Sir Simon Wessely being replaced as President of Royal Society of Medicine 2019

Modernising the Royal Society of Medicine: We Speak to its President-Elect
September 13, 2019

full article here
https://www.medscape.com/viewarticle/918344?src=130919_expert_kirby_onc&faf=1

 

Unfortunately still almost a year away.

 

I wonder what wesselys next top position will be?

 

Sounds like Professor Kirby will be a breath of fresh air.


Please excuse a small bit of divergence here from Dr. Kirby's new appointment.

I wish to comment on his discussion in the article on prostate cancer, the PSA etc.

As Dr. Kirby says the PSA cannot differentiate between BPH and prostate cancer.

We need a more accurate and modern test; a higher PSA number creates concern and perhaps unnecessary testing, sometimes including repeated biopsies - which are no picnic.

More awareness of prostate cancer is very important, but the inaccuracy of the PSA creates much concern and repeated travel through the medical system - not a pleasant journey.

As for an MRI for prostate cancer - these tests are not always accurate.

 

Better tests would be good but we always have to work with what we have.

My experience of PSA is that an intelligent interpretation makes it a very useful test - which is why I am still on the forum. The same for MRI. The important thing is to have highly skilled people reporting the significance of the test in the clinical context. I had the benefit of that because I am medical. I was operated on by Kirby. The real problems are that the NHS has no resources (my own hospital could not give me a date for surgery - not even a date in three months time - because all beds were tied up with emergencies), and that people interpreting tests are often not very bright.

My impression is that the people saying these tests cause unnecessary harm are those not very bright people to be honest. Biopsy is not very nice but it gets you a diagnosis.

As far as I can see the whole thing about not looking for prostate cancer because it might worry people is part of a demedicalising obsession by people like Cochrane that the government finds very convenient because it means they do not need to spend money on real treatment. They do not have to worry that 30% of patients under UCLH urology got lost to follow up not so long ago - probably just because the appointment system was so chaotic.

As it says in Kirby's patients' waiting room - there are lots of useful things you can do about prostate cancer but doing nothing is not one of them.

 

Yes, being on this forum has made me much more astute to what is actually happening in the NHS. What seem like highly desirable approaches to most patients, such as the 'integration of services', 'extending community-based services' and 'treating people holistically', are in reality just double-speak for the demedicalisation of NHS healthcare.

The personal, social and long-term economic costs of this approach are going to be frightening, but how long will it take for this to become apparent to the average member of the public? Unfortunately, too long to put the brakes on it and reverse it in time to prevent many patients suffering serious harm.

 

Can we chip in and buy him a clock as a hint that it is time to retire?

 

That could be expensive and time consuming.

As it would be preferable for him to retire several decades ago it will take a while to come up with a clock delivery system to get it to him fast enough to allow this to occur.

There is also the issue of packaging. In order to arrive on time, according to superman, the clock will need to be traveling in excess of 186,000 miles per second. Even a 1lb clock traveling at that sort of speed could cause considerable damage, to the planet, when it arrives.

So packaging...important.

 

If only we had Dr Who as a member of the forum...

 

@Jonathan Edwards

I agree with all you said - just voicing very timely concerns re the whole issue - rather interesting this article would land on the forum the very day important results for a loved one were reported in consult.

Yes, we need to work with what we have, just wish the PSA was more definitive. I would never suggest ignoring this issue. In fact just the opposite. I was however a bit surprised to see some men have repeat biopsies. Less invasive of course than surgery.

I am totally in favour of following medical advice about all prevention checks.

Except, I draw the line at avoiding
chocolate!