Worrying response from haematologist?

[Poppet11]

I keep browsing the CPD/CME comments section of the BMJ article and came up with this comment:

"I have never worked in an area with access to homocysteine or methymalonic acid assays - ? this is unusual, or not. If not unusual what is the relevance of their discussion in a BMJ clinical review ? better focusing on how to practice with the imperfections of the standard B12 test"

That comment is from a haematologist (inc transfusions)

Now, what do the NICE and BNF guidelines say again about referring patients to haematologists? Because the above comment indicates to me that they aren't quite getting it?

I'm just wondering how this particular clinician is going to 'practice' with the current imperfections - rather than simply get patients additional tests that may confirm a diagnosis.

Right. Had a coffee now I'm up for a rant.

The whole research paper revolves around the metabolic pathways and the reasons the serum b12 test is unreliable and gives alternatives to the test so they can pick up patients suffering neurological degeneration who are not getting treatment.

And this pleb comes along and says what is the point in mentioning the alternative tests?

Can we take it that he didn't score very highly in the test he elected to take?

So, he wants to 'practice' with the serum b12, does he?

Here's the alternative research paper.

DNA changes in the spinal cord fluid indicate the deficient levels of the serum b12 test should come into play at around 500ng.

Sorted.

[BrecklandRanger]

I suspect the person wants an easy life (who doesn't?), when trying to diagnose/treat patients . But the fact remains that we're talking about people's health.

[Poppet11]

You can only see so many of the CPD/CME comments at once - when one comes on another gets shifted off - but the main issue that seems to have been brought to light is that doctors presumed this was an easily diagnosed condition and they have discovered it is anything but. The research doesn't really focus on treatment but several of them are picking up on the fact that it's not easily treatable either.

I just think this is coming as a heck of a shock to them - some are 'getting' it and some just can't grasp that they were getting it so wrong.

(Others still don't understand it)

But you are spot on - this is about people's lives. It's unfortunate that it's going to be more difficult for doctors in future with respect to getting a 100% diagnosis (which they thought they were getting before) but they would have been able to resolve it much quicker had they been reporting all these 'returning' and 'remaining' symptoms back to higher authorities rather than sending patients away to try and cope on their own.

[Leilanilea]

In other words he's saying "my way or the highway." Such obstinate and willful ignorance is appalling.

[Poppet11]

Do you think it's an NHS attitude?

You can't help wondering that if people such as this were in private practice they would realise they wouldn't last long.