A Night In
Thursday, 05 November 2020
A NIGHT IN - MEDICINE, EVIDENCE AND LIFE – BYOB
Dr Margaret McCartney, GP, Writer & Broadcaster
Dr Margaret McCartney is a GP in Glasgow, freelance writer, broadcaster, and author of three popular science books, The Patient Paradox, The State of Medicine and Living with Dying. She regularly writes articles for The Guardian and currently contributes to the BBC Radio 4 program, Inside Health. During the Covid-19 pandemic, Dr McCartney contributed content to academic journals and broadcasting platforms, personal blog, and social media to inform the public and dispel myths about coronavirus disease. From 2020 she will be a CSO career researcher, and she is an honorary fellow at the Centre for Evidence Based Medicine in Oxford.
Note of Med Chi meeting 5th Nov 2020
The President welcomed everyone to the first on-line meeting of the 2020/2021 session and apologies were noted (see separate sheet). She also noted that sadly there had been several deaths of past members of the Society:
- Dr Frank G.G. Shepherd died peacefully at home on Sunday 5th July, a retired GP from Elmbank Terrace practice.
- Dr Edith Beveridge, consultant paediatric anaesthetist, died at home from an acute MI on 7th July.
- Dr John Hern died on 24th July aged 83. John was a consultant neurologist in Aberdeen
- Dr Peter Carter died 8th September. Dr Carter was 98 years old and a retired GP, Student health.
On a happier note Dr Mary Fraser, who still lives in Aberdeen, had her 100th birthday this week, and a card was sent on behalf of the Society.
Professor Murray noted that she was delighted to welcome invited guests who would usually be invited to the Annual Founders’ Dinner and apologised that they had to provide their own refreshments and was even sorrier that they would miss the traditional annual rendition of “The Lum Hat”, a ditty that has become the Med Chi’s anthem! Guests in attendance were:
- Prof George Boyne, UoA Principal & VC
- Dr Janet Jenkins, President of the Edinburgh Med-Chi Society
- Ms Marichen Meyer, Solicitor, Burnett & Reid. The President expressed thanks to the Society’s out-going solicitor
- Mr George Alpine for his many years of legal expertise and welcomed his successor Ms Marichen Meyer.
Lord Provost , Mr Barney Crockett, and Society Accountant, Mr Chris Smith, were unable to attend.
The President then introduced the speaker for the evening, Dr Margaret McCartney (biography above). She noted that the format for the evening would be an informal hour for questions and answers and provide some enjoyable conversation that would hopefully fill the void, of which so many are acutely aware just now.
1. Professor Murray then posed the first question of the evening: While we would not wish a pandemic on the world, has Covid-19 been a gift to medical writers like yourself? Dr McCartney reiterated the fact that we would not wish the current global pandemic to be happening, but agreed that it had provided a significant amount of information for medical journalists to use in their reflections and discussions.
2. Having been an active member of the Medical Campaign Against Nuclear Weapons as a student, Dr McCartney was asked if she was still involved. She had fond memories of her involvement with the group whilst studying in Aberdeen and was extremely grateful to one of the local consultants for hosting meetings and funding a trip to a conference. She spent time helping with the Faslane Peace Camp. She is still an active campaigner, but now as part of an organisation called Medact, which also encompasses concerns for environmental issues.
3. A question was posed in relation to the reliability of modelling data in relation to Covid. It was noted that several models exist, not all with the same predictions. Dr McCartney noted that all models carry a degree of uncertainty and are based on assumptions, which should be listed. When expressing certainties, confidence intervals should be noted. The National Statistical Agency is looking to standardise Covid modelling. Modelling is often inaccurately represented in the media. At No. 10 press briefings, it is usually news journalists, rather than health journalists, who are present and appropriate questions are not always asked. Currently, there are few trials on modelling and this needs to be addressed.
Another Society member noted that a model from Imperial College London had produced accurate numbers in terms of infection rates and interventions. Dr McCartney felt that the model was not clear enough about the impact of interventions, that the track and trace intervention was poor, and the model does not account for other excess mortality. She felt that basing Government policy on one model was dangerous and that not enough attention was being paid to appropriate advice from SAGE e.g. in relation to lockdown.
4. Dr McCartney was asked about her thoughts on the excess deaths during the Covid-19 pandemic. She responded by saying that many deaths are likely to be early deaths rather than excess deaths. There is currently insufficient data to comment and, in time, an audit of death certificates and patient notes will be required. She felt that many people were dying with Covid, rather than from Covid, and that there may be better information about this in the future.
