Category Archives: Psoriasis

Eight artworks inspired by mental health problems

The Perspective Project hosts art, poetry and writing with the aim of ending stigma and providing an outlet for those with mental health problems. The 24-year-old founder, Mark Anscombe, is already sharing the work of over 30 artists from around the UK, US and Canada, all of whom have various mental health issues. The project accepts submissions in any form, and people can submit anonymously

As a GP, having my heart surgery cancelled gave me a new perspective on NHS underfunding

I am a GP partner in Oxford. I have worked in the NHS in Oxford for 20 years, barring two years in a post in rural Canada. In July 2017, we returned to the UK and a friend of mine, who’s a cardiothoracic anaesthetist, commented on my bounding neck pulses as we were chatting over a beer. A little later that day, I had a listen to my heart and even I, a GP, could hear a loud murmur. I asked one of my colleagues to have a listen, just to check I wasn’t being paranoid. I think he was trying to make me feel better and reassured me: “It’s probably just a flow murmur.”

Nevertheless, I saw my GP that day. With detached, mildly mounting alarm I registered the abnormal findings she discovered. High blood pressure, wide pulse pressure, mild tachycardia and, of course, The Murmur. Her worried expression made me more alarmed than the findings, and I found myself trying to reassure her that everything would be OK.


It’s quite difficult to describe the strangled sense of anger as I watched Jeremy Hunt on the news that night.

I saw the cardiologist in October and as soon as he mentioned he wanted to get the medical student, I knew I was in for some bad news. He told me I had severe aortic regurgitation, where blood flows in the reverse direction from where it’s supposed to as the heart pumps. He said he’d see me in six months and by that time I would have a new aortic valve. My reaction was silence, followed by expletive-laden surprise, not least as I had had no symptoms at all. Also, doctors never get sick.

It’s funny how that kind of news affects you – for a week or so, I was mentally crossing things off the list of things I could do with the rest of my life, and confronting the possibility that I might not see my daughter grow up.

In December, I was very relieved to get a date for my operation in January 2018 but my urgent surgery was cancelled when I called in at 10am on the day of admission. It’s difficult to describe the sense of loss that I felt. It came as a surprise, even for someone who works in the NHS every day. I really did not know what to do with myself.

As doctors in the NHS, we are trained from an early stage to soak up punishment, not to complain and to always carry on. But with my patient’s brain, I idly wondered how other people might be coping with similarly disorientating news all over the UK. About how they might be thinking how unfair this was, and what would they do now. Lives put on hold, terrible feelings of uncertainty, resignation and finally acceptance. After such news they must love, fear and hate the health service all at the same time. Nevertheless, the NHS is so beloved that it would never cross their minds that the government would have deliberately underfunded it for the last seven years. Some people might think it’s pretty decent of ministers to apologise for all the disruption, and that the government, to its credit, is forward-planning for a winter crisis.

The fact is, of course, that it is not, and that the crisis was entirely avoidable and is down to consistent underfunding. Doctors and the Kings Fund predicted it, even the head of NHS England predicted it. It’s quite difficult to describe the strangled sense of anger as I watched Jeremy Hunt on the news that night. I’m not sure how much more short-notice my surgery cancellation could have been, and yet here was my ultimate boss telling me that this was being done to avoid just such upheaval.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

I was back to work the next day and I have my game face firmly back on, but I can’t deny it has been disruptive and upsetting. I’m determined not to let any of these developments compromise my patient care and commitment to the NHS. I am sanguine, but waiting hopefully for another appointment. I understand that this situation may well occur again. In that circumstance, I look forward to a time when the apology from my health secretary and prime minister will be replaced by sustained hard investment in the NHS. Platitudes and short-term measures will not save or improve it. And yet, as many commentators have already suggested, perhaps that is this government’s point.

As a GP, having my heart surgery cancelled gave me a new perspective on NHS underfunding

I am a GP partner in Oxford. I have worked in the NHS in Oxford for 20 years, barring two years in a post in rural Canada. In July 2017, we returned to the UK and a friend of mine, who’s a cardiothoracic anaesthetist, commented on my bounding neck pulses as we were chatting over a beer. A little later that day, I had a listen to my heart and even I, a GP, could hear a loud murmur. I asked one of my colleagues to have a listen, just to check I wasn’t being paranoid. I think he was trying to make me feel better and reassured me: “It’s probably just a flow murmur.”

