Doctors order needless scans on the elderly because they fear talking about death, study suggests

[Sly Saint]

Elderly patients are being given unnecessary scans in their final years by doctors who are afraid of discussing death, a study in a BMJ journal suggests.

A small study of 96 elderly NHS patients whose average age at death was 88 revealed they had hundreds of scans between them despite a lack of evidence that the procedures would help.

More than a quarter of the patients had more than 10 separate scans, such as x-ray, CT and MRI scans, in the six months before they died - almost one every other week.

‘A burden of over-investigation’
Researchers from Ashford and Saint Peter’s Hospitals NHS Trust, in Chertsey, Surrey, suggested that one of the possible reasons for the serial scanning was a loss of importance in recognising that a patient is dying and then “managing subsequent conversations”.

They said this was “the crux of these missteps in clinical management that lead to a burden of over-investigation on both patients and the health service”.

The authors also suggested that 20 to 50 per cent of scans had no medical benefit and were more likely to have been delivered because the patient expected it rather than it making a material difference to care.

Between them, the 96 patients underwent 389 x-rays, 92 ultrasound scans, 192 CT scans, and 6 MRI scans - a total of 679 procedures.

They had all been admitted to a single hospital between July and Dec 2021 and the sample size accounted for a quarter of all the patients aged 80 or over who died during that time.

Doctors order needless scans on the elderly because they fear talking about death, study suggests (msn.com)

 

[Jonathan Edwards]

Of course a study of this sort will never identify the 679 procedures that weren't done in other people and might have been of use. This sort of moralising overgeneralising approach to medicine has always been around and should be ignored. All a doctor can do is make the best decision they can at the time. If there is a lack of information then it is more sensible to investigate. With a system of people being shunted around without any continuity lack of information is everywhere, but that doesn't mean you shouldn't do the tests.

 

[bobbler]

Doctors order needless scans on the elderly because they fear talking about death, study suggests (msn.com)

This smells strange to me

although I guess it depends how they count one fir things like x-rays?

I’m imagining most were in hospital anyway. And I also imagine because of the nature of what happens when you are ill with other things most had had falls before or ‘to’ end up there

so if 4 x-rays per person is because eg the metaphorical equivalent of each finger counts as a separate x ray so just to check their left side (leg, hip, arm etc) is technically five but all done in one go then maybe


But otherwise it feels an error in the data and not a phenomenon there’s no way it would get past things for some old dear to be wheeled to x-ray five times in a week ? Not for no reason?

 

[bobbler]

Of course a study of this sort will never identify the 679 procedures that weren't done in other people and might have been of use. This sort of moralising overgeneralising approach to medicine has always been around and should be ignored. All a doctor can do is make the best decision they can at the time. If there is a lack of information then it is more sensible to investigate. With a system of people being shunted around without any continuity lack of information is everywhere, but that doesn't mean you shouldn't do the tests.

Yes there are indications of selective descriptions of their sample ie wheedling

ave age 88

96 patients in six months

claims this accounted for a quarter of patients 80yr or over who died during this time, but doesn’t define how many that was OF their sample.

could easily have been that half the sample were early 70s with something potentially treatable . Isn’t it more likely too that a x ray for a broken hip reveals eg cancer or some other condition needs to be looked into when it’s an older person just due to nature of prevalence

and I know three women who were in their 90s when cancer was found and treated.

they haven’t confirmed convincingly these shouldn’t have been done ?

what do the medics being spoken for think of this sort thing? It’s interesting seeing them having words potentially put in their mouths.

 

[Sly Saint]

UK patients going private to escape referrals ‘black hole’, say GPs

Patients are increasingly turning to private healthcare to escape a referrals “black hole”, GPs have warned, as the NHS struggles with a shortfall of available appointments.

