First diagnosis often wrong, doctor warns
Doctors do not have enough time to properly diagnose patients and some are harmed or even die because their real problems are not spotted early enough, a doctor has warned. Doctors make a ‘working diagnosis’ when first faced with a patient and treat them accordingly, a doctor has said in the British Medical Journal online.
But sometimes that original diagnosis is proved wrong, only when the patient does not respond to treatment or deteriorates, Gordon Caldwell, a consultant physician at Worthing Hospital, West Sussex said. “The consequences can be significant. A patient treated according to a working diagnosis of pulmonary embolism (clot on the lung) who actually has pneumonia may die of untreated pneumonia.
“The time taken to reach the correct diagnosis may be crucial for the patient’s chance of survival. Over my career I have seen many errors in the working diagnosis causing harm to patients and even death,” he wrote.
These errors in the working diagnosis are made when medical notes are not available or are disorganised, test results cannot be seen or doctors are under pressure to finish seeing patient and discharge them home to free up beds.
Dr Caldwell said: “Through fear of litigation and losing face and simply because of the difficulty of explaining the complexity of what we do every day, we have failed to let our patients and society know about this very important problem.
“We must design our working spaces and information systems to maximise doctors’ ability to see, understand, and deliberate on the information needed for more precise diagnosis. “We must allow clinicians enough time to be careful in diagnosis, treatment planning, and treatment review. We must urgently consider how to provide rooms, time, and information for doctors to do the most difficult part of their job and the part most prone to error: the clinical thinking in making the working diagnosis and treatment plan.”
Cancer patients from wealthy areas of Britain have a much better chance of surviving
That pesky social class factor again — a factor behind a whole host of epidemiological correlations
Cancer patients in the wealthiest parts of the country are far more likely to survive than those in poorer areas, figures show. Those from impoverished households face a much bleaker prognosis with less chance of still being alive a year after diagnosis.
On average, a person diagnosed with any type of cancer in England has a 65 per cent chance of surviving at least 12 months, compared with 62 per cent a decade ago.
But the figures from the Office of National Statistics show a distinct gap between the rich and the poor with those living in wealthy regions enjoying survival rates almost 25 per cent higher.
The report worked out the average one-year survival rate for all types of cancer for every primary care trust (PCT) in England using figures from 2006, the most recent available. It found that those living in Hammersmith and Fulham in West London had the highest survival rate of 70.3 per cent, closely followed by Westminster, and Kensington and Chelsea. Bournemouth and Poole, Bromley, Worcester and North Somerset also recorded survival rates close to 70 per cent.
By contrast Newham, one of the poorest PCTs in East London, had the lowest one-year survival rate of just 56.3 per cent, with similarly low figures in Waltham Forest, Tower Hamlets, and Barking & Dagenham. Rates of around 60 per cent were recorded in East Lancashire Teaching PCT, which encompasses Burnley, and Leicester City PCT.
Cancer experts say the poor are missing out on early screenings and treatments because they are ‘intimidated’ by the NHS. Professor Karol Sikora of Imperial College, London, said: ‘Rich and middle-class people use the NHS far better. By contrast, the poor feel intimidated. ‘They are made to feel unwelcome at surgeries and hospitals [How British!] and this means they are less likely to push for treatment or early screenings.
‘If a middle-class person gets told they have to wait six months for a screening they will kick up a fuss and be seen. ‘They also are more aware of what the Health Service offers.
‘Women are more likely to go along for their mammograms and men to their prostate screenings so their cancers will picked up earlier and more easily treated. ‘The NHS is meant to be free – but rich people know how to use its services better.’
Catherine Thomson, of Cancer Research UK, said: ‘These figures are encouraging and reinforce previous ones showing that in general cancer survival rates have significantly improved over the past 40 years. ‘But this study also flags up certain areas, particularly those in the North of England and those which are generally deprived, that are consistently falling short of the national average.
‘Late diagnosis of cancer could help explain some of this northsouth divide and why the poorer areas tend to do worse. ‘This could help highlight where efforts to promote early diagnosis could be best targeted to help save lives.’
British Food Standards Agency spent £7m on ‘nannying’ campaigns
The Food Standards Agency has spent nearly £7 million on posters, adverts and leaflets to educate consumers about improving their diets over the last year. MPs and campaigners said the figure was proof that the Agency had wasted taxpayers’ money and was “nannying” citizens.
