MEDICAL NOTES

[ IF BEING the subject of a satirical debate on the BBC’s News Quiz is an indicator for the importance of a news story, then the report that the Metropolitan Police are set to refuse to attend calls involving mental illness is one of the big stories of recent weeks. The move, according to leaked documents published in The Guardian, was prompted by impatience on the part of Met Commissioner Sir Mark Rowley with progress in implementing an approach to responses called ‘Right Care, Right Person’.

As with most of these stories, the background somewhat dilutes the headline. The approach has been in place in a number of trial areas for some time, with a measure of success.

• New approaches to treatment are a perennial element in medical advances, whether in the field of new drugs or in therapies to replace drugs in the treatment of certain conditions. Chronic pain is one condition where the medication needed to treat the condition has traditionally been addictive or dependence inducing. Recent approaches to the treatment of pain have focused on alternatives to opioids and the like, with support to counter the effects of withdrawal being offered.

The Faculty of Pain Medicine, while welcoming the offer of alternatives and support to withdraw, has cautioned against the stigmatisation of patients whose treatment still depends on powerful pain killers as the only defence.

• Pain has hitherto been a difficult condition to quantify, being entirely dependent on subjective measurement – I refer readers to a previous column relating my own post-operative experience. A breakthrough in San Francisco has indicated for the first time that pain can be measured by using implants in the brain to measure the brain’s response to pain.

The news is one more instance of technology being the conduit for medical advance. Another has been reported closer to home. In Scotland researchers have developed a method of diagnosing heart attacks quicker and more accurately by means of an algorithm developed using artificial intelligence.

• A technology that has been around for a little longer than AI is the use of ionising radiation in both diagnostics and treatment. Orthopaedic surgeons are one group using such treatment routinely, and there is concern that female surgeons can be at a raised risk of breast cancer as a result. A working group of the BOA has expressed concerns at the level of protection provided by current PPE for women. One of its members is articulating those concerns effectively.

• While risks associated with the workplace can be identified and legislated for, the many risks associated with cut-price cosmetic or bariatric surgery abroad are less easy to guard against. Even the very act of returning home after surgery can present serious dangers, such as DVT. Two associations representing aesthetic and bariatric surgeons respectively have voiced their concerns about what they term ‘surgical tourism’. Their message is to ‘Consult a UK surgeon first’ – and ideally stay in the UK for your procedure.

The many advantages of consulting a well-regarded surgeon in this country are explained by two leaders in the field.

• Being able to give informed consent is one of the pitfalls of surgical tourism: if much of the protocols surrounding the procedure is in a foreign language, how do you know if you are getting what you expected?

The issue is complex enough at home, where the patient’s consent may be based on an appreciation of the risks associated with a procedure. Case law is its usual dense quagmire in that area, as elucidated by a senior ophthalmologist. q