AIBU to think that most people want clinicians and our wider system to have real autonomy?

[GEEpEe]

So I have a medical issue. Repeated pilonidal sinus. Common on hairy men who sit a lot. I'm a GP and hairy so that is me.

Laser treatment has been shown to reduce the reoccurance rate in some patients but not enough for the NHS to fund the treatment.

It's one of those things where if you have the obvious risk factor of thick, plentiful body hair and when they operate, they're removing copious amounts of said hair from the tunnel created, lasering that individual seems to make sense.

But as clinicians, we are so tied to protocol about who meets the criteria for referral/treatment and I know myself that you get shit from higher up when you don't obey. I'm known as a maverick and rebel but all I can really do in most cases like mine is refer and make some sort of suggestion of such a treatment in the notes.

I could afford private lasering but I've been trying to "fight" the CCG to let clinicians make individual decisions about who might benefit from lasering to no avail. Now I've had quite extensive surgery and my wife is putting her foot down and saying I've got to get my whole arse lasered but that's another thread!

My question is wouldn't you prefer overall if your GP and specialists could make individual decisions about what treatment might work for YOU based on available evidence and personal values and goals rather than just stats from RCTs that make blanket rules about who can get what?

And yes I can also afford private care, but most of the people I see with my issue who would benefit from lasering cannot. I think that's a problem..

I would like that, that’s why I have private insurance. It’s pretty obvious that the NHS heavily rations healthcare. It’s also pretty obvious that it would go under if doctors were allowed to treat their patients properly unless it switched to a part payment model (not going to happen because it’s political suicide) or a substantial amount of money appeared from somewhere (not really possible, the country is in massive debt and pretty much all state funded services are already underfunded).

Decisions based on evidence... yes..

Decisions based on personal values and goals .. No.

You can see the problem there right....

So say, if someone didn't want surgery on something but did want to control the pain it causes for whatever personal reason, I should just insist they have surgery or nothing because the evidence points away from medical management and towards surgical cure?

Or say a woman wanted to have a homebirth outside of guidelines? No again? We just don't help her because our guidelines say people like her are better off in hospital? Is that the NHS you want?

Or if a woman wants to formula feed, do we insist she give her baby some form of breast milk because it is superior to formula. So we prescribe the baby donated milk that she must feed it?

Agree with you. Should be patient focused healthcare not protocol focused healthcare.

How much money was spent on your surgery? Enough for a few courses of laser I bet.

But you’re on a loser here. This is mn. You are male and a GP. That’s many points against you.

So if you’d paid for the treatment you CAN afford you would have saved the NHS treating your problem AND treating the resulting sepsis? Ffs. Get OFF your arse and open your wallet if you can and stop using resources those less fortunate need.

@runningawaywiththecircus

Is that treatment available privately and is it recommended by NHS practitioners? Laser hair surgery is in my case.

You sound very naive op. Of course in an ideal world a HCP would refer every Tom, Dick and Harry for whatever procedure the gp and patient deemed necessary.

In the real world with limited funds gps just manage whatever they can with meds and refer on whatever they can't. Imagine if it was all left to each HCPs opinion, the NHS would be more overwhelmed than it already is.

But what you're misunderstanding in your own naivety is that the patients we don't refer still have ongoing issues which either require medication to alleviate symptoms, take up appointment times and/or require acute medical attention from A+E or similar. Those who do not cost money this way end up extremely dissatisfied with their health system despite their contributions to its existence.

So for example, the kid who is required to have 5 bouts of tonsillitis for 2 years in a row will need lots of antibiotics and may even visit A+E, perhaps by ambulance, over that course of time.

I've suffered with pilonidal sinus before but was lucky enough it eventually went away without intervention (other than forcing it to burst myself whilst keeping it as clean as possible). I am now very careful about my long hair falling in my natal cleft! I've had electrolysis elsewhere on my body (I am an unfortunate hairy female but no pcos diagnosis) and yes it does hurt but I'd still much rather have that done and never suffer with pilonidal sinus again.

It would be more efficient to potentially cure or at least effectively treat than attempt to mask.

@TheGoogleMum

That's why I couldn't understand people saying that lasering hurts. They've obviously never had the top of their arse crack explode with blood, pus and hair.

Buy a Phillips Lumea. You can even buy them from catalogues and they work very, very well.

@RunningAwaywiththeCircus

Yeah it's more like 1 in 10'000 or something.

@RunningAwaywiththeCircus

You'd like to think but doesn't quite work like that.

So for example, the kid who is required to have 5 bouts of tonsillitis for 2 years in a row will need lots of antibiotics and may even visit A+E, perhaps by ambulance, over that course of time. well presumably someone has analysed the actual data to come up with the optimum criteria for referral??? Are you suggesting that they have opted for a more expensive course that is also worse for the patient? If so presumably there are paths to changing the criteria?