Take a 2019 Tea Break with Delta

[Willmaz223]

Originally Posted by Mike Bell

Yes, we’ve made a lot of mistakes over many many years, but can we afford to continue making them.......

NO!

[andy97]

Originally Posted by Willmaz223

NO!

People rately make decisions they know are wrong/ mistakes at the time. They make decisions based on their understanding of the info to hand at the time, and think they are doing the right thing for their circumstances/ requirements.

[Gerard C]

Indeed, Andy. Indeed. My point. Exactly. Could not say better.

[Mike Harte]

I mentioned 3D printers elsewhere on this forum, and it reminds me of the wonders that Noel Fitzpatrick, the small animal vet, is able to achieve. He gets outside engineers to produce 3D printed replacement bone from a metal to implant in animals that require such drastic surgery. The replacement part is always a perfect match (certainly on the TV programmes that feature it) and is generated by the measurements created by his practices' CT and MRI scanning machines.

A recent programme featured a dog owned by a consultant orthopaedic surgeon, who was blown away by the advanced techniques that Fitzpatrick practices, saying that he wished they could use them in human surgery - or words to that effect.

I find the programmes absolutely fascinating, because he appears to have devoted his life to the animals that he and his colleagues treat. I would imagine him to be a lovely man, although I would guess that he expects perfection from his staff. Well worth a watch if you haven't seen any of the programmes.

[Willmaz223]

Originally Posted by andy97

People rately make decisions they know are wrong/ mistakes at the time. They make decisions based on their understanding of the info to hand at the time, and think they are doing the right thing for their circumstances/ requirements.

We'd all be laughing if every decision we made turned out to what we thought it would be when made the decision.

[grantp]

Originally Posted by Willmaz223

We'd all be laughing if every decision we made turned out to what we thought it would be when made the decision.

In reality swap 'every' to 'any' and you would probably have a better success rate objective.

If it is your decision you can probably live with it.

If it is someone else's decision made on your behalf and turns out to be less than satisfactory ... what then?

[Willmaz223]

Originally Posted by grantp

In reality swap 'every' to 'any' and you would probably have a better success rate objective.

If it is your decision you can probably live with it.

If it is someone else's decision made on your behalf and turns out to be less than satisfactory ... what then?

Your response depends on what type of person you are.

[grantp]

Originally Posted by Mike Harte

I mentioned 3D printers elsewhere on this forum, and it reminds me of the wonders that Noel Fitzpatrick, the small animal vet, is able to achieve. He gets outside engineers to produce 3D printed replacement bone from a metal to implant in animals that require such drastic surgery. The replacement part is always a perfect match (certainly on the TV programmes that feature it) and is generated by the measurements created by his practices' CT and MRI scanning machines.

A recent programme featured a dog owned by a consultant orthopaedic surgeon, who was blown away by the advanced techniques that Fitzpatrick practices, saying that he wished they could use them in human surgery - or words to that effect.

I find the programmes absolutely fascinating, because he appears to have devoted his life to the animals that he and his colleagues treat. I would imagine him to be a lovely man, although I would guess that he expects perfection from his staff. Well worth a watch if you haven't seen any of the programmes.

Interesting, isn't it, that we habitually provide pets with private medical care (even at ages where the observation that they have survived so long could be counted as some sort of survival miracle) ... but ignore humans or deprive them of the equivalent level of support.


Are humans the only species on the planet that despises itself enough to wish it did not exist while rooting for other species that seem to have no demonstrable extended long term purpose other than just being?

[midgetman]

No Grant we have similar medical insurance to our pet insurance - it's called the NHS.

"Private" medical insurance is a back up for himans, there is *only* "private" insurance for pets.

Sent from my SM-G950F using Tapatalk

[grantp]

Originally Posted by midgetman

No Grant we have similar medical insurance to our pet insurance - it's called the NHS.

"Private" medical insurance is a back up for himans, there is *only* "private" insurance for pets.

Sent from my SM-G950F using Tapatalk

Hmm.

People will spend enormous amounts, with or without insurance, for pets even when, due to age or some very obvious health issues, the pet in question has little chance of surviving with a decent quality of life for a useful period.

And the insurance will automatically exclude any repeat occurrence of the same problem - much like humans health insurance outside the NHS funding umbrella.