The most recent figures show GP practices make about 400,000 referrals a month to outpatient clinics that are fully booked. Some patients will be able to choose an alternative provider, some will be booked at a later date, but many end up being bounced back to their local surgery.
Dr Dean Eggitt, a Doncaster GP and chief executive of the city’s local medical committee, said: “I think the NHS has collapsed because it is no longer providing universal care. I will say to a patient, ‘I can refer you, but it’s not going to get sorted for a year and I can just help you cope.’”

Eggitt said he discussed with patients the options of care in the private sector, with many choosing to pay for some of their care. Analysis published by the Nuffield Trust in May revealed a 30% increase in people paying for hospital care across the UK since the pandemic.

GPs typically refer patients to outpatient clinics using the NHS e-referral service, which can also be used by the patient to book a suitable appointment. The most recent figures, for July, show there were more than one million appointments booked in England, but 407,173 cases in which no slots were available.

UK patients going private to escape referrals ‘black hole’, say GPs (msn.com)

 

[Ash]

Of course a study of this sort will never identify the 679 procedures that weren't done in other people and might have been of use. This sort of moralising overgeneralising approach to medicine has always been around and should be ignored. All a doctor can do is make the best decision they can at the time. If there is a lack of information then it is more sensible to investigate. With a system of people being shunted around without any continuity lack of information is everywhere, but that doesn't mean you shouldn't do the tests.

Yes and when you have media and research healthcare culture that is constantly openly suggesting our population is too old people are living too long we can’t afford the ‘burden’ of people being alive, people having a heart attack can’t get an ambulance never mind people getting an appointment for a consultation or scans, healthcare providers don’t wear masks because only the “vulnerable” die of Covid, it’s not really very convincing to argue that the important problem is anyone being averse to talking about death not when they’re all acting like they’re actually quite keen to bring it on at the decision making levels.

 

[Keela Too]

And yet, when an individual has become very frail (and perhaps increasingly so in recent months) is it really fair to put them through the stress of the transport, the waiting, the testing, and the travel back?

Some tests just may not be worth that amount of physical distress they can cause while happening.

I think it is right to think about these sorts of issues, but I don’t think it’s easy to make blanket rules.

 

[Jonathan Edwards]

And yet, when an individual has become very frail (and perhaps increasingly so in recent months) is it really fair to put them through the stress of the transport, the waiting, the testing, and the travel back?

If that saves them dying a particularly harrowing death after weeks of unnecessary pain, it is worth it even if like my mother they are 102.

We have recently been through this with mum. The GP and care home staff dithered and deliberately avoided dealing with a problem that ended up being a major threat to comfort and a major source of distress for all. If tests help to avoid distress they are very well worth while.

Yes, tests are done unnecessarily, but across the board, however old people are, in the current NHS much more harm comes from not doing tests than from doing them. Until that changes I think easy moralising articles about this do nobody any good.

 

[Keela Too]

If that saves them dying a particularly harrowing death after weeks of unnecessary pain, it is worth it even if like my mother they are 102.

That would certainly be worth the testing, but it doesn’t change the concept some tests may not be.

Eg Unpleasant tests/procedures on one weak eye, when the other is still functioning well.

 

[Jonathan Edwards]

Eg Unpleasant tests/procedures on one weak eye, when the other is still functioning well.

Its an interesting example. But my mum developed acute wet macular degeneration in her right eye aged 89. It was left alone initially and progressed such that she lost all central vision. She later had some treatment but the damage was done. Over the next ten years she developed cataracts in both eyes and a decision was made not to operate on the cataract in the only good eye in case it went wrong and she had no vision. The cataracts have progressed and she is now blind and has to be fed and taken to the loo which is distressing. It is never easy.

 

[Ash]

That would certainly be worth the testing, but it doesn’t change the concept some tests may not be.

Eg Unpleasant tests/procedures on one weak eye, when the other is still functioning well.

That wouldn’t be testing being done to “avoid talking about death” which I really don’t think is an actually existing problem of any significance.

But also certainly where the NHS is concerned getting any testing or treatment is a fight rather than something thrown at one. So I am sure it would be readily accepted if a person were to turn down unwanted testing unless doctors felt that this testing was necessary.