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Journal of Back and Musculoskeletal Rehabilitation Journal of Back and Musculoskeletal Rehabilitation 9 (1997) 21-22
What about the next 25 years? R.W. Porter* Royal College of Surgeons, Nicolson St., Edinburgh, Scotland EH8 9DW, UK
The year is 2021. Mr BJ is a 27-year-old factory worker. He is in bed with back pain and sciatica. He tells his GP about it through videolink and stands out of bed to demonstrate the distribution of his pain. A prescription comes through by fax and his wife collects the nasal spray. The pain does not settle down and 3 weeks later he visits the 'Back Centre'. A non-medically qualified Back Advisor tells him he has a L5 /SI symptomatic disc protrusion, and confirms the level with an electrical scan. She organises some McKenzie treatment for his trunk list, and he has three visits to a therapist. It is all recorded on his personal medical computer file by 'voice processing'. No joy! Unfortunately he does not get better. He learns bye-mail that if he cannot explain why he is off work so long, his job will be at risk. He pays privately, money up front first, and sees a 'Lumbar disc specialist' - highly trained in a narrow field. He fills in an interactive questionnaire, has a blood profile and in 20 min has the answer 'back to work in no time' the specialist says, 'just take this code number home, and tune into this video risk/benefit programme. If you want me to do an intervention send me the signed agreement and I can have you on the list next Monday. It will cost you 50000 euro marles'.
* Tel.:
+441315566206; fax: +441315576406.
He agrees and in the meantime tunes into the Surgical Intervention section of the 'What everyone should know about surgery' on the Internet. He learns that protruding discs release monocyte chemotactic protein-I which can resorb discs and when he attends for the intervention on Monday asked why no one had suggested that he have a course of monocyte stimulating factor, 'not yet provided lad, does not have the NEMB certificate' says the surgeon. So before midday he has an endoscopic laser intervention. Unfortunately he has a stormy time. He speaks by video link both to his GP and to his solicitor. The latter makes a personal visit. The surgeon has to admit that he failed to do a proper clinical examination, and it would have been better to leave the disc to resolve naturally. It does not go to court but is settled by fast-track arbitration through the Alternative Dispute Procedure for an astronomical sum. Never mind his work now. Properly invested, this compensation will keep him for life. There is the potential for much good but also much that is bad as we look forward to the next 25 years. 1. Improved electronic communications. 2. Better record keeping and retrieval. 3. Rationalised management of acute back pain.
1053-8127/97/$17.00 ({:) 1997 Elsevier Science Ireland Ltd. All rights reserved.
P//SI053-8127(97)00043-2
22
4. 5. 6. 7. 8. 9. 10.
R. W. Porter / Journal of Back and Musculoskeletal Rehabilitation 9 (1997) 21-22
Use of non-medically qualified advisors. Highly specialised surgeons. Improved investigations. Certification of valid therapy and consent. Poor clinical assessment. Poor personal communications. Much failed treatment.
11. Increased alleged negligence. 12. Fast track settlement. 13. Obsession with health. 14. Financially orientated society. So who wins?
Journal of Back and Musculoskeletal Rehabilitation Journal of Back and Musculoskeletal Rehabilitation 9 (1997) 21-22
What about the next 25 years? R.W. Porter* Royal College of Surgeons, Nicolson St., Edinburgh, Scotland EH8 9DW, UK
The year is 2021. Mr BJ is a 27-year-old factory worker. He is in bed with back pain and sciatica. He tells his GP about it through videolink and stands out of bed to demonstrate the distribution of his pain. A prescription comes through by fax and his wife collects the nasal spray. The pain does not settle down and 3 weeks later he visits the 'Back Centre'. A non-medically qualified Back Advisor tells him he has a L5 /SI symptomatic disc protrusion, and confirms the level with an electrical scan. She organises some McKenzie treatment for his trunk list, and he has three visits to a therapist. It is all recorded on his personal medical computer file by 'voice processing'. No joy! Unfortunately he does not get better. He learns bye-mail that if he cannot explain why he is off work so long, his job will be at risk. He pays privately, money up front first, and sees a 'Lumbar disc specialist' - highly trained in a narrow field. He fills in an interactive questionnaire, has a blood profile and in 20 min has the answer 'back to work in no time' the specialist says, 'just take this code number home, and tune into this video risk/benefit programme. If you want me to do an intervention send me the signed agreement and I can have you on the list next Monday. It will cost you 50000 euro marles'.
* Tel.:
+441315566206; fax: +441315576406.
He agrees and in the meantime tunes into the Surgical Intervention section of the 'What everyone should know about surgery' on the Internet. He learns that protruding discs release monocyte chemotactic protein-I which can resorb discs and when he attends for the intervention on Monday asked why no one had suggested that he have a course of monocyte stimulating factor, 'not yet provided lad, does not have the NEMB certificate' says the surgeon. So before midday he has an endoscopic laser intervention. Unfortunately he has a stormy time. He speaks by video link both to his GP and to his solicitor. The latter makes a personal visit. The surgeon has to admit that he failed to do a proper clinical examination, and it would have been better to leave the disc to resolve naturally. It does not go to court but is settled by fast-track arbitration through the Alternative Dispute Procedure for an astronomical sum. Never mind his work now. Properly invested, this compensation will keep him for life. There is the potential for much good but also much that is bad as we look forward to the next 25 years. 1. Improved electronic communications. 2. Better record keeping and retrieval. 3. Rationalised management of acute back pain.
1053-8127/97/$17.00 ({:) 1997 Elsevier Science Ireland Ltd. All rights reserved.
P//SI053-8127(97)00043-2
22
4. 5. 6. 7. 8. 9. 10.
R. W. Porter / Journal of Back and Musculoskeletal Rehabilitation 9 (1997) 21-22
Use of non-medically qualified advisors. Highly specialised surgeons. Improved investigations. Certification of valid therapy and consent. Poor clinical assessment. Poor personal communications. Much failed treatment.
11. Increased alleged negligence. 12. Fast track settlement. 13. Obsession with health. 14. Financially orientated society. So who wins?
