MEDICAL NOTES

[ WHEN I CAME ROUND from anaesthetic after serious vascular surgery some years ago, a nurse asked me to rate my pain on a scale of one to ten. My answer was a strangled “twenty seven!” – an answer that obviously hit a nerve with the staff as I heard the words ‘twenty seven’ being repeated around the hospital as I was wheeled to a ward.

I had been adjured by my wife before I went under to “don’t be brave; take whatever they offer”: her 40-odd years as a nurse, ward sister and eventual matron had led her to the conviction that pain should not and need not be endured.

Taking pain seriously is happily becoming more accepted in the medical profession; and not just among pain specialists. Our regular contributor Dr Chris Jenner reflects on how pain medicine has developed over the years; but pain is still in many instances undertreated.

• Vascular surgery is coincidentally a specialism that attracts a disproportionate number of claims, according to research carried out by surgeons at two Lancashire hospitals – in one of which the aforesaid operation took place. Delay in treatment was the most common cause for complaint, a failing that plagues many areas of medicine concerned with the cardiovascular system – almost always a result of the widely-recognised ‘gridlock’ in NHS services.

• Delayed treatment can be catastrophic in the case of Charcot’s neuroarthropathy, as described by another regular contributor, Dr Bobby Huda. In some cases a delay of up to three months can result in loss of a limb. It is a condition that many GPs only see once or twice in their entire careers, and is often mistaken for gout.

• Some problems, however, do not become apparent for a number of years. Brain injury that develops as a result of consistent head impacts, such as those experienced by football and rugby players, may not develop for many years. High-profile examples are now finding their way to court and we await developments.

• In neurological cases the line between the physical and the psychological can become blurred. Head injury can be seen to be a causal factor in the development of brain tumours and brain injury can result in cognitive issues that can be treated by a speech and language therapist. Similarly, physical injury can result in psychological trauma, such as that experienced by burns victims. It can be counterproductive, however, to predicate the psychological effect on the size or the extent of the burn. A team of experts at a leading hospital have produced a myth busting website page to explain some of the pitfalls.

• It is easy to be bogged down in the seemingly interminable succession of bad news regarding our health system and the problems it seems incapable of addressing. The 2021 Census showed that, in general, we are not as ill as we were 10 years ago. Figures published by the ONS, which carries out the Census on behalf of Parliament, showed a marginal reduction in the number of us who see ourselves as ill or disabled.

• The picture only shows a half-full glass: despite overall national improvements in selfreporting of health, disability and levels of caring, there is still a regional disparity. You guessed it: the North and the devolved nations fare less well than the South. Levelling up needed? q