Nevertheless, I saw my GP that day. With detached, mildly mounting alarm I registered the abnormal findings she discovered. High blood pressure, wide pulse pressure, mild tachycardia and, of course, The Murmur. Her worried expression made me more alarmed than the findings, and I found myself trying to reassure her that everything would be OK.


It’s quite difficult to describe the strangled sense of anger as I watched Jeremy Hunt on the news that night.

I saw the cardiologist in October and as soon as he mentioned he wanted to get the medical student, I knew I was in for some bad news. He told me I had severe aortic regurgitation, where blood flows in the reverse direction from where it’s supposed to as the heart pumps. He said he’d see me in six months and by that time I would have a new aortic valve. My reaction was silence, followed by expletive-laden surprise, not least as I had had no symptoms at all. Also, doctors never get sick.

It’s funny how that kind of news affects you – for a week or so, I was mentally crossing things off the list of things I could do with the rest of my life, and confronting the possibility that I might not see my daughter grow up.

In December, I was very relieved to get a date for my operation in January 2018 but my urgent surgery was cancelled when I called in at 10am on the day of admission. It’s difficult to describe the sense of loss that I felt. It came as a surprise, even for someone who works in the NHS every day. I really did not know what to do with myself.

As doctors in the NHS, we are trained from an early stage to soak up punishment, not to complain and to always carry on. But with my patient’s brain, I idly wondered how other people might be coping with similarly disorientating news all over the UK. About how they might be thinking how unfair this was, and what would they do now. Lives put on hold, terrible feelings of uncertainty, resignation and finally acceptance. After such news they must love, fear and hate the health service all at the same time. Nevertheless, the NHS is so beloved that it would never cross their minds that the government would have deliberately underfunded it for the last seven years. Some people might think it’s pretty decent of ministers to apologise for all the disruption, and that the government, to its credit, is forward-planning for a winter crisis.

The fact is, of course, that it is not, and that the crisis was entirely avoidable and is down to consistent underfunding. Doctors and the Kings Fund predicted it, even the head of NHS England predicted it. It’s quite difficult to describe the strangled sense of anger as I watched Jeremy Hunt on the news that night. I’m not sure how much more short-notice my surgery cancellation could have been, and yet here was my ultimate boss telling me that this was being done to avoid just such upheaval.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

I was back to work the next day and I have my game face firmly back on, but I can’t deny it has been disruptive and upsetting. I’m determined not to let any of these developments compromise my patient care and commitment to the NHS. I am sanguine, but waiting hopefully for another appointment. I understand that this situation may well occur again. In that circumstance, I look forward to a time when the apology from my health secretary and prime minister will be replaced by sustained hard investment in the NHS. Platitudes and short-term measures will not save or improve it. And yet, as many commentators have already suggested, perhaps that is this government’s point.

Why does America still have so few female doctors? | Elisabeth Poorman

When my friend was in her fourth year of medical school, she and her boyfriend sat down with their dean to discuss their residency applications. They were entering a “couples’ match” where partners rank programs together in order to end up in the same city.

The match is a nerve-racking and opaque process. Both have since gone on to have successful academic medicine careers, but on that day in the dean’s office, they were nervous. My friend asked the dean for reassurance.

“I’m sure it will all work out,” she recalled the dean saying. “After all, in 20 years your boyfriend will be running his department and someone has to take care of your kids.”

Medicine has long been a career path in the US for women in science, with women entering the field in nearly equal numbers to men for 20 years. But along the way, many women fail to advance and to earn the same recognition and salaries as their male counterparts.

These differences are often framed as “individual failures”, in spite of the robust evidence of gender discrimination. Women are told to advocate for themselves, to be better negotiators, and, in private, not have children if they are going to succeed.

The medical profession must confront this sexism if we are to address why women have double the rates of burnout as male colleagues, and among the highest levels of suicide in the country, at 2.5 to 4 times the rate of the general population.

As a culture and a profession, medicine continues to systematically disadvantage women physicians at every stage of their careers, causing many to leave. As a result, we are losing some of our most talented doctors.

When I decided as a young girl to become the first in my family to go to medical school, the road ahead was daunting, but no more intimidating because of my gender. Since 1992, women have made up at least 40% of medical school students, peaking this year at more than 50%. Back then, many ascribed to a theory of “critical mass” where women would transform a culture created by and for male physicians through numbers alone.

