“Ethical Duty” – by Helen May


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helenmay80Recently, the Academy of Royal Colleges argues UK doctors have an “ethical duty” to prevent waste (http://www.bbc.co.uk/news/health-29920025). The report refers to “overuse of Hb1AC tests”. Whilst, I believe it is important to have data about a patient to help manage their condition, I wondered if this was my experience. But I realised, the opposite might be true. Let me describe my experience of blood testing:

Hb1AC is measured just before my annual review and the results are given to me during the review. This separation of the tests requires some logistics planning on my part because all I receive in the post is a letter inviting me to the local hospital for the review and advise to bring any medication I am on. No mention is made of blood or urine tests. That is because I was given all the paperwork I needed in my last review. Yes, I have to store the blood test request form for a year and remember where I put it and that the results take two weeks. So I must visit the nurse to take the blood test two weeks before my annual diabetes review. The Hb1AC test (and others) is completely the responsibility of the patient.

I want to keep my relationship with my diabetes consultant (or, usually, one of his registrars) on an even keel. I don’t want to rock the boat (too much) by suggesting he changes his processes, especially when they usually work okay for me. But on one visit, I said with a smile, “I’m always surprised with myself that I have found the paperwork for the blood test you gave me a year ago”. To which he replied, “I am always surprised when anyone does: most usually lose it or forget.” I probably opened and closed my mouth a few times but decided against telling him how to do his job.

But thinking again about the “ethical duty” of UK doctors, I wonder. Isn’t it wasteful to invite patients to an annual review knowing that most of them will not have any test results to review? My weight, blood pressure and “resting” heart rate (after rushing to the hospital) is measured at the start of the review. But I do not believe this is sufficient information to determine how well I am managing my diabetes.

Sometimes, it’s worse than that. On more than one occasion, some of my blood test results “ have not made it into the system.” I interpret this as “got lost” because I never see the results. The doctor and I discuss my past results and assume everything is probably the same so we don’t need to worry.

Back to thinking about wastage: here I think we have two areas of wastage: a review without all the information and a blood test which was taken (and the costs associated with it) but not looked at because they went missing.

I believe, in the UK, we are very lucky to have the NHS. But as a tax payer, I want to know my money is not wasted and is being spent wisely. Overall in the cost of treating people with diabetes, I am sure the cost of Hb1AC testing is a small percentage. I still believe the biggest saving is reducing the cost of future complications (which, I read somewhere, accounts for 80% of the spending on diabetes). However, as the Academy of Royal Colleges argues, it is an ethical duty to prevent waste. And this should include preventing any waste.

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