Diagnosis before treatment (Dr Phil Welsby)

Diagnosis before treatment
In the United Kingdom there is an unpredicted shortage of hormone replacement therapy (HRT). I t must have been unpredicted otherwise preventative actions would surely have occurred. So what went wrong?
Traditional medical teaching is that ideally a diagnosis should precede any treatment and that a comprehensive diagnosis should comprise anatomical, functional and aetiological aspects. So how does a breakdown of HRT shapeup?
The anatomy is clear. There are not enough tablets to go round.
The functional is that many women of a certain age will have been inconvenienced, to put it mildly.
So what about the aetiology? This is the one thing that has been missing from all commentaries. The lack of supplies has as the final common pathway of accountability, a failure of the suppliers and producers and one is entitled to ask the reason. Were there financial considerations? Was this a failure of capitalism? Why did several manufacturers fail in their capitalist, never mind medical, responsibilities? An impending failure of supply would in business terms seem to be an ideal entrepreneurial opportunity.
Is the concept of blame relevant? Before this question is addressed we have to confront the fact that the concept of blame in major projects, where responsibility if diffused, commonly seems to be neglected to the advantage of those responsible. Similar examples of public failure are easy to find. Examples include the Edinburgh Tram debacle – the planning Committee of this major public engineering project did not have an engineer on the planning committee and overran on price and time of completion. Bonuses were offered for those who had failed. The new Edinburgh Sick Children’s’ Hospital was built and signed off but its opening had to be postponed at the last minute because of an inadequate ventilation system and it is uncertain when it can be opened, if at all. A whole new hospital in Liverpool lies uncomplete because the bankruptcy of the constructors. There is an opportunity cost in all of these failures, extra money that could have been better spent has to be found to remedy these errors. Blame seemingly is “an unhelpful and inappropriate response.”
But back to HRT. Perhaps those responsible should be named? Perhaps a women of a certain age should be put in charge of the investigation?

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