It spent £3.47 million on its salt awareness campaign, including devising a quiz to educate consumers. One question was: “Too much salt is bad for your heart. a. True b. False”.
It also spent £554,000 on its Christmas Food Hygiene Campaign, designed to stop families undercooking their turkeys.
The figures were published in a written answer supplied by Anne Milton, the health minister, in response to Andrew Stephenson, the Conservative MP.
Mr Stephenson said: “Whilst I am not opposed to all public awareness campaigns, I thought the salt campaign typified the nannying behaviour of several government bodies. “I was appalled to learn that the Salt Awareness Campaign cost £3.5 milion and that the Food Standards Agency spent a further £3 million on other advertising and PR. I can see little justification for this expenditure, particularly as it took place whilst the country was still in recession.”
The FSA, whose budget last year was £152 million, has come under fire for its handling of meat from cloned cows entering the food chain. It was also widely ridiculed for publishing an online guide advising football fans to cut down on drinking beer and eating crisps during this summer’s football World Cup.
As well as suggesting fans watching the game in a pub drank fizzy water with a slice of lemon, it also advised: “You could walk to the pub instead of taking the bus, or use half-time for a brisk walk and some fresh air.”
Tim Cox, at Liberal Voice, a Liberal Democrat group that campaigns for lower taxes, said: “The news that the Food Standards Agency has spent £6.7 million of taxpayers’ money on public awareness campaigns over the last year is scandalous.
“The British public do not need bureaucrats in Whitehall to tell them when to have dinner, or to advise them on what to eat during the World Cup. This is patronising, self-serving nonsense. The Coalition should cut all similar activities immediately.”
The campaigning arm of the FSA will be transferred to the Department of Health, under plans to slim down the Agency’s role.
Ms Milton said that the FSA’s campaigns had been effective, pointing out that the results of the most recent urinary analysis survey, which took place in 2008, showed a significant fall in the average population daily salt intake from 9.5g in 2001 to 8.6g.
Many more people were checking the labels on food to see how much salt and saturated fat they contained.
How Britain attracts more migrants than France AND Germany put together
Britain is surging ahead of France and Germany as a magnet for immigrants, figures showed yesterday. Tough controls mean that the two countries that once drew in hundreds of thousands of migrants a year have now achieved a virtual balance between immigration and emigration.
Yet the new count shows that in 2008 Britain opened its doors to almost ten times the number accepted by France and Germany together.
The latest figures from Eurostat, the European Union’s statistical arm, drew calls from campaigners for the Government to follow the example of Berlin and Paris and bring in measures to limit the impact of immigration on Britain.
Ministers promised earlier this week to ‘bear down’ on every aspect of immigration into Britain from outside the EU after the latest British figures showed a big leap in net migration – the number of people coming to live in the country minus the number leaving to live abroad.
Eurostat figures say that in 2008 the United Kingdom grew because of net migration by 226,400.
Germany, which no longer accepts unskilled migrants and which declined to accept Eastern European workers when Poland and other countries joined the EU, had negative net migration.
That meant that 53,600 more people left the country to live abroad than arrived.
France, which experienced a brief immigration boom in 2007, cut back net immigration to 77,000.
The curbs now in place in France have led to increasing political unrest over hardline policies such as the expulsion of thousands of Roma and the removal of French citizenship from immigrants found guilty of attacking police officers.
Net migration numbers in Britain are the third highest in Europe, behind Italy and Spain, which have seen high levels of arrivals from Africa and from Latin America, and where signs of popular unrest over the impact on jobs and public services have been growing.
Critics of the Rome and Madrid governments have said they have encouraged higher immigration by offering amnesties to illegal immigrants.
How we lost control of immigration
In 2008, the EU figures say, net migration in Italy was 437,900 and in Spain 413,800.
Eurostat uses different methodology to Britain’s Office for National Statistics. The ONS has calculated net immigration at 163,000 in 2008. Last year, it rose sharply to 196,000.
The effects of immigration in Britain are becoming increasingly politically sensitive, largely because of worries that population growth will cause strain on housing, transport, water and energy resources.
One minister in the last Labour administration promised the population would never hit 70million, but Whitehall statisticians say that level will be reached in 2029.
An analysis by the House of Commons library has also shown that England has now become the most crowded country in Europe, except for tiny Malta.