But because we in the UK have, at least notionally, a 'free at the point of use' service that we think will cover everything we expect that it will deliver even though we know it does not always do so and cannot do so.

Even the surgeon in Mike's post observed that the level of treatment available from the vet is beyond what he can offer to his human clients.

Even privately?

I guess it's a question of values.

[Mike Harte]

Grant, when it comes to health services in the UK, I don't think that it is quite as black and white as one may think.

There is no doubt that one of my daughter in laws would have died about 4 or 5 years ago after being diagnosed with Stage 4 cancer of the colon and bowel which had migrated to her liver. By good fortune, she was covered by my son's PHI through his firm and she has, therefore, received surgery and medication that would not have been available under the NHS because of cost and the cocktail of drugs that she received are not on NICE's list.

It was because the drugs worked so well that the surgeons could operate to remove all the diseased tissue over a number of sessions.Unfortunately, she is not in total remission, but she is being monitored closely and further surgery is not out of the question. And she is lucky that she was covered by a commercial policy because my son has just become a partner in a different firm who have a different insurer. But they permit partners and employees to switch insurers and will continue to cover pre-existing conditions.

I, on the other hand, have a heart condition which can only be treated by the NHS. I am lucky that the problem was uncovered here in West Yorkshire where it just so happens that there is one of only four cardiac consultants in the UK that specialise in this condition. There is one other in Liverpool and two in London, and none in private practice.

[grantp]

Originally Posted by Mike Harte

Grant, when it comes to health services in the UK, I don't think that it is quite as black and white as one may think.

There is no doubt that one of my daughter in laws would have died about 4 or 5 years ago after being diagnosed with Stage 4 cancer of the colon and bowel which had migrated to her liver. By good fortune, she was covered by my son's PHI through his firm and she has, therefore, received surgery and medication that would not have been available under the NHS because of cost and the cocktail of drugs that she received are not on NICE's list.

It was because the drugs worked so well that the surgeons could operate to remove all the diseased tissue over a number of sessions.Unfortunately, she is not in total remission, but she is being monitored closely and further surgery is not out of the question. And she is lucky that she was covered by a commercial policy because my son has just become a partner in a different firm who have a different insurer. But they permit partners and employees to switch insurers and will continue to cover pre-existing conditions.

I, on the other hand, have a heart condition which can only be treated by the NHS. I am lucky that the problem was uncovered here in West Yorkshire where it just so happens that there is one of only four cardiac consultants in the UK that specialise in this condition. There is one other in Liverpool and two in London, and none in private practice.

Mike,

Yep I am reasonably well aware of the potential constraints of the NHS on both a national level and the likelihood of local differences for what is or is not funded.

And private cover, which I had for some years on a partial payment scheme under corporate terms and then retained later for family reasons until the cover would no longer have applied and the payments became greater than seemed to make sense - especially when most of the likely age related treatments would probably be referred back to the NHS anyway.

When the kids were younger I spent some ridiculous amounts, in context, getting treatment for a hamster and buying stuff to put in a goldfish tank. In fact buying 2 tanks since the fish outgrew the first one rather quickly.

More recently I have observed the elder daughter parting with significant sums in pet insurance for 2 cats and a dog, all of which have required treatment.

One of the cats recently died having been clearly unwell for a while but with apparently difficult to diagnose and rather aggressive but unusual cancers. This was an animal that had been obtained when they lived in Oz because they thought the cat they had taken with them needed a feline companion. I think they found it at a sanctuary. It had some very annoying habits, cost a fortune to bring back to the UK and eventually, as the illness progressed in the final 2 or 3 weeks, had some significantly expensive treatments when in reality it would have been best to put it down.

Around the world one observes that not every culture has the same attitudes towards human or animal health as is so often found in what we call the 'civilised' world.

One has to wonder at what point both sources of health care will be deemed to be unsupportable from an economic point of view.

[Gerard C]

One has to wonder at what point both sources of health care will be deemed to be unsupportable from an economic point of view.
People will spend enormous amounts, with or without insurance, for pets even when, due to age or some very obvious health issues, the pet in question has little chance of surviving with a decent quality of life for a useful period.
Great sentences, Grant, I could fully agree with you. But. Out of my curiosity, are your parents alive, how many living children do you have, what kind of relationship do you have with them, how old are you and what is exactly your health condition? Anyone of your family reading the forum?

