Medicine

NHS kills young woman

By Chris Rangel MD ⋅ August 9, 2007 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

Socialized health care kills patient with excessive wait times for MRI.

A 22 year old English woman collapsed and died from a rare brain tumor after having severe headaches for over a year and after no less than 5 visits to her physician. Her headaches were diagnosed as “stress related” and she received 6 physical therapy sessions for head and neck pain. Only after she became so sick that she had to quit her job was she referred to a neurologist who ordered an MRI of the head. The MRI request was labeled “relatively urgent” and so this patient was moved higher on the MRI waiting list so that she would only have to wait 13 weeks to get the MRI!! She died 3 days before her MRI appointment.

13 WEEKS? If this is how long it takes for a “relatively urgent” study then how long would it take for a “routine” study, a year? How long for a “stat” study, a month? If MRIs and other advanced imaging take this long to get done then the use of such imaging for the diagnosis and management of serious acute illness becomes impractical as the patient will either have died, become permanently injured, or advanced beyond a curable stage by the time the test is done!

If advanced imaging is used for the evaluation of chronic illness such as chronic joint or back pain takes this long to get done then this increases morbidity or the amount of time that the patient remains in pain before a diagnosis is made (severe degenerative joint disease of the knee) and the appropriate treatment is done (knee replacement).

Either way, such pathetic waiting times for advanced testing increases both morbidity and mortality as evidenced by this sad case.

It’s far more difficult to second guess the primary physician in this case. Headache, even chronic headache is a very common presenting symptom in primary care and the vast majority of cases are benign. Other than having focal findings on the neuro exam (i.e. speaking difficulty or weakness in one extremity or on one side) there are no hard and fast guidelines on when to order advanced imaging of the head like a CAT scan or MRI.

However, most physicians will order imaging when the headache is either worsening and/or not responding to standard therapy. The threshold for most American physicians to do this is usually far less than a year and 5 consecutive visits for the same problem. I’m not sure what it’s like in the National Health Service as far as ordering expensive tests. Is there pressure to avoid expensive tests or is this how UK physicians are trained?

Regardless, any health care system, especially one that is heavily dependent upon public funding, is going to face some degree of cost restrictions and rationing. But as this case clearly shows, there needs to be a considerable amount of flexibility and urgency when it comes to getting studies where the differential diagnosis obviously includes diseases that can kill or injure!

Having to wait 13 weeks to get an MRI when the intent is to look for something far worse than migraine or simple tension headache is pathetic! It’s like waiting a week to get an EKG for crushing substernal chest pain.

“Alright Mr. Smith, you’re either having a massive heart attack or a really bad case of heartburn. Obviously the heart attack could kill you. So, I’m going to check for this with an EKG but it will take a week to get done so in the meantime take two aspirin and come back in a week if you’re still alive.”