A Doctor’s Email

Dec 1, 2017 | Pernicious Anaemia | 7 comments

I recently received an email from a GP who wanted to know if we knew of anyone who required weekly injections to live a more or less normal life. I replied that I had and that many of our members need much more frequent injections than the standard every 3 months in the UK.

“Thanks for your email Mr Hooper.
Actually, this is my second patient. The first gentleman is on daily injections, but still gets some symptoms.
This lady is on one injection a fortnight, but still has such profound fatigue that I think she will need it weekly. I am concerned there are other abnormalities in the pathway that I haven’t addressed. I am also going to start her on folic acid.
Please do keep me in the loop if you know of any other data which might help, any other tests I can do or any other supplements that might help. It’s frustrating as a doctor to not know WHY some patients don’t get the full benefit and what I can do to make it better”.

There are a number of things that the email illustrates and which need to be discussed.

Firstly, there are doctors, perhaps a growing number of doctors, who are now aware that treatment of Pernicious Anaemia needs to be tailored to the individual need of the patient. Hurrah! I hear you shout. But there’s a problem here. Whilst GP’s are allowed, nay even encouraged to make sound clinical decisions for the benefit of their patients, it has come to my attention in recent weeks following a number of meetings with GP’s that the Trusts which oversee the contracts with the individual doctors are increasingly monitoring the prescriptions written by surgeries and even individual doctors. Where there is perceived to be excessive prescribing of a particular medicine the health centre or individual doctor is told to reduce the number of scripts to bring the surgery or doctor in line with ‘normal’ prescribing practice. So, even though the GP above will want to treat the patient on an individual needs basis she may well be told that this practice is not acceptable and will be told to stop.

The second point is that the failings of the way in which Pernicious Anaemia is diagnosed and treated leads not only to frustrated patients but also to frustrated doctors.

And, thirdly, it just shows the need for some robust scientific research into why some patients manage perfectly well on a three-monthly regimen while others, including the patient mentioned above needs a daily injection.