But the top leadership positions in medicine remain predominantly male. Only 15% of department chairs are women, and 16% of medical school deans are female. For the past 10 years, according to an Association of American Medical Colleges report, women in academic medicine have received only 30% of new tenured positions.

If female doctors were on even playing field with their male colleagues, we should have reached parity long ago. As Dr Julie Silver, associate professor at Harvard Medical School, told me: “Medicine should be leading the way” in gender equity. Instead, women are at a disadvantage beginning in medical school.

The most important part of our education involves interacting with patients and winning their trust. If patients do not wish to talk to us because they mistrust women or minorities, this has serious consequences for our education.

According to a survey by Stat News and Medscape, 41% of women in medicine reported a patient making an offensive remark about their gender, compared with 6% of men. About 1 in 5 physicians reported a patient making an offensive remark about their race.

As Dr Huma Farid, a South Asian obstetrician at Beth Israel Deaconess Hospital, explained: “When people look at a white woman, they think she’s a nurse. When they look at me, they think I’m there to collect their tray.” We are rarely given any forum to discuss that doubt or even open bias and discrimination.

Our medical educators are also affected by gender bias. Male medical students are more likely to be labeled as “quick learners” than women, and that gap actually grows through medical training

Dr Vineet Arora, associate professor at the University of Chicago, says that “because we don’t talk about gender bias openly, students may not believe that it exists.” They will therefore interpret their individual failures and successes as due to their hard work and merit alone, ignorant of the ways some students are at an inherent disadvantage because of who they are.

Evaluations in residency also favor men. One study found that at the beginning of the residency, women residents were rated as slightly better on average than their male peers, but by the end of training were on average 3 to 4 months behind their male counterparts.

Differences in residency evaluations have real consequences for physicians’ careers. They affect their selection in competitive fellowships, research awards, and even the licensing process. Nonetheless, I am aware of no systematic effort at any institution to address bias in these evaluations and help evaluators give trainees a fair shake.

Gender also plays into our ability to work with other professionals in the hospital. Dr Andrea Christopher, a physician at the Veterans Affairs Medical Center in Boise, Idaho, noted that in residency nurses were more likely to help her male colleagues, but did not know how to address the discrepancy.

“I would put in orders, and the male residents would put in orders, and theirs would be done and mine would not,” she said. “And a senior nurse came over to me and said: ‘You just have to do your own EKG, set up your own IV, and collect urine, and eventually they’ll notice.’ I was afraid to discuss this with my superiors because I thought if I complained, it would reflect poorly on me.”

Though we rarely address this prejudice head on, studies have found that in simulated cases, nurses were less likely to help women physicians with procedures, and more likely to view women physicians negatively than male physicians for the same mistakes.

Of course, nurses are dealing with their own issues of gender discrimination. Nurses report rates of sexual harassment of around 70%, comparable with rates reported by female physicians. Male nurses are also paid more than female nurses for comparable work, and are more likely to be promoted.

After residency, institutions continue to overlook women physicians’ accomplishments. From the portraits hanging on an institution’s walls to the names of medical societies to the number of women giving lectures, women are consistently under-represented.

Pay is the clearest indication of whom institutions value. One study of academic medical centers found women physicians earn $ 51,315 less, on average, than their male colleagues. With adjustments for factors such as faculty rank, years in practice and graduation from a top medical school, women still earned $ 19,878 less. This salary gap appears to be widening.

Many have asked women to become better negotiators to overcome this disparity in pay, but this discrimination is an institutional choice, and institutions have to be responsible for solving it.

Dr Jen Gunter, a San Francisco based obstetrician gynecologist, left academic medicine in part because of persistent gender discrimination that she faced in her career. After years working at a Midwestern institution, she found out that her male colleagues were “making more money for doing less work.” When she spoke with administrators, they told her that the men “had families to support and she didn’t.”

Later, at a different institution, she had a complicated triplet pregnancy with her children requiring medical care in the ICU. “I was the primary breadwinner,” she said in an interview, “but my children needed a mom and a doctor.” She found herself overwhelmed by her family responsibilities as she was applying for tenure, and under-supported by her institution.

Though she had spent her entire career in academics and had four different board certifications (when most physicians have one), when she asked for help she was told “maybe academics are just not for you.”

She found herself overwhelmed by her family responsibilities as she was applying for tenure. When she asked for help, she was told by her dean “maybe academics are just not for you.”

