Examination of Witnesses (Questions 160-164)
16 JUNE 2004
DEPARTMENT OF
HEALTH
Q160 Mr Steinberg: Professor, what is
the percentage of mistakes made by doctors in terms of referring
people as non-priority who turn out to be priority?
Professor Richards: It is very
difficult to put a figure on that. I think one has to remember
how difficult it is for a GP who sees probably only seven or eight
new patients with cancer in a year but will see hundreds of patients
who have symptoms which just possibly could be cancer. That is
why we issued guidelines on referral, and those guidelines are
being revised by NICE at the moment, and it is why we are working
with GPs to improve decision support so that they can make the
best decisions with patients about who needs to be referred urgently
to hospital.
Mr Steinberg: I have always had the feeling,
since I came onto this Committee, that doctors are very arrogant.
Chairman: Unlike Members of Parliament.
Q161 Mr Steinberg: Unlike Members of
Parliament. I think I read in a Report somewhere that, the information,
the guidelines which had been given out, 50% said it was useless
anyway. That is the attitude I would expect from a lot of doctors,
that they always know better. Should there be a sort of national
guideline, standardisation?
Professor Richards: First and
foremost, I would like to defend my clinical colleagues against
that charge.
Q162 Mr Steinberg: I can give you lots
of examples after the meeting.
Professor Richards: I am not saying
there are no examples of it at all. I think that the culture amongst
doctors has changed enormously during my working time, where we
have moved very substantially from a period of paternalism to
one of a great deal more of working in partnership with patients
to do what is best for patients and what they want. We may not
have gone as far as we need to on that, but certainly over the
25 years that I have been a doctor I have seen very, very substantial
changes in that regard. I am not saying we have not got further
to go, and certainly we are keen to work with doctors to help
them to know when to refer patients urgently.
Q163 Chairman: You have closed your book,
Sir Nigel. It is always a dangerous thing to do, because I have
got one last one for you, following that marvellous speech from
your colleague. When you come back in five years' time, do you
expect to be able to tell us that our survival rates are comparable
to the best in Europe?
Sir Nigel Crisp: I expect us to
have closed the gap. Also it depends on where their survival rates
are going. What is clear at the moment is that our survival rates
are improving faster and we are starting to catch up. It is clear
also, and maybe this gives me the opportunity to say just one
thing to pick up on this, that the other thing I think we will
see is patients with much more information. This is one of the
underlying issues which I think has been around this Committee
and also is part of the answer to Mr Steinberg. We do need people
to understand the treatments which are available and the success
rates, and I think that will be a force which probably you will
be reporting on in five years' time, whether I am here or not.
Q164 Mr Steinberg: Can I defend what
I said. I had a constituency case where a lady was referred to
a consultant not as urgent, and she contacted me and I told her
to go back to the doctor. When he wrote the letter he had forgotten
to put "urgent" on it, so she went down the list and
was not seen as an urgent case because he forgot to say it was
a priority. Is that good enough?
Sir Nigel Crisp: No.
Professor Richards: No.
Chairman: Thank you very much, Sir Nigel
and Professor Richards. It has been a very good hearing. I think
colleagues have dug up some very interesting information. Thank
you very much.
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