A&E and whiplash

Two things appeared simultaneously in the news in 2013. The first was a backlash against whiplash. Whiplash injuries, it is said, are costing motorists hundreds of pounds per year in insurance premiums that have to cover the growing cost of whiplash injury claims. Many of these are fraudulent. Cue media hysteria and demands that all such patients be assessed by neurologists.

Now neck injuries as the result of a sudden acceleration/deceleration, such as when a car comes to a dead stop in a hurry, the occupants are thrown forwards and then jolted back by the airbag going off, are not infrequent. But if such a movement results in ligament or muscle tears, or even strains, then nothing will show up, except for a bit of stiffness. Nothing will appear on an MRI scan or X-ray. Nor do you need a neurologist to diagnose a nerve root injury; pins and needles, numbness and weakness, or even muscle wasting, are very easy even for a lay person to fathom. I wrote a letter to “The Times”:

Just because a test doesn’t show anything does not prove that nothing is wrong. The majority of “whiplash” injuries are due to tears of muscles or ligaments and these may be very painful – for a while. But they won’t show on X-rays or scans, and clinical examination will show no evidence of nerve damage. However well over 90% will settle down and the best treatment is early mobilisation, which significantly reduces the risk of chronic symptoms.

Whether such injuries should be compensated is doubtful. In countries where compensation is not available people just get on with life, and that is what should happen here. Physiotherapists and rheumatologists will be far more use in achieving this. Neurologists tell patients nothing is wrong and the patients get upset because they know something is wrong. They need to be told they are right, but that it will get better.

It was printed (I think my 65th, but I have lost count now). Things went quiet.

The second thing that pitched up was related to the financial problems of hospitals, as it was a stark warning that accident departments were now so overstretched that they could not cope now, let alone during a winter epidemic, of which one is overdue. So cue more hysteria about increasing staffing levels urgently.

There is an oxymoron in this alone, as increasing staff numbers means more costs, which hospitals cannot afford. The solution – to merge departments so that the staff can be redistributed through a smaller number of departments – is sensible, but a second oxymoron looms. If you have fewer hospitals then you have fewer beds to admit the patients who are ill enough, so the A&E departments clog up with sick folk waiting to be admitted. Send them home! But there is no evidence either that doing that is safe, or that it is cheaper. So there’s oxymoron No 3.

But what of the whiplash thing, you ask. I was coming to that. Suddenly the press was alive with the whiplash thing once more following a report suggesting that all such victims should be refused any form of compensation – unless they have been assessed in an A&E department! What good will that do? There are no tests to prove injury and anyway the onset of symptoms may be delayed by a day or two. Think about your sprained ankle. Did you not limp around uncomfortably for the day, only to find that the next morning it had swollen horribly and you couldn’t walk on it?

So. The UK’s emergency services are stretched to breaking point, rationalising them makes then less accessible and reduces the ability to admit patients and suddenly it is suggested that you flood them all with whiplash patients who will demand useless and expensive investigations for no purpose whatsoever.

Oxymoronic? I think we