[andy97]

By the same taken, Grant, we often put pets down before the end to prevent undue suffering. Perhaps we should do the same with humans??

There are plenty of politicians who might qualify, due to causing suffering to others.......

[Mike Bell]

Originally Posted by andy97

By the same taken, Grant, we often put pets down before the end to prevent undue suffering. Perhaps we should do the same with humans??

There are plenty of politicians who might qualify, due to causing suffering to others.......

Now now....

[Mike Harte]

One thing that comes across loud and clear on the Fitzpatrick programmes is that he is driven by by his ethics and morals when it comes to how to treat, or not as the case may be, the animals that are brought to him. And he, certainly on the programmes, discusses this with the owners.

Out of curiosity, when was the last time that a doctor discussed that with you as a patient? Me, never!

I don't know if it still applies but in the past you needed better O Level/GCSE and A Level results to get on to veterinary studies at university than for human medical courses. And even lower grades were required for dentistry courses.

[VIVA GT]

Originally Posted by Mike Harte

One thing that comes across loud and clear on the Fitzpatrick programmes is that he is driven by by his ethics and morals when it comes to how to treat, or not as the case may be, the animals that are brought to him. And he, certainly on the programmes, discusses this with the owners.

Out of curiosity, when was the last time that a doctor discussed that with you as a patient? Me, never!

I don't know if it still applies but in the past you needed better O Level/GCSE and A Level results to get on to veterinary studies at university than for human medical courses. And even lower grades were required for dentistry courses.

Like you Mike, I do find watching his programmes a fascinating activity, but unfortunately, I get more emotional about things as I get older, so often do so with tears in my eyes!
I can understand why a Vet needs to have better (initial) qualifications than a doctor. They have to deal with a number of different species (although I appreciate that vets can specialise), plus, their patients cant tell them what's wrong or where it hurts, they have to work it all out for themselves.

[grantp]

Originally Posted by andy97

By the same taken, Grant, we often put pets down before the end to prevent undue suffering. Perhaps we should do the same with humans??

Very true Andy, pets, indeed animals in general, are often put down to avoid suffering and to some extent, one imagines, because the treatment fees would be unaffordable for many owners/keepers.

As for treating fellow humans the same way and for the same reasons - do you think that does not happen? The difference might be that in such situations it may well be that the person involved prefers that approach. Such a decision is not something that we have a way of 'discussing' with any degree of certainty with an animal.

But if we did I think my daughter's recently departed cat had been trying to give them the message for quite some time before they resorted to some veterinary care resulting in a fairly expensive operation which it survived by 2 days iirc.

When my mother was diagnosed with pancreatic cancer she was advised that there was a chance that an operation might help. As a relatively fit and active 77 years old at the time she opted for the operation.

The surgeon, as surgeons do, wielded the knife, realised that there was no way he could do anything and was never heard from again. Not even an after surgery bedside visit.

The oncologist, a nice young chap with a lot in his mind, waited for her to recover from the operation and then prescribed what ended up as 2 courses of chemotherapy. Not very pleasant but could have been worse.

At the last appointment with him, after she had completed the second course with no improvement, he gently advised that there was nothing more he felt he could do. He had used the best drugs available at the time and the ones that were the least unpleasant to take. Also the most expensive, apparently.

On the morning of the final appointment he had received notice that his application for the funding of that particular treatment for my mother's case has been turned down by the NHS funding board. A decision that was obvious a bit tardy no matter how one looks at it. Taking most of a year to make such a decision for a cancer type with a typical survival time after diagnosis that is commonly measured in weeks may seem to be unfortunate as far as practical planning is concerned.

No doubt the oncologist would have to find a way to fix his budget overspend somehow. Presumably there were and are ways of making this happen within the NHS.

My mother was grateful for the extra months - she gained perhaps a year in total although possibly less since we cannot know what would have happened had the operation been avoided and the cancer left untreated.

For public consumption she always pronounced that she was going to 'fight' the cancer and put on a brave face but in reality there was little she could possibly do to change the way things developed. Having an invasive operation at her age takes several months to recover thus potentially losing some of the benefit to be gained from the chemo treatment's life extension potential. After the last appointment with the oncologist I think she came to the conclusion that it was time to let go although for public consumption she was still 'fighting it'.

