunteers will undergo assessment, and the successful completion of two assessments will qualify those people for a Level 3 accreditation from the Open College Network.

If you are living with a long-term medical condition, then you are the expert we are looking for. So why not share that expertise with fellow patients and make their lives more manageable? If you are interested, call Helen Tindall on 01724 298422, or Sally Eaton on 01724 298404.

The last word must surely go to Lord Salisbury who, in a letter to Lord Lytton in 1877, wrote: ‘No lesson seems to be so deeply inculcated by the experience of life as that you never should trust experts. If you believe the doctors, nothing is wholesome: if you believe the theologians, nothing is innocent: if you believe the soldiers, nothing is safe. They all require to have their strong wine diluted by a very large admixture of insipid common sense.’

Expert Patients – you have that supply of common sense!

(First published in the Scunthorpe Telegraph, Thursday 25th August 2011)

Thursday, September 15, 2011

Thought for the Day

The people who get on in the world are the people who get up and look for the circumstances they want and if they can't find them, make them.

George Bernard Shaw

The Power of Love

Looking through my writing archives for the month of March, I came across the following article, initially published in my weekly column for...