A further question was posed about the communication of personal risk during the Covid-19 pandemic. Dr McCartney noted that the shielding letters received by patients recommended severe restrictions which were burdensome to comply with. Patient information was double-checked by GPs, but GPs were often informed after the patients received the letters. Some patients who received letters did not actually require to shield. In contrast, conditions which are now known to carry increased risk from Covid complications, such as diabetes and obesity, were not included. In the initial stages of the pandemic, 100 000 people were removed from the shielding category after GP input. This caused confusion and meant that some support services put in place for these patients were then lost e.g. home food delivery, benefits. She also expressed concerns about the way negative results are communicated to patients. If someone is self-testing, it is important they receive an accurate result. The false negative rate is currently 2-29% and there is no research into where the false negatives are arising in order to be able to address this. It is therefore important that test results are put in the context of patient symptoms and this is not always the case.
5. The next question related to research into non-drug related Covid interventions. Dr McCartney replied that she is aware of only eight or nine collaborative non-drug intervention trials worldwide looking at the impact of eg. social distancing, shielding and isolation. She noted that risk in relation to these interventions should be communicated to patients in the same way as shared decision making under normal circumstances. Continuation of patient-centred care is important. There is a responsibility to both minimise risk and minimise adverse impact on quality of life, with one Society member noting that quality of life could be measured against reasonable expectations pre- and post-Covid. Dr McCartney added that some patients do not wish to stop shielding eg. anxiety, and that it is impossible to “count” that harm.
6. Dr McCartney was asked about the likely effects of Brexit on the availability of medicines in the UK. She answered that she did not know. Drug shortages already occur and investigation of these suggests that the process is complicated and occurs randomly. The Covid-19 pandemic has impacted the global supply of raw materials for medication and she anticipates that this will worse post-Brexit. Attempts to bolster supply chains are in place. She also mentioned that the increase in prescription requests at the onset of the pandemic has not yet returned to normal.
7. One of the evening’s guests contributed some observations. She had been identified as a possible shielding patient and received an e-mail from Sainsbury’s about home delivery. In contrast, she also received notification from the GMC saying that her licence to practice (rescinded on retirement) could be reinstated to allow her to return to work. She also mentioned that in current times, death is often seen as a failure of medicine, rather than a natural process. Dr McCartney noted that she is not keen on excess intervention and feels that supporting a good death is preferable in appropriate circumstances. She thinks medical TV dramas create unrealistic expectations, e.g. huge resuscitation success rates, and that the medical profession require better training in the communication around death.
8. Dr McCartney was asked how she felt care homes could handle the situation of relatives not seeing their loved ones for a long a period of time better, particularly if their relative has died during the separation. She noted that care homes do seem to be shut off from society and are in a very difficult position, often bearing the brunt of the blame if one of their residents dies from Covid. She added that the life expectation of those in care homes was limited and the risk of Covid must be balanced against residents seeing their relatives. She feels that there will be “scars” on the next generation as death and grief are very difficult in separation. She added that management of “at home” deaths is poor just now, with increased phone management of palliative care and death. Getting back to being a personal physician again is important. There is currently a lot of criticism of General Practice because of the challenges of seeing patients face-to-face and the resultant effect on communication. Continuity of care is more important than ever and in Dr McCartney’s own practice, the doctors are seeing their own patients as often as possible.
9. The next question asked about Dr McCartney’s thoughts on euthanasia. She noted that medical opinion tends to be polarised on this issue and that she is personally opposed to euthanasia, noting that doctors are generally poor at assessing quality of life. She prefers to concentrate on improving palliative care, whilst also avoiding over-treatment at the end of life.
Another Society member observed that cultural change was required to effectively address overtreatment. Despite the previous CMO, Dr Calderwood’s, Realistic Medicine document, doctors can still find it difficult to choose to treat wisely. It was noted that perhaps structural change within the NHS might make the adoption of cultural change easier.
10. Dr McCartney was then asked if she felt that social media in medicine was a force for good. She replied that she has mixed feelings about social media. She thinks it is okay if someone does not have too many followers, but when numbers increase, expressed opinions can be “tribal”. It is not a good platform for dealing with uncertainty and posts can be critical, which is difficult. She likes social media platforms for meeting colleagues and engaging in discussions about research.
11. The final question asked how Dr McCartney saw the future, particularly in relation to dealing with infections. She replied that she did not know, but there is a lot of past information to draw upon for research.
The evening concluded with Dr McCartney receiving thanks from the President. The usual gift of a book of the Heritage of the Med Chi will be posted to Dr McCartney.