The human equivalent of putting down a pet is basically a controlled departure, perhaps finally supported by a hospice facility if a place can be found.

The most common request from patients would seem to be for pain control in one form or another. It would seem that there has always been some medical potential for providing people, particularly elderly people, with the comfort they seek form pain control when they reach that point in their lives.

Of course the unmentionable observation in all of this is to discuss whether the treatments are in fact beneficial to the patients (individually) and whether they are affordable in the long view to society as a whole.

That certain treatments are available privately (in the UK) and others not suggests that those treatments that are not available are not viable on a cost benefit analysis.

In the UK private medicine can avoid putting any numbers on the procedures by deferring to the NHS.

In countries with private medical care schemes the financial overhead question is moved to a different decision making process ethic.

I'm not aware of a system used in the developed world that is without its critics - but would love to learn of one should it exist.

Other parts of the world seem to approach such delicate matters with alternative ideas for what is and is not acceptable. For both humans and kept animals.

[Mike Harte]

Originally Posted by grantp

That certain treatments are available privately (in the UK) and others not suggests that those treatments that are not available are not viable on a cost benefit analysis.

The problem is, how do you value a life?

In my daughter in law's case, he has enjoyed, up to now, an extra 5 years of a fairly good life, and there is no reason that that shouldn't continue for a further number of years.

But that was because of the benefits provided by private health care. The drugs that she took initially were not available on the NHS then, and I am told still not, and they shrunk the tumours sufficiently that the surgeons were then able to operate. And at her last scan, there was no evidence of any return of the cancer to the original areas.

Unfortunately, it has travelled to her lungs and they are treating those lesions as they occur, the last time with non-invasive treatment.

Yes, it has cost a small fortune which the insurers have paid. And the new insurers have picked up the ball since the beginning of this month.

[Mike Harte]

Grant, you also mention about pain relief, especially for the elderly.

I don't think that there is any doubt that certain, maybe many, doctors prescribe increasing strengths of pain relief, predominately opiates, to patients that are nearing the end of life, especially those who have discussed the matter with their physician.

The problem is that in the UK the practice can be deemed to be illegal. And that is why most members of the medical profession do not talk about it.

[crmalcolm]

Originally Posted by Mike Harte

The problem is, how do you value a life?

A very difficult question to answer, but one that does have to be answered in many differing situations.

I think the hardest thing to comprehend when a financial figure is placed on a life, is the lack of emotion that seems to carry and how cold and calculating (literally) it is.

An interesting quick read can be found here.

Two figures that jump out at me from the paper -
US Department of Transport - $9.2million per statistical life.
Average cost of suicide - $941,000-$2,725,000.

[Peter Mallett]

Originally Posted by Mike Harte

The problem is, how do you value a life?

This is how the English Courts generally do it.

Originally Posted by Wai Sum Chan, PhD, FSA, HonFIA, CStat
Professor of Finance
The Chinese University of Hong Kong

When assessing future pecuniary loss in personal injury litigations
in common law countries, courts often use the multiplicand/multiplier approach.

Lump Sum = Multiplicand  Multiplier

 The multiplicand (the future annual loss of income and the annual
consequential expense, such as the cost of care) is established by
evidence put before the judge, who then has to decide an
appropriate multiplier.

 The multiplier is used to discount the future pecuniary values into
a present lump sum, considering the time value of money, the
plaintif's mortality and contingencies other than mortality.

Of course it also depends on the victim's age and life expectancy.

Not an easy task for the law courts since whatever they do, it is likely to be considered inadequate.

Mike, glad to hear your daughter in law is being treated well. I thought it would be of interest to demonstrate how life is legally valued.

[grantp]

Originally Posted by Mike Harte

Grant, you also mention about pain relief, especially for the elderly.

I don't think that there is any doubt that certain, maybe many, doctors prescribe increasing strengths of pain relief, predominately opiates, to patients that are nearing the end of life, especially those who have discussed the matter with their physician.

The problem is that in the UK the practice can be deemed to be illegal. And that is why most members of the medical profession do not talk about it.

Indeed. Although personally I would not talk about it.

Pain relief seems to be an ever more controlled part of medicine.

