A Cambridgeshire GP has highlighted the potential snowball effect of ordering routine tests on a Friday. Writing in the British Medical Journal, Dr Newton related her personal experience...

Suffering from several chronic illnesses including severe cardiac failure, Dr Newton's father had expressed a very strong desire to avoid further hospital admissions. However, a routine blood test done on a Friday resulted in a high potassium level being phoned through to the out of hours service. The out of hours GP, who didn't know him, then decided to admit him to hospital.

During that weekend admission, his potassium level was corrected but his general status deteriorated. The family felt that he wasn't receiving good basis nursing care, and that speedy pain relief was not available, as the nurses were run off their feet. Eventually, Dr Newton transferred her father to a BUPA hospital where he received adequate basic nursing care and analgesia; 48 hours later he died there peacefully in a private room.

Dr Newton encouraged GPs reading her experience to reflect on the wisdom of ordering routine blood tests on a Friday. Terminally ill patients should have their individual circumstances and wishes considered when interpreting abnormal blood results. Usually, the most appropriate person to do this is the patient's own GP, in discussion with the patient and their family.

CNK comments: NHS acute medical wards can and do provide excellent standards of care for acutely unwell people. But, usually they are not the most appropriate places for people with terminal illnesses to spend their last few days of life. Yet the private sector should not be the 'only other option' relatives feel driven to. Rather, we should be aiming for universal, 24/7 provision of excellent palliative care - whether in patients' homes, local hospices or hospitals - so that a 'good death' on the NHS becomes more of a normally available, realistic expectation and less of a lucky coincidence. Baroness Finlay's Palliative Care Bill is working towards this vision - we urge you to support it.

Care Not Killing