Normally...

Normally, I am fully booked for morning surgery.

Normally, every single patient turns up.

Normally, I have several extras.

Normally, the extras are children with coughs and colds.

Today, I think one of my extras has just presented with a possible cancer that I have not diagnosed for nearly 20 years.

Testicular cancer used to be a killer disease (particularly Teratoma). I remember as a young doctor working at the Royal Marsden Hospital, seeing the introduction of Cis-Platinum and seeing how well patients did. That was an exciting time to be in Oncology. People started getting better.

So I have asked for an urgent scan, and then will decide where my patient will be treated (that will be a combination of my knowledge and his preference): my colleagues have helped me with my decision.

Early diagnosis of a curable cancer in a youngish patient.

That's what my job is all about.

NICE to see you go......

There is much hyperbole in the press about the plans to remove from the National Institute for Health and Clinical Excellence (NICE) their judgements on new drugs.

There is absolutely no objectivity in the reporting, and they use case stories of patients to publicise this. This is referred to in parts of the health system as 'shroud-waving'.

I find this whole situation somewhat disturbing, for two reasons - firstly, here was an objective method for determining the value of new medication, and secondly it is likely to result in the drugs bill becoming hugely inflated, as clinicians will face huge pressure to prescribe drugs that are marginal, unproven or enormously expensive. I will face that pressure, and will feel the need to prescribe for my patients.

It was actually the one role of NICE that the Jobbing Doctor took notice of.

The Government say that they are likely to negotiate a formula directly with the pharmaceutical companies, and that will be effective. I doubt this very much indeed.

I don't suppose the media will now be full of stories about hip replacements in the elderly being deferred because of new cancer treatments eating up the finite resources we have for health.

And if NICE aren't doing this any more, is there any need for this rather unnecessary and nannying organisation?