A blocked nose is not trivial !

I was interested to recently read (another) newspaper article recently that was bemoaning the fact that people attend their GPs with trivial symptoms or symptoms that should be dealt with by a capable Pharmacist or even family member. They quoted that 40000 people a year apparently visit their GP with dandruff, 20000 with travel sickness and 5.2 MILLION with a blocked nose. As a Specialist Rhinologist, I not only found it somewhat insulting to have my work trivialised in this way, but surely the clue is in the numbers of patients that suffer from this condition, and I would contend that the majority of them are managed suboptimally in the Primary Care Environment. 

I have my own theory about why this is, which is for several reasons.

Unfortunately, Ear, Nose and Throat (ENT) Surgery is taught very poorly in Medical Schools around the UK. In a survey I recently carried out, of the 26 Medical Schools in the UK only 21 have ENT taught at all. Those that do teach it all have a very small ENT Curriculum, usually lasting less than a week. If we reflect that in the present (and future) NHS environment, the Government has set the agenda that more and more services and money are being targeted towards Primary Care (i.e GP and out of Hospital services) and as a result most of todays Medical Students will become GPs rather than Hospital Specialists, the ENT Knowledge in the community is becoming more and more diluted. It is an interesting statistic that 10 to 15% of all GP Consultations are ENT related, and that 2% of the entire population will seek an ENT Consultation each year. The news is not all bad, however, as more Foundation Doctors in training are rotating through ENT Departments in Hospitals, and will therefore have a 4 month period learning some ENT Surgery during their Postgraduate training. Some of these Doctors will subsequently become enthused with ENT, realise it's relevance and interest, and may seek to become GPwSI in ENT (GP with Special Interest). These GPs can advertise themselves to Commissioning Bodies (i.e Clinical Commissioning Groups or CCGs) and provide ENT Services in a Primary Care environment, ideally with the engagement, guidance and support of their local ENT Hospital Department. I must emphasise, however, that these Doctors are NOT ENT Specialists ! As it says on the tin, they have an interest and engagement in the topic, but do not have years of experience in dealing with all aspects of ENT practice like Hospital Specialists do... The other frustration is that even for my Primary Care colleagues that DO have an interest in ENT, the tools and equipment they have in Primary Care are usually rudimentary, often consisting of a pentorch, tongue depressor and Auroscope (often not working or with batteries on their last legs !) making only a cursory ENT examination possible. This is in direct contrast to the up to date endoscopic and microscopic instrumentation that we have routinely in a Hospital ENT Outpatient Department, with all Allied Specialities such as Audiology (Hearing Tests), Speech and Language Therapy, Radiology (X Rays) and Blood Tests (to name but a few) on site and immediately available. 

The other issue that unfortunately may mitigate against referral to a Specialist is the ongoing need for the CCGs to save money. Because of the inevitable overheads involved in a Hospital environment, referrals to a Hospital cost the CCG more than treating you in the GP Practice or referring you to a local GPwSI. I will let you make up your own mind about which environment YOU would prefer to be seen in..   

With these thoughts in mind, when Angela Epstein from the Daily Mail contacted me, and asked me what ENT symptoms GPs may have trouble with, I thought her article may be an excellent forum in which to air my frustrations !

Here is the article for your interest - http://dailym.ai/1aCeo6p

As a summary, I would ask you not to allow your ENT symptoms to be trivialised. Ask for a referral to a ENT Specialist if they persist despite your GPs treatment and start to impact on your daily life - do not be fobbed off ! As you will see in the same Daily Mail article, my colleague Myles Black mentions that even your hearing loss may not be straightforward as you or your GP may think.

If you have the facility to go Privately then do, as you will be assessed and treated straight away by a Specialist and far quicker than through other referral pathways and in a pleasant and unhurried environment.  

Finally, if you do have problems with your nose, ask your GP to see an ENT Consultant who specialises in problems concerning the nose, who is termed a Specialist Rhinologist within the umbrella of ENT Surgery. These days, most Surgeons worth their salt will subspecialise within their NHS and Private Practice, and a such a subpecialist will have all the tools in their armamentarium to offer you an optimal service. As Surgery becomes more complex and specialised, the days of any Surgeon being a true 'Generalist' and being up to date in all aspects of their Speciality is over - be aware!



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