My younger daughter has had chronic arthritis since aged 2.

Over the years she has needed various operations to assist her continued mobility.

She has no problems with anaesthetics during the operations but tends to get sickness afterwards and only certain pain killers work. None of them work well on tablet form due to the sickness which typically persists for about 2 days.

She can brief the staff in advance of the surgery. Everything is in her notes.

Every time they insist on her going through a discovery process for anti-sickness treatment (that never works) and various tablet based pain relief options starting with those that she know are ineffective even without the sickness to eject them from the body before they are absorbed.

By the time they get to the stuff that works delivered in a form that takes effect ... the need is past and she is ready for discharge.

Last time, a few weeks ago, a day case procedure ran so late that the 9am scheduled time eventually ran to after 3pm and so resulted in an overnight stay which, given the pain relief treatment problems, then resulted in a second overnight stay and occupation of the bed until the early evening on the third day.

Apparently this last time they were trying some newly available pain killers. So no chance of making use of a proven product and process from the previous experiences. Plus the delays of getting hold of the only on duty doctor who could sign off changes of treatment plan.

I'm not knocking the people individually or the service ultimately delivered but we have to wonder whether the way things are organised and managed at the moment are affordable today and will continue to be affordable in the future.

This is, sadly, a doubly contentious point of discussion with a growing and ageing population, the spread of 'lifestyle' health decisions (especially elective changes) and a general expectation that even the most advanced and therefore often ever more expensive treatments that provide only marginal benefits must be available as a matter of course.

At some point someone in politics is going to become incredibly unpopular when they have no options left but to ask how the overhead of the 'free' service can be reduced.

Maybe there should be a cycle of public eduction that persuades children to think as much of their peers as they do of their pets?

It might take a couple of generations but who knows what might come of it?

[Mike Harte]

Grant, not that it will be of any consolation to you or your daughter, but her experiences are not confined to the NHS.

My daughter in law also suffers from an intolerance to many of the painkillers that she has been given, mostly intravenous, after coming out after general anaesthetic whilst recovering in the ICUs of at least three leading private hospitals. And that, like your daughter, is after the issues are raised with the ICU staff at the time. But every time they claim that they are prescribing something new that shouldn't cause any problems, but that they are also giving her anti-nausea to counter any potential problems.

One could even be left with the impression that the prescriber was being paid commission to use certain drugs, although I am sure that that cannot be the case!

[Mike Harte]

Originally Posted by grantp

At some point someone in politics is going to become incredibly unpopular when they have no options left but to ask how the overhead of the 'free' service can be reduced.

Maybe there should be a cycle of public eduction that persuades children to think as much of their peers as they do of their pets?

You raise an interesting point about education, and how that can be used to save the NHS huge sums of money.

As I wrote earlier, I am a patient of a certain group of individuals who have a medical condition that, with the currently available medicines and surgery procedures, will have to live with the condition for the rest of their lives. And it affects mainly males and those over the age of about 50.

One of the main differences with our group is that, even though there is nothing more that can be currently offered by our consultant, we are not returned to the care of our GPs. What happens is that the patient receives an extra long consultation, always with the consultant plus at least a very senior nurse practitioner and sometimes with a clinical psychologist, that can last up to 2 hours.

The patient will then be invited to join a small selection of other patients with their partners/carers, and over weekly meetings over a 4 week course, will be educated about the ailment and how best to live with it.

This regime has been found to save the NHS money in the long term. The patient learns about what is happening to his body especially his heart, and becomes aware of how to best deal with any symptoms that may arise. It has led to a dramatic lessening of the need for GP appointments, and has also reduced calls on the ambulance and A & E departments.

Unfortunately, it costs extra money to initially set up for patients, but the long term costs are vastly reduced. But the NHS bean-counters only look at the short term costs.

I am actually involved in service, and am helping our consultant to develop a patient only website to help existing and new patients. It is hoped that by later this year we will created a portal where the patients, who come from as far as Newcastle in the north to Northampton towards the south, will be able to have Skype type consultations with the team without leaving their homes.

Just one other point to close. One of the major differences between us and other groups of patients is that we all have direct email routes to members of the clinical team, plus we also have a 24 hour mobile phone point that we can contact in the case of emergency. Of the many patients within the group, I am only aware of one that has felt the need to use this facility.