When I worked in accident and emergency a man hobbled in who had broken his ankle two weeks earlier. I asked him why he had not come before. He told me that the Government were running a series of adverts on TV telling the public not to go to A&E with minor conditions.
“I didn’t want to bother you” he said.
I tried to explain that ‘minor conditions’ did not mean a broken ankle but I knew he meant well and he had tried to do the right thing.
Is there a danger that the Covid-19 crisis will lead to the same problem?
Are people not asking for medical help, scared of catching the virus or not wanting to bother the staff who are already too busy?
Both Dr Rob Dyer, the lead medical director, and Mr Ian Currie, the acting medical director at Torbay Hospital, have expressed concern as reported in Torbay Weekly.
Although many routine cases have been postponed, the NHS is still open for business.
There has already been an increase in deaths in people who did not have coronavirus.
Underlying these cold statistics are personal tragedies but it is important to stand back and look at the figures. On the week ending April 17 there were 3,000 deaths not put down to coronavirus. Are these deaths undiagnosed coronavirus or are they people who did not seek medical help when needed?
Since I qualified I have seen some dramatic improvements. As a junior doctor in the 1970s I was responsible for any medical patient who was admitted; heart attacks, diabetic comas, asthma, epilepsy and almost anything else.
Looking at just one of these conditions, heart attacks, patients were admitted, I carried out the basic blood tests, ECG and chest x ray and waited to see what happened. They either got better or had a cardiac arrest when I carried out CPR with varying success. There was even a paper published that showed that people with heart attacks who were kept at home were more likely to survive than those admitted to hospital.
Today, at the first sign of a heart attack patients are given a ‘clot-busting’ injection which makes a huge difference to the outlook. Once in hospital they have an ‘angiography’; dye injected into the blood vessels around the heart. This shows up any blockage which can be cleared with a stent, a small tube placed inside the artery.
There is also the option of a coronary artery bypass, a larger operation to bypass the blockage.
After patients are discharged they are given medication to reduce their cholesterol and keep their blood pressure under control.
The outlook is dramatically better.
This is not just professional; it is personal.
None of our children had a grandfather. My father died in 1969. He had a problem with a heart valve. This was caused by rheumatic fever which he developed during the war due to the appalling conditions fighting in Burma. Today, he would have had a valve replacement.
My father-in-law developed angina in the early 1970s and died of a heart attack. Today, he would have a stent or bypass graft.
Is there a danger that, today, people will ignore the early symptoms of a heart attack and loose vital time?
It is not just heart disease. Many cancers have a much better outlook if caught early and yet there is a two thirds reduction in referrals for suspected cancer.
Are people ignoring a change in their bowels, are women ignoring breast lumps or men ignoring testicular lumps?
Is anyone looking at a nasty mole changing, itching and bleeding and deciding to wait until after the lockdown? Will we see an increase in cancers which are too late to treat?
Remember the NHS is not just there for coronavirus; other diseases have not gone away.