So why my rather dismal title for this piece? Well today I went for my biennial appointment at the hospital, my usual nerves even more strained than usual as I had been alerted on my previous visit that this time I faced having to make an appointment for a colonoscopy - not the most pleasant of experiences but one which I accept is intregral to an early alert for cancer - and colitis sufferers run a much higher risk than the average human being.
So when the consultant had asked me a few fundamental questions, made notes on my weight and then dismissed me with a 'see you in two more years', I experienced a deep sense of relief at first, then I plucked up the courage to ask about the promised colonoscopy.
"Oh we've scaled those back," he said, "and now, until you're 65, we arrange one every fifteen years."
Well my immediate relief was tinged with a sense of concern. Fifteen years? For someone with colitis? I'm sure they get a lot of information from blood tests and so on which are mandatory on each visit, but I am both surprised and concerned that the NHS is now leaving this very important investigatory process for so long between examinations.
I am pretty sure that this is not the situation in the United States for example where people at risk are examined in depth far more frequently than that. I'm sure the Health Service will say that, given other supporting evidence via blood and urine tests, there is no need for colonoscopies on a more frequent timescale - but I am really hoping that this is driven by a rational look at necessary procedures and NOT by the lack of resources to do the job!
2 comments:
Well, Brian, this is actually something I know a little about. Not, of course, about your own medical condition or pains or fears. But I do know that one reason the NHS and the health systems of other Western nations is so superior to the American system is they are based on something simple.
Evidence.
If dozens or even hundreds of studies of randomized clinical trials, properly sifted through the most rigorous of statistical filters, indicate that your chance of dying from colon cancer is the same if you get a colonoscopy next year or in 15, then it makes sense to do the least.
Oh, maybe not to YOU, but evidence-based medicine should not be about you, in particular. It is about risk, odds and money. One caveat, though. Every person with a particular condition is different from every other one and, through genetic research, we are on the verge of preventing, treating or curing disease based on how YOUR genes interact with YOUR environment.
I don't know the actual statistics I am referring to and I don't practice medicine (except on the Internet), but I am confident that no doctor not practicing in the United States would give you ... well ... a bum steer.
I am certain you could call someone and without waiting too long get some citation for a systematic evidence review that would indicate whether your doctor was right.
If not, contact me by mail and I will try to locate useful information.
Hi Ira
Thanks for your detailed and well reasoned observations on my piece. I'm sure you're right and, in fact, I know that a lot of information is gleaned from blood tests etc about the changing state of one's health and it probably is the case that there IS no advantage in greater frequency of detailed bowel photography.
My own condition has responded well to treatment over the twelve years and so its not a personal worry so much, more an observation that what seemed imperative every ten years only two years ago now is not. I still wonder if this is due to a complete clinical reassessment of need or whether it is driven finance up.
If I become personally concerned about this in the future I'll certainly take steps to find out if the NHS policy is purely driven by medical criteria, and thanks for your post
Brian
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