Sir Andrew Green, of the Migrationwatch think-tank, said: ‘France and Germany have brought immigration down very substantially, probably helped by the recession. ‘These figures demonstrate that the Government can bring the level of net migration right down, provided ministers are determined to do it.’
According to Eurostat’s calculations, in 2007 net migration into Germany was 45,200 while France blipped suddenly upwards, from 90,100 in 2006 to 302,500. In 1998, when the immigration boom into Britain was just beginning, net migration for this country was 97,400. This is the level to which the Coalition is pledged to return.
The BBC completely fails to understand the Tea Party movement
With the smug incomprehension in which it takes so much pride (can’t understand – won’t understand!), the BBC sets about the American Tea Party Movement as if it were a cross between the Klu Klux Klan and the German neo-fascist brigade. Not once in all the demonic depictions I have seen and heard (last week’s Newsnight package was particularly outrageous) have I heard a mention of what the TPM is actually about: taxation. (Note to BBC editors: the movement is named after the Boston Tea Party because it is protesting about the imposition of higher federal taxes and over-weening controls on citizens who believe their voices have been ignored.)
The British generally and the BBC in particular have a real problem understanding the obsessive suspicion in which the power of central government is held in the US. This is not some funny redneck eccentricity: it is fundamental to the Constitution which gives individual states much greater sovereignty than the countries of the European Union enjoy. The states have independent judicial systems (some states have capital punishment, others do not) and separate taxation systems (some have sales taxes, others do not). Only a Supreme Court ruling can over-turn state law by, for example, declaring something (such as abortion) to be a legal right which a state legislature may not deny.
Traditionally there is only one nationally imposed tax – federal income tax – which is designed to pay for those functions that must be carried out by national government. Resistance to the Obama healthcare reforms is as passionate as it is precisely because it imposes a federal requirement to purchase health insurance which seems to contravene the basic economic freedom guaranteed by the Constitution. The BBC obviously finds it impossible to believe that ordinary people could actually take issues like this seriously. (They can only be racists or hillibilly know-nothings.) The Corporation really ought to encourage its correspondents to get out more and talk to some of the articulate Americans who don’t spend their lives in liberal salons.
History under threat: British pupils receive just 38 hours of lessons at secondary school
History is ‘disappearing’ from state secondary schools because head teachers no longer value the subject, a survey has found. Teenagers are receiving as few as 38 history lessons during their entire secondary education as schools downgrade the subject in favour of trendy ‘themed’ teaching.
Hundreds of schools no longer teach history as a stand alone subject to 11 and 12-year-olds, instead offering ‘integrated’ topic-based humanities or social science courses, according to research by the Historical Association.
The trend emerged ahead of an expected blueprint from Education Secretary Michael Gove for boosting traditional subjects such as history. He will launch a review of the curriculum later this year with a view to ensuring children leave school with core knowledge, including British and world history.
And he will also flesh out plans for a new English Baccalaureate, which will be awarded to pupils who gain five good GCSEs in English, maths, one science, one humanities subject and one language.
But the Historical Association study, based on returns from 600 teachers, found that heads increasingly fail to see history as worthwhile. One history teacher at a comprehensive said: ‘We are disappearing. Integrated humanities is the way our senior management team wants to go, and they see us as awkward, backward obstacles if we suggest subjects like history are valuable in their own right.’
Another warned: ‘The history department is feeling that we shall disappear into a mix of ‘thinking skills’ and ‘vocational pathways’ which do not seem to recognise the contribution that history can make to developing young learners.’
Growing numbers of secondaries are compressing three years’ of history study into just two years, usually during pupils’ second year. The practice was uncovered in 10 per cent of secondaries in 2010 – up from five per cent last year.
Since growing numbers of schools are offering generic humanities or social science courses for the first of these two years, some teenagers are receiving just 38 hours of distinct history lessons a year, taught by a specialist. Some 31 per cent of schools – and 55 per cent of flagship academies – merged history with other subjects to form generic humanities courses in 2010. A year earlier, the figure was 28 per cent.
In some schools, children are banned from taking history GCSEs in case they fail and damage the school’s league table position.
Dr Richard Harris, the chair of the Historical Association’s secondary education committee who led the study, told the Times Educational Supplement: ‘The Government must make a decision about what children are entitled to do – we think this should be at least three years of history teaching by a specialist.’