Last year I wrote a blog “Women’s bodies shamed in medicine”, (1) on how women are treated both as doctors and as patients, and how their position as doctors has improved out of all recognition in the last fifty years. There are far more women in senior positions in medicine in the UK now, and their contribution to the advancement of medicine has been crucial in many fields. Their position is now secure.
But I read the recent case of a senior doctor, Dr Deborah Burns, who rushed her seriously ill adult son to an east London hospital where she worked, and where he later died of sepsis, (2). and I felt perhaps that we are being complacent. What happened was unforgivable. Despite the doctor having phoned the hospital in advance, given them the diagnosis of sepsis, and indicating that her son needed immediate emergency treatment, the staff who received the patient did not take his case seriously enough or quickly enough, and he died of sepsis. In March this year the coroner decided that his care was not up to standard and that she would would issue a prevention of future deaths report to the hospital, calling on it to share the changes it had made since the patient’s death. It was made clear that the patient was very seriously ill and he might not have survived even with immediate treatment. But the patient was not treated with not treated as the senior consultant (in Paediatrics), in that very hospital where she worked, but as a patient’s mother, whose medical knowledge was not listen to. I don’t know what was in the minds of those staff, nurses, doctors, and others, when they ignored the evidence of the very ill patient in front of them and refused (despite being asked eight times) to provide the immediate antibiotics and intravenous fluids he so desperately needed, and which was mandated by every rule for treatment of sepsis. In the event, they delayed treatment until other less important procedures had been done.
If you turn this on its head, and imagine that the consultant was an equally senior man, with an authority that came from a long tradition in that hospital of being obeyed quickly at all times, would the same thing have happened? Somehow, I doubt it. It was the very fact that a women in such a senior role at that hospital could be ignored in such a way, that has left this doctor unable to work, with a diagnosis of complex grief, and continues to feel betrayed over her son’s death. Especially as the hospital never admitted any liability. That really worries me.
The fact is that every patient can be treated badly, men as well as women, and doctors do not necessarily have the status they expect. As a society, in every encounter we have with other people, we tend to categorise them in terms of their physical attractiveness, height, gender, colour of skin, presence/ absence of disability and so on.This is human nature, and we can only try to be fair to people. But when considering the vulnerability of patients in a medical setting, it is essential to put these feelings aside and treat every patient well. Rank, gender or race should not count.. But “rank” of medical staff, of patients, of diseases, and in organizations more generally, permeates medical culture. Consultants, junior staff and nurses are ranked at the top, doctors in their foundation year at the bottom, and “resident doctors” (formerly “junior doctors”) in the middle, do nearly all the day to day work of treating patients. Nurses also have their ranks which have been extremely rigid over the years in the NHS, and are only now beginning to soften a little.
Diseases too are seen in relative importance, with serious and curable illnesses at the top, (like the one above), and these get the lion’s share of resources, research, and status. Going down the scale you get routine curable illnesses, then serious but incurable diseases, then diseases considered to be contributed to actions by the patients themselves (they may be considered less worthy of treatment, even though that should never happen). Minor diseases of the elderly, which are a considerable nuisance, don’t need the full gamut of excellence that other conditions might get. In a way, it is to do with making sure patients are treated efficiently, spending the resources on those you know you can help. So varicose veins, piles, dental decay, chronic skin diseases, nasal and eye discharge – all at the bottom of the pile. And I totally understand that.
Looking through that list, dental decay stands out as one condition which should have much more money spent on it, and the law should be changed. Because of the food industry’s need to make money, more and more processed food is packed with harmful substances, with sugar the worst of them as it rots children’s teeth, So the commonest reason for admission of children to hospital is extraction of carious teeth. That is dreadful for them, and very bad for their health in later life. The solutions have to lie in government action to prompt the food industry to stop packing food with cheap sugary ingredients. Despite many entreaties from dentists and others interested in preventative diseases, it hasn’t happened yet. Tooth decay is seen as self inflicted, even though it is often a direct result of poverty. Children can get free dental care on the NHS, but too many disadvantaged children never get the care they need. Or it may not even be a problem of poverty – well-off parents are now using pouches to feed their babies. This is what I got when I googled baby pouches recently – “Baby food pouches offer convenience but should be used sparingly as a primary food source, as some can lack key nutrients like vitamin C and iron, and they may hinder the development of fine motor skills from not chewing. When including them in a diet, check labels carefully for added sugars, even if the sugar is from fruit, and prioritize whole foods for better nutrition and developmental benefits”.