Reproductive choices weigh heavily on women physicians, who face opaque, inflexible and generally abysmal maternity leave policies. These policies range from 12 weeks of paid leave to only 6 weeks of federally mandated partial pay for new mothers, to no separate maternity leave for trainees. Nearly one in three physician mothers reported experiencing discrimination because of pregnancy or breastfeeding. Many have trouble following the same recommendations they give to new mothers because of these policies.

More open forms of sexism and sexual harassment are rampant in this profession. Many were afraid to go on the record, but a few women did agree to speak about harassment they had experienced.

Dr Meredithe McNamara, a pediatrician at the University of Chicago, told me that in medical school, a surgical fellow told her to “get on your knees and suck my dick” during a surgical case when she couldn’t answer his question. She was asked to write up the incident when the rotation ended, but did not, in part because none of the other half dozen people in the room reported it.

Dr Sarah Candler, an assistant professor at Baylor College of Medicine, told me a prominent colleague groped her during a dinner at a leadership conference. She tried to get the help of a male peer who remained oblivious. He continued to touch her bottom until she got away, and apologized the next day “if he did anything wrong.” “I didn’t even know who to report it to,” she told me.

Gunter had a similar experience at a different national leadership meeting.” A few years ago, a very prominent person in academics, at a medical conference, I could not get his hands off of me,” she said. “Literally, I’m peeling his hands off of me. I asked two male colleagues for help, and they said, ‘What should we do? We can’t control him.’”

Sexism can be overcome, but it must happen at an institutional level. All of these issues of discrimination, from sexual harassment to paltry maternity leave policies to salary discrepancies are an institutional choice. Leaders who make a concerted effort to combat gender discrimination can advance women, and in the process, retain the widest pool of talent in their organization

Discrimination, from sexual harassment to paltry and penalising maternity leave policies to salary discrepancies are institutional decisions which institutions are responsible for changing.

Female medical leaders like Silver and Dr Lauren Thorndyke at the University of Massachusetts Medical School are tackling discrimination by promoting and mentoring women and minorities. Their efforts are more effective when they are explicitly supported by their institutions. At Massachusetts Medical School, for example, women now make up 26% of the faculty, compared to 17% at Harvard Medical School.

Like other professions, we need to address sexual harassment head on and not place the burden on victims to speak out. We need policies to promote and pay women and minorities so that we can continue to benefit from their talent and professional dedication.

Think of the patients that we could treat, the diseases we could cure, the innovations in our dysfunctional healthcare system women could innovate if institutions stopped thwarting our talents.

  • Elisabeth Poorman is a primary care doctor in Everett, Massachusetts and a clinical instructor at Harvard Medical School.She is on twitter at @drpoorman

Fears of Brexit drain as more EU27 ambulance staff quit the NHS

Increasing numbers of European Union-trained ambulance staff are quitting the NHS, raising fears of a Brexit drain from the 999 service just as concern over slow response times grows.

There are fears the departures could exacerbate high vacancy rates in ambulance services in England, which are already one of the most understaffed areas of NHS care.

Freedom of information requests submitted by the Liberal Democrats have revealed what the Lib Dems say is an “alarming” trend of resignations among ambulance staff trained in the other 27 EU countries.

The responses from England’s 10 ambulance service trusts show that 101 paramedics, call handlers and other staff from the rest of the EU left in 2016-17 – one in seven of the 688 EU27 personnel who were working for the trusts during that time.

Last year was the second in a row in which the number of leavers rose: 81 did so in 2015-16 and 78 quit in 2014-15.

“It is deeply concerning to see a rise in ambulance staff from the EU leaving the country. This is especially alarming when we are facing such a severe shortage of paramedics,” said Baroness Judith Jolly, who speaks for the Lib Dems on health.

“These EU citizens save lives in our communities every day, yet ministers have treated them like dirt and failed to give them certainty over their futures here,” Jolly added.

At the South Central Ambulance Service, 27 of its 143 EU27 staff quit – the most among the seven trusts that provided full figures. At South East Coast Ambulance Service, 20 EU nationals left – one in three of its cohort of 57 – while 18 of 152 did so at the London Ambulance Service, slightly fewer than the 21 who left the year before. The biggest increases in quitters were at the South Central (27, up from 17) and North West services (15, up from eight).

