Maxine Vaccine examines the lessons of a preventable death for doctors and the healthcare industry, and asks whether the true barriers to integrated care are cultural rather than economic.
This week, many UK newspapers carried the story of Alina Sarag: a 15-year-old Birmingham girl who died of tuberculosis after being told by two doctors that her problems were purely ‘emotional’. The correct diagnosis was only made post mortem.
The patient suffered from breathing difficulties, severe weight loss and frequent vomiting. Her GP allegedly refused to refer her for a blood test, suggested she needed to see a psychiatrist, and asked her if she was missing a boyfriend.
Later, a doctor at Birmingham Children’s Hospital diagnosed her problem as “a psychological issue”. She died after a respiratory arrest, and a pathologist said she had “one of the most severe cases” of TB in his experience.
This terrible chain of events was a failure of the medical profession to approach a critical problem empirically, rather than applying the ‘patient psychology’ of a TV doctor.
Alina Sarag’s GP allegedly said: “We don’t need these tests, we are not going to get them done either.” Because he had already put the patient into a box: she was the type of patient he knew all about.
As the squeeze on NHS funding intensifies, it’s that kind of doctor – cynical, hasty, preferring cleverness to evidence – who will flourish. The new CCGs will be assessed in terms of their business performance. That means competing with other health organisations, not working with them.
Expert clinical opinion has pointed to a need for integrated care – for primary and secondary care providers to work more closely together, ensuring that each patient is supported by a combination of diagnostic and therapeutic services, so their treatment is evidence-based and meets their real needs.
Within that context, the pharmaceutical industry has the opportunity to work across the spectrum of care providers to bring the right medicines to the right patients, at the right time, at the right dosage. The outcome is both definable and achievable: optimal medication. That’s what patients deserve.
Whether CCGs and Foundation Trusts, as businesses, will be incentivised to achieve that, or whether putting patients into convenient boxes and making categorical diagnoses will prove a better fit with the new business culture of the NHS remains to be seen.
But when you put a person into a box, you may be nailing down the lid.
Maxine’s views are not necessarily those of Pharmaceutical Field.