I couldn’t have put it better myself! though actually it was written using Artificial Intelligence, as most summaries are these days. I personally think such pouches should be banned.”
Older patients can get a lot of trouble with their eyes. The common ones, cataracts and glaucoma, are treated very well, with the services having been developed to such an extent that almost every elderly patient can expect to get fast, appropriate and expert high tech treatment,. Such operations may be done more quickly in the private sector, but the expertise is there for everyone. Retinal detachment is an emergency and treatment improving all the time, There is also good treatment for the wet form of macular degeneration, a drug called Avastin.(4) This really was a breakthrough. It was first developed for colon cancer, and was out of patent by the time its use for macular degeneration was discovered. Some ophthalmologists reasoned that the way it worked could help in macular degeneration and tried it out, and it worked well for the wet form of the disease. Even so the pharmaceutical industry fought a long action against it being used for this purpose and wanted to charge a very high price, even though the companies had not incurred any expense at all in its development for this condition. There were several court cases, eventually reaching the Supreme Court in 2020 when it was found to be lawful for the NHS to use cheap generic drugs like avastin for this purpose. There was a huge saving for the NHS as macular degeneration is so common, and opened the way for other medications to be developed.
But there is a huge range of conditions which should not affect eyesight but may be painful, irritating and generally an awful nuisance. The commonest are dry eyes, which causes extreme irritation, and is sometimes difficult to diagnose. The treatment is primarily lubricants, which can be bought over the counter, but sometimes more effective treatments, such as ciclosporin, an immune suppressing drug which prevents transplanted organs being rejected, is used. This, given in injection form, can have serious side effects. However, it seems safe enough given as eye drops for dry eyes resistant to other treatment, but it can still be absorbed into the body so care should be taken. Some ophthalmologists in Scotland use it for children with severe hay fever. But It should only be prescribed by specialists, and most patients jog along with artificial tears, bought over the counter. It is rare to get referred to specialists though.
It is true to say that in any of these troublesome conditions it is very rare for a breakthrough treatment to be found.
To start with, most of the treatments are Over The Counter treatments (OTC) – substances not on the NHS list, which the patient will pay for at the chemist. There is little incentive for the pharmaceutical companies to do expensive clinical trials which would prove their value as prices are high enough for them to make a big profit. If it were proved, then the NHS would bargain very strongly to bring the price down in order that more people could get the benefit. The NHS is known the world over for driving a hard bargain because it is such a large market. (In the USA Pharmaceutical companies have managed to push prices to the limit because there is no central government negotiation, and no price controls)
The same is true with other OTC remedies such as vitamins, gels for arthritis and herbal remedies – they are very profitable for the Pharma companies. Vitamins are available on the NHS if it is proved that you are sufficiently deficient in it, and then you will get the exact dose you need to make up the deficiency. People who really believe in the power of vitamins to cure many maladies will happily pay a lot of money for them, even though in most cases it is a waste of money.
The second reason is that with such “nuisance” illnesses is that there would be very little tolerance for any harmful side effects. All medications can have bad effects, but if they are rare, the good that can be done is worth while if it cures, or helps, long term serious diseases. I remember a new treatment that came out for irritable bowel syndrome about ten years ago. But it had rare but serious side effects and so it was withdrawn. Now treatment for that, and many other disease are managed by changes in diet, which is a very welcome development. Even diets can have bad effects though, in general, it is better than taking tablets.
And the third reason is that we need the media to tell us about exciting new breakthroughs (such as with metagenomics (5)which I wrote about in a previous blog), but they are less keen to headline treatments for more mundane diseases. And we all know of media stories for breakthroughs in treatment that work wonderfully well, yet it is only in the fine print that you see that the studies have been in mice and it will be at least ten years, if ever, before a suitable treatment is found for human beings. In these “Nuisance” conditions, pharmaceutical companies will advertise new treatments to doctors, but they don’t get to hear of everything. In other countries where pharmaceutical companies can advertise directly to patients, it is different, but advertising can lead to over-promotion and misleading claims.
