Patient Information Leaflets

Patient information leaflets - are the helpful? Or a waste of time? Margaret McCartney is a GP who writes for the BMJ and this week she focuses on the pros and cons of patient information leaflets. Any hospital clinic, GP practice and waiting room in the UK tends to be awash with a range of patient information leaflets. The source of the leaflets is variable - some originate from individual trusts, while others come from charities and external organisations. 

A recent review of practice saw 128 trusts asked to send in the leaflets they gave patients after inguinal hernia repair. The researchers found that information in the leaflets was variable - for example the information on when it would be safe to return to work was variable. So who develops these information leaflets and checks the content? It seems that there isn't a single rigorous process for developing them and that practice is variable, meaning that information given to the public may be of poor quality. Patient information leaflets are used for giving patients information which cannot all be given in a short appointment. They also give the patient something to read when they get home in case they forget what has been discussed, and most leaflets offer contact information should the patient have further questions. Patient information leaflets also help to reduce litigation. One private company has been set up which provides patient information leaflets, 'Eido', set up by a surgical registrar in England. Hospital trusts can pay in excess of £6000 a year for the right to distribute these leaflets. Some trusts, such as Guy's and St Thomas' in London have a bank of their own leaflets, developed 'in house'. 

Concerns about inconsistent and inaccurate information in these leaflets is not new but progress in the area has been slow. There have been calls for a national strategy to tackle the problem: a single source of peer-reviewed, accurate information leaflets for the NHS which reduce problems with inconsistency and provide standardisation. In a company as large as the NHS, this may be very challenging, but I would like to see NHS Scotland take on that challenge to reduce replication and improve patient communication. A link to the article can be found here.

NHS Safety and Lord Sugar's new Apprentice

Prof Don Berwick

Today Professor Don Berwick published his review into patient safety in the NHS in England following the recent Stafford Hospital enquiry. He is an international expert in improving patient safety and was formerly President and Chief Executive Officer for the Institute of Healthcare Improvement (IHI). He was also former health advisor to Barack Obama. After the enquiry into deaths in Staffordshire, the NHS in England asked for his analysis and recommendations for improving the NHS. Most of his recommendations don't come as much of a surprise to doctors who are already be familiar with the work of the IHI but here are some of the most important points:

• The NHS remains an international gem and could be the safest system in the world.
• Cultural changes are needed, criminal sanctions are only required in extreme cases of wilful or reckless neglect.
• The NHS should be compelled to inform patients if serious errors are made in their care. 
• Trusts should be keeping a close eye on staffing levels to make sure patient care is not suffering.
• Staff must be given good support and training to help make sure they take pride and joy in their work.
• Patient harm shouldn't be accepted as being inevitable.

A BBC news article summary of the report can be found here: http://www.bbc.co.uk/news/health-23572696

The winner of BBC's The Apprentice this year had a controversial plan to start up skin aesthetics clinics which offer topical cosmetic procedures such as Botox in the UK. The doctor who won the Apprentice, Dr Leah Totton, did well to beat off the candidates and showed her quality as an investable candidate during the tasks but her business plan does seem poorly contrived. Her claims to be 'an expert' in the field who can teach her s

Dr Leah Totton

taff to run the clinic are hard to believe. It has to be born in mind that although she is a qualified doctor (at exactly the same stage in her career as I am today), she has only two years of experience as a post-graduate (and given that she must have taken a few months out to film The Apprentice I doubt she has met the requirements to complete FY2) and cannot possibly have learnt the skills required to carry out the techniques she wants to offer in such a short period of time. She has done well to win the process and I did want her to win the final, but I have to doubt the ethical grounding of her decision to leave NHS practice to start a chain of clinics offering private cosmetic dermatological procedures.

One thing which is certain is that the professional organisations who represent the kind of work she is looking to become involved in have unanimously rebuked her proposals and will definitely not be supporting her clinics. The British Association of Dermatologists (BAD) and other organisations released the following press statement a couple of weeks ago:

The main professional bodies for plastic surgery and dermatology today jointly and unequivocally condemn BBC Apprentice winner Dr Leah Totton’s capacity to set up and run a chain of outlets offering injectable facial treatments such as Botox and fillers. Not only the British Association of Dermatologists (www.bad.org.uk), the British Association of Aesthetic Plastic Surgeons (www.baaps.org.uk) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (www.bapras.org.uk) but a whole host of high-profile clinicians have taken to social media in a Twitter storm denouncing the junior doctor’s dangerously inadequate credentials for the project.

The extensive independent Review of Regulation on Cosmetic Interventions led by Sir Bruce Keogh (which issued its report earlier this year) highlighted problems within the non-surgical cosmetic sector and called for urgent development of an accredited training framework by Health Education England. The recommendations of the Review were welcomed by specialist professional groups who emphasise patient and public safety must be put ahead of commercial interests. They continue to urge rapid Parliamentary approval in order to take the recommendations forward and ensure that proficient implementation and improved patient care is in place – but in the meantime, the public remain at risk.

Mr Graeme Perks, President of the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) says “At a time when all professionals are collaborating with Sir Bruce Keogh to improve cosmetic surgery practice and protect the vulnerable, it is a concern that a very junior doctor can make claims to be an authority in this field and provide the direction and clinical judgement that only comes with experience. The results of BBC Apprentice provide yet another demonstration of why Parliament must act fast.

Prof Chris Bunker, President of the British Association of Dermatologists states  “We are seeing more and more complications at the hands of inadequately trained practitioners and counterfeit products. These adverse events can be permanent and life-ruining, and there are even reports of blindness being caused by inappropriate injection of fillers. Many patients require continued treatment and support on the NHS.

According to Rajiv Grover, consultant plastic surgeon and BAAPS President“What this debate needs is a strong injection of common sense – if Dr Leah Totton were training to be a GP she would not be able to work unsupervised for another four years after qualifying. Yet in the private sector she is setting herself up to train others. Having a stab at running a business shouldn’t be taken literally.

According to Dr Tamara Griffiths, dermatology representative on the European Committee for Standardisation (CEN) which has been developing EU-wide standards for cosmetic surgery “Dr Totton is a very junior doctor and her claim to be an expert in the field of cosmetic procedures may not measure up to the review by the European Committee for Standardisation, where international consensus has been reached regarding the imperative of adequate and accredited training.”