Yvette had come about her headaches. “They’ve been going on too long,” she told me in a beseeching tone of voice. “I need a scan, to see what’s going on.”
This is a common scenario. Whether it’s headaches, tummy pains, weight loss or a cough, the patient is scared, usually about cancer. There is touching faith that a scan will provide the answer. And there is often an underlying fear that they’ll have to fight to get one.
“Of course we can arrange that.” Experience has taught me to agree upfront. “Is it OK if I ask you a bit more about it first, to check a scan’s the best thing to do?” Yvette nodded and I began the time-honoured process of gathering the patient medical history – something that doctors will spend at least a decade learning to elicit and interpret.
If Sajid Javid’s pronouncements on 4 February are to be believed, soon patients won’t have to bother with any of this. In a speech to mark World Cancer Day, the Health Secretary promised continued expansion of the community diagnostic centres that he launched last October. These diagnostic hubs – many located in accessible settings such as shopping centres – were intended to give clinicians swift access to tests when we need them. But following his speech Javid confirmed he wanted them to become walk-in services, so that “to get those scans that people need… they don’t necessarily need to go through their GP”.
This is the latest manifestation of a flawed belief that has corrupted health policy in England for the best part of 15 years: namely, that GPs are too expensive and largely unnecessary in today’s NHS. It is generated by a fusion of two phenomena. There is the steady supply in some sections of the press of “GP failed to diagnose…” stories. While any instance of underperformance should be taken seriously, most diagnostic difficulty arises not from incompetence but from the unavoidable uncertainties and complexities that GPs contend with daily. Each headline-grabbing case skews attention away from the millions of appropriate diagnoses made every month, the great majority of which are made purely on the basis of medical history and examination.
The negative media portrayal of GPs combines with what might be termed “malignant technophilia” – a condition first apparent in Matt Hancock when he was health secretary, and which has now affected Javid too. The hallmark symptom is a delusional confidence in technology’s ability to fix complex problems. For Hancock it resided in the power of the app: for Javid it appears to lie in the all-seeing, all-knowing “scan”, which, if made sufficiently accessible, would detect all pathology currently being missed by supposedly lackadaisical clinicians.
Yvette’s headaches proved to be emanating from her neck; they required nothing more than simple medication and physiotherapy stretches. I’m all for expanding capacity for scans so that I can obtain them readily when needed. But removing medical generalists from the diagnosis process won’t improve outcomes for patients. Instead, it will clog up diagnostic hubs with worried people such as Yvette who need different kinds of help. Any expansion in capacity that has been created will be rapidly consumed.
Injudicious use of medical tests does more than waste resources. Roughly one in five scans will identify “incidentalomas” – abnormalities that weren’t suspected. Almost all of these are entirely innocent and irrelevant, but that can usually only be established by repeat imaging over a protracted period of time, compounding rather than relieving patient anxiety and consuming yet more resources.
It takes years to train a new workforce, but there is a large pool of qualified people who have walked away from an increasingly beleaguered NHS over the past decade. If Javid focuses relentlessly on improving staff conditions and morale, he will find clinician numbers quickly start to recover. Yes, provide more technology and tools. But above all else, we need the skilled clinicians to deploy them.
[See also: It can’t schmooze GPs, so Big Pharma targets patients and politicians instead]
Hear from the UK’s leading politicians on the most pressing policy questions facing the UK at NS Politics Live, in London. Speakers include Sir Keir Starmer, Ben Wallace, Lisa Nandy, Sajid Javid, Professor Sarah Gilbert, Jeremy Hunt, Layla Moran and Andrew Marr. Find out more about the New Statesman’s flagship event on the 28 June here.
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This article appears in the 02 Mar 2022 issue of the New Statesman, Hero of our Times