Danny Mortimer, co-convener of the Cavendish Coalition, a grouping of health and social care organisations that fear Brexit’s possible impact on the NHS and social care, said: “Any indication that the NHS is becoming less attractive as a place to work for paramedics and ambulance staff, from abroad or from the UK, is worrying.”

Mortimer added: “The certainty now being offered EU nationals is a massive step forward. The health and social care sector looks forward to government proposals for new migration systems which we hope will place greater weight on the contribution international recruits make to the health and wealth of our local communities.”

Dentists warn of child tooth decay crisis as extractions hit new high

NHS surgeons are performing record numbers of operations to pull out rotten teeth in children.

Hospitals extracted multiple teeth from children and teenagers in England a total of 42,911 times – 170 a day – in 2016-17, according to statistics obtained by the Local Government Association.

That is almost a fifth (17%) more than the 36,833 of those procedures that surgical teams carried out in 2012-13. Each one involves a child having a general anaesthetic and at least two teeth removed.

“These statistics are a badge of dishonour for health ministers, who have failed to confront a wholly preventable disease,” said Mick Armstrong, the chair of the British Dental Association, which represents most of the UK’s dentists.

He condemned “ministerial indifference [to] … the child tooth decay crisis”. Ministers were being “short-sighted” by not taking children’s oral health more seriously. Under-18s in England were receiving “second-class” services to prevent rotten teeth, in contrast to Scotland and Wales, both of which have a dedicated national programme, Armstrong added.

Tooth decay chart

The cost to the NHS of removing severely decayed teeth in under-18s has also escalated over those four years, from £27.3m to £36.2m.

Health campaigners said the “alarming” trend showed children were eating too many sweet foods and should prompt tough action to cut their sugar intake.

“These figures show that we have an oral health crisis and highlight the damage that excessive sugar intake is doing to young people’s health,” said Izzi Seccombe, a councillor and the chair of the LGA’s community wellbeing board.

Children’s poor dental health can limit their ability to eat, play, socialise and speak normally, she added.

The government’s main policy to prevent tooth decay in children most at risk, called Starting Well, was not given new funding and operates only in parts of just 13 local council areas in England, the BDA said.

“This short-sightedness means just a few thousand children stand to benefit from policies that need to be reaching millions,” Armstrong said.

Dr Nigel Carter, chief executive of the Oral Health Foundation charity, said the rise in childhood teeth extractions was “completely unacceptable” and was causing pain and distress for the under-18s undergoing the procedure.

Dr Sandra White, Public Health England’s director of dental public health, said: “Parents can reduce tooth decay through cutting back on their children’s sugary food and drink, encouraging them to brush their teeth with fluoride toothpaste twice a day, and trips to the dentist as often as advised.”

Prof Russell Viner, officer for health promotion at the Royal College of Paediatrics and Child Health, said ministers should ban television advertisements for foods high in fat, salt or sugar before the 9pm watershed and stop fast food shops opening near schools and colleges.

Shifting care closer to home will ease pressure on hospitals | Ewan King

New year is associated with hope and optimism. But for the NHS, the headlines tell a different story: hospitals at full capacity. As you might expect, these articles focus on what is going wrong: headlines such as “NHS in crisis”, stories of beds in corridors and stressed-out nurses. Clearly these problems are real, but focusing only on hospitals won’t solve the problem. We need to think more broadly if we are to find lasting solutions; we must think about prevention, and how far it is embedded in local systems.

For some time, health and care reforms have been about shifting care closer to home. The programme of vanguards and sustainability and transformation plans was intended to herald a greater focus on prevention and self-care to reduce pressure on hospitals. There is some evidence that these reforms are working: Hertfordshire’s prevention-focused Better Care for Care Home Residents Vanguard, for instance, led to a 45% reduction in hospital admissions and A&E attendances between April 2015 and May last year.

But we are not yet able to see the scale of change necessary to make a significant dent in demand across England and beyond, because of financial pressures, which make it difficult for organisations and commissioners to fund new, innovative services; inward-looking leadership teams focused on short-term goals and local evidence and solutions; a lack of integration across health and social care and housing; and outdated performance management and contracting systems.

A seismic shift – at the level needed – is not straightforward to deliver. As Nesta, Shared Lives and the Social Care Institute for Excellence (Scie) argue in a new report on innovation, we know a lot about what works to support independence in ways that reduce demand for urgent care, but less about how to extend the benefits to more people. As the report concludes: “New and better ways of delivering relationship-based care are needed, and already exist, but are inconsistently implemented or poorly scaled.”

