Most of those referrals will be \u201cappropriate\u201d, such as for those requiring a joint replacement for an arthritic hip, or where there is genuine uncertainty about what is amiss and how to resolve it. But a substantial proportion are not.<\/p>\n
Within the same locality, referral rates can be five times higher in one practice compared with another, strongly suggesting that some GPs have a low threshold for offloading their responsibility for sorting out patients\u2019 ailments onto the hospital<\/a>.<\/p>\n The imperative for \u201cdemand management\u201d here is self-evident, as a substantial reduction in those 900,000 monthly referrals will mean those who might benefit from a specialist opinion would do so much more expeditiously. Hospitals refusing \u201cinappropriate\u201d referrals is a start.<\/p>\n The blood pressure drug that comes out on top<\/p>\n When it comes to treating raised blood pressure<\/a>, there is no shortage of possible medicines on offer. More than 60, at the latest count, fall into six main classes, each working in a slightly different way. They are, pretty much, equally effective. The question of whether one might be preferable to another revolves around the likelihood of their adverse effects.<\/p>\n And here, if surprisingly, there does seem to be a clear \u201cwinner\u201d<\/a>: the angiotensin receptor blockers (ARBs), the best known being losartan. These, according to a recent review, are less likely to cause fatigue (beta blockers), ankle swelling (calcium channel blockers), persistent cough (angiotensin-converting enzyme [ACE] inhibitors), or predispose to diabetes (thiazide diuretics).<\/p>\n This does not mean that those whose blood pressure is controlled by one or other of those other classes should consider switching to an ARB \u2013 still, it is a useful reminder to those troubled with adverse effects that there are \u201calternatives<\/a>\u201d.<\/p>\n At-home remedy for blocked ears<\/p>\n Finally, on remediable causes of deafness (as recently mentioned in this column<\/a>), my thanks to retired orthopaedic surgeon Ramesh Nayek for his DIY method for flushing out wax impacted in the ear canal. This entails instilling water under pressure, which at one time would be routinely carried out by the doctor\u2019s surgery. But no longer; they have apparently better things to do, so patients are usually advised to have it done privately<\/a> at a (minimum) cost of \u00a350.<\/p>\n Mr Nayek suggests first softening the wax with a few drops of hydrogen peroxide in each ear for two or three days. Then fill a syringe with warm water and gently direct it down the ear canal (assistance may be required). Both items are readily purchased from the chemist (\u00a31.50 for the hydrogen peroxide, 50p for the syringe), with a net saving of \u00a348.<\/p>\n Email queries and comments in confidence to Drjames@telegraph.co.uk<\/p>\n","protected":false},"excerpt":{"rendered":"Most of those referrals will be \u201cappropriate\u201d, such as for those requiring a joint replacement for an arthritic…\n","protected":false},"author":2,"featured_media":761647,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[43],"tags":[5079,6612,13888,102,2281,2960,2196,251543,200201,5438,56,54,55],"class_list":["post-761646","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-ageing","tag-blood-pressure","tag-conditions","tag-health","tag-health-and-fitness","tag-healthcare","tag-hospitals","tag-james-lefanu","tag-nhs-national-health-service","tag-standard","tag-uk","tag-united-kingdom","tag-unitedkingdom"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/761646","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/comments?post=761646"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/761646\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media\/761647"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media?parent=761646"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/categories?post=761646"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/tags?post=761646"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}