So it can be difficult for patients to know how to navigate the system – how to know when their troublesome symptom really is best managed by themselves, and when there really might be an answer somewhere out there which will work better. Primary Care teams include dentists, optometrists, nurses, physiotherapists and pharmacists and they are now very important as a first port of call for patients, and may be attached to doctors’ surgeries. There are now well established pathways whereby pharmacists are paid to give professional advice when they sell OTC treatments, and I welcome that, and in a previous life helped to introduce such a scheme locally.
I was disappointed though when I went to a Pharmacist to buy 1% hydrocortisone cream recently (for mild eczema). I was sold it without question but when I got home I found that they had actually sold me something for athletes foot, which contains an anti fungal medication. No problem I thought, I will take it back and exchange it for the simple hydrocortisone cream. But no, they can’t do that (because of rules saying that once dispensed it can’t be re-dispensed) so they would not make any money by giving me a free tube of HC 1%. So they put me through the minor ailments scheme (unfortunately relaying each question through the non qualified person at the desk ) asking me why I needed it, even though the first time I got it without advice and paid for it myself. Now that costs the NHS a fair amount of money, rightly so as the pharmacist is giving me the benefit of their expertise. They then dispensed the 1% HC cream and told me to keep the anti fungal cream. Perfectly legal, but the scheme is for giving people advice as to which cream to use and other advice on management without medication, not providing medication needed because of their mistake. Optometrists provide the same sort of service in Scotland and Wales for free, as they can give you a full examination with a slit lamp, which a GP can’t, and there is a wide range of OTC eye treatments available; they can prescribe a limited number of medications. Some of them are very expensive, though.
But more generally, if the condition is getting worse, of course you should see your GP and follow their instructions. They will note any “red flag” symptoms and act accordingly. Referral onwards to a consultant should be might be necessary even without the “red flags”. If you still don’t get anywhere at the moment you may well have to pay privately. And if the consultant can’t offer any treatment you may have to live with it. There is no legal right to a second opinion on the NHS, but in secondary care (in hospitals) in severe cases patients and relatives have the right to request one, and healthcare professionals must consider their requests seriously. More recently Martha’s Rule (6). has been introduced in England (Scotland already had such a rule), after Martha Mills died in hospital with sepsis. If a patient’s condition is deteriorating and parents or relatives are worried they can get a rapid review from a critical care outreach team. Sadly there was no time for that in the case of Dr Burns’ son, but patients and their relatives are getting more rights in the NHS which could prevent tragic deaths.
With the present difficulties of the NHS, more and more patients are having to pay privately in order to get timely treatment. I have written about this before, about how the private system is allowed to cream off the easy straightforward cases and pass back cases to the NHS if things go wrong; the NHS is still the only organisation which trains doctors, with all the associated costs, and the fact that as consultants have usually worked for the NHS, and some still do, they are doing it in their “spare time” which means that they can’t give either their NHS or their private patients much time for discussion for unexpected events. This means that private care is often more expensive in Britain than in the rest of the world, not less.
One last thing. It seems that this whole article is about to get completely out of date. It seems that in China, and in some places in the USA, patients are using Chat boxes as their go-to place for medical information. Apparently they are very knowledgable, and give advice in a very friendly manner, and you don’t even have to leave your home! Sometimes platforms even combine AI interaction with a human doctor to get a final diagnosis. What’s not to like? Unless you are a doctor of course, as we might need a lot fewer of them in the future!
References
(1) elen samuel https://scepticalgp.com/2024/07/07/womens-bodies-shamed-in-medicine/
(2). https://www.bbc.co.uk/news/articles/cwyg0844q1jo
(4).https://uk.news.yahoo.com/doctor-eye-removed-sight-saved-060829577.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAA
(5). https://www.england.nhs.uk/2024/12/marthas-rule-already-saving-lives-in-nhs-hospitals/https://restofworld.org/2025/ai-
(6) chatbot-china-sick/
Elen Samuel, doctor and writer 