So what can national policymakers and local health and care leaders do differently? First, we need to restate the case for preventive, community-based care and, as part of this, more clearly articulate how it will make a difference to people’s lives. For example, in our report we describe a place in the near future where people are supported to maintain their independence, improving their wellbeing at reduced cost to the NHS. What if you have a long-term condition such as chronic obstructive pulmonary disease; are you able to join a Breathe Easy peer support group to help you manage the condition?

We also talk about North Yorkshire, where an innovation fund has been used to fund initiatives reducing isolation, preventing falls and supporting people to stay at home when they want to. Local care and support providers say this has helped them to build their networks, and they are now working in partnership with more local services.

Second, we need collective local leadership focused on keeping people well and better supported at home, underpinned by a strong commitment to integrated commissioning and to changing funding flows to support more community-based care.

A hospital trust chief executive recently told me that investment away from beds and A&E services would support far better preventive approaches – but there has to be a system-wide strategy for all to lead and support if bed pressures arise.

Third, we need to make better use of the evidence we have, making a stronger case for investment in preventive care. In Scie’s prevention library, we have a mass of evidence-based examples of community-led care and support that helps to reduce demand for hospital care. Age UK’s personalised integration approach in North Kent is a model of holistic support targeted at older people with long-term conditions. It has led to a 26% reduction in non-elective hospital admissions. Commissioners need to use these examples to argue for spending more on preventive models of care and support.

Carrying on as we are is unlikely to succeed; we are firefighting in the face of growing demand in hospitals without always considering what wider changes are needed to prevent this growth. The social care green paper, to be published in the summer, provides a good opportunity for setting out plans for a more preventive, person-centred, health and care system, but there is nothing to stop leaders being more ambitious about prevention right now.

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Women get worse care after a heart attack than men – must they shout louder? | Ann Robinson

Women are getting worse medical care than men after a heart attack, resulting in unnecessary deaths, according to a new analysis of 180,368 Swedish patients, followed up for 10 years after a heart attack. When women were given optimal treatment (surgery or stents, aspirin and statins), they did as well as men. And the situation is likely to be even more obvious in the UK, says the British Heart Foundation, which part-funded the study.

And is this glaring gender divide because women ignore their symptoms? Get different symptoms – more easily confused with indigestion? Are taken less seriously by GPs? Are less likely to have heart disease when investigated for chest pain? Are less likely to have tests such as an ECG? Receive different treatment in hospital? And are less likely to be offered implantable devices that prevent later deaths?


This study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment

The likely answer to all these questions is yes. There’s a subconscious bias at work that means if I see an overweight, middle-aged male smoker with a bit of breathlessness or chest discomfort in my GP surgery, I’m more likely to think “heart disease” and if she’s female to think “acid reflux”. Historically, that may have been statistically understandable, but it’s now an unjustified bias that GPs need to recognise and counter by following proper referral pathways.

Even the most objective of GPs will respond to what a patient says. So women and men alike do themselves no favours by underplaying symptoms or suggesting that they’re sure it’s indigestion or muscle pain. In my experience, women are more likely to self-blame than men: “I let myself go over Christmas and have put on weight so probably I need to just cut down and this pressure in my chest will go.” This is exactly what a woman said to me recently but an ECG showed signs of strain on the heart and triggered an urgent assessment at a rapid access chest pain clinic for specialist care to prevent a heart attack.

I’ve always assumed that although a woman is less likely to present their symptoms and be referred appropriately by the GP, once she gets to hospital, she’ll be treated the same as a man. But this study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment. This doesn’t chime with my clinical impression; our female patients discharged from hospital after a heart attack are on the same drugs and have undergone the same procedures (stents or surgery) if needed as our male patients.

Clinical guidelines are based on objective criteria and gender is not one of them. It requires further interrogation of UK databases to verify whether this same apparent damaging discrimination is happening elsewhere. It would also be useful to hear comment from Swedish cardiologists and their department of health to understand what lies behind this scary story.

On the plus side, we continue to live longer than ever and the rates of circulatory disease (heart disease and stroke) continue to fall. In the UK, most of us will die of cancer, circulatory disease or dementia. Falls in smoking rates, changes in lifestyle and medical advances have all made the chances of having a heart attack and surviving one better than we could have imagined in the 1970s, when my dad died aged 48 after his third heart attack.

But the tragedy is that there are still 42,000 premature deaths a year from heart disease in the UK that are now potentially avoidable. Men and women alike need to recognise the signs, seek medical help and demand prompt and optimal care. And it seems that, as in so many areas, women may need to shout louder to be heard.

Ann Robinson is a GP

Essex woman dies after waiting nearly four hours for ambulance

An 81-year-old woman was found dead in her house after waiting almost four hours for an ambulance.

The pensioner, who lived in Clacton, Essex, called 999 on Tuesday complaining of chest pains, according to the GMB union. East of England (EEAST) ambulance service said a crew arrived three hours and 45 minutes after the initial call.

Dave Powell, GMB regional officer, said the crew had to force their way into the property on arrival because the control room could not contact the woman by phone, and found her dead.

“They’re devastated because they’re not in the job to find people dead, they’re in the job to help people and keep them alive,” said Powell.

“It puts enormous strain and stress on people who are working really hard as it is.

“Three hours and 45 minutes is totally unacceptable for an elderly woman on her own with chest pains.

“Something has got to be done and the government has got to wake up to this crisis.”

He said such cases were likely to be more widespread than the public was aware of.

Sandy Brown, the deputy chief executive at EEAST, said: “Our sincere condolences and apologies go out to the patient’s family and friends and we are truly sorry for the ambulance wait that occurred at this incident.

“We have very publicly expressed how stretched the ambulance service is and the pressures our staff and the NHS as a whole have been under the past few days. As a trust, we have experienced our busiest days ever and we know our partners in the hospitals are in the same situation.

“A clinician in one of our control rooms made a welfare call and spoke to the patient at 9.47pm and an ambulance crew arrived at the address at 11.46pm. The patient was found unconscious and not breathing and sadly died at the scene.

“This incident is being investigated by the trust and we will report back our findings in due course.”

Ambulance services, like hospitals, have struggled to cope in the midst of the NHS’s winter crisis. Last week, EEAST raised its operational level to the highest possible, an indication that its ability to respond to potentially life-threatening incidents had been affected. In some cases, it used taxis to transport patients to hospital.

The service says it received 4,200 calls on Tuesday, compared with a daily average of about 3,000. It says it has also been affected by a shortage of capacity at hospitals, with nearly 500 hospital handovers lasting an hour or more between 29 December and 1 January inclusive.

EEAST is not the only ambulance service that is struggling. On Tuesday, North East ambulance service also raised its operational level to the highest possible, citing “extreme pressure”.

Norman Lamb, a former health minister whose North Norfolk constituency is served by EEAST, said that while it was possible the woman could not have been saved even if the ambulance had arrived quicker – for example, if she had suffered a cardiac arrest – tragic consequences were unavoidable where there was underinvestment in the NHS.

“I’ve been making clear that the state that the system is in, it’s inevitable that people will lose their lives and failures of care will mean people will be left with long-term disabilities,” he said.

“One of the major strains is the ambulance service and its link with A&E, problems with handovers and ambulances stacking up, which leads to delays. Paramedics are having to work long shifts because of insufficient workforce. These are the human consequences of the financial state the NHS is in. This is why it’s vital the government acts, the prime minister can’t stand by and allow the NHS to deteriorate.”

Woman nearly blinded by Christmas card glitter

A woman was nearly blinded by a Christmas card when a piece of glitter worked its way into her eyeball.

The 49-year-old attended the ophthalmology department of Singleton hospital in Swansea complaining of a painful, reddened eye, loss of vision and swollen eyelid.

Doctors spotted a lesion on the patient’s cornea and initially suspected it to be caused by a herpes simplex infection, according to a case study published in the British Medical Journal (BMJ). But when the lesion was examined under a powerful microscope, a shiny surface was spotted inside.

The patient remembered getting glitter in her eye when it rubbed off a Christmas card. The glitter had formed into a clump, causing a lesion that mimicked the symptoms of a herpes infection, the report said.

The report advised doctors to always ask about the cause of a possible trauma to the eye, even if the symptoms seemed to clearly indicate a common infection.

“The lesion may have been easily misdiagnosed as a herpetic simplex infection by non-specialists for which treatment would have been topical antiviral ointment instead of removal and antibiotics,” the report said.