How to avoid unnecessary interventions

Dear Fiona Godlee,

“80% of the final accurate diagnosis and one hundred per cent of the
future management strategies could be arrived at, at the end of listening
to the patient and reading the GP referral letter. This can only be
refined 4% by all physical examinations and 8% more by all the
investigations including PET!” This was the startling new revelation in
one of the finest papers published by some of the leading lights of
British medicine at that time, Mitchell, Hampton, Harrison, Pritchard, and
Seymour, in one of their prospective double blind studies of medical
outpatients published in 1975 in your own journal. (1) This led to a nice
letter by the then editor of Postgraduate Medical Journal, Barry
Hoffbrand, entitled “away with systems review-plea for parsimony.” If you
investigate every one very thoroughly all of them would need some
intervention, drugs or invasion. Clinical medicine on the bedside,
practised by well trained humane physicians, can drastically cut down
interventions. “If you listen to your patient long enough, s/he will tell
you what is wrong with her/him,” Lord Platt in 1949.

This must have been lost in the cacophony of myriads of hi-tech
selling articles in all journals every day, including yours. George Orwell
was right when he wrote that: “There are some ideas so wrong that only a
very intelligent person could believe in them.” My friends make fun of me
whenever I exhort the virtues of bed side medicine and its benefits to the
common man. Your editorial talks about the NHS in trouble. Please spare a
minute to think of the vast sea of humanity below the poverty line in the
“so called third world” where the present top heavy hi-tech stuff has
become a curse. Many smaller countries trying to ape the western top heavy
technological medicine are going broke by the day! Hi-tech medical care is
being sold in those countries as health care. In fact, the right word
should be health scare system. A cursory look at the present media hypes
of the so called swine ‘flu is a good example. New hidden secrets of that
pandemic are leaking to the media daily.

Overdosing of drugs is another big scandal. Uffe Ravneskov analysed
the absolute risk reduction and NNT of anti-hypertensive and anti-
cholesterol drugs published in 2002 in the BMJ which, if understood by
patients and prescribing doctors, could bring down their sales to just
about 5% of the present business! (2) These truths are all brushed under
the carpet in our CME system funded by the industry. Let us try to have
the right type of medical education to our future doctors to undo this
damage. The present converts can never be converted again to sanity.

Yours ever,

Bmhegde

1) Hampton JR, Harrison MJG, Mitchell JRA, Prichard JS, Seymour C.
Relative contributions of history-taking, physical examination, and
laboratory investigation to ... BMJ. 1975; (May):486-489.

2) Ravnskov, surviving without treatment. BMJ; 2002: 1353a. eletter 18th
June 2002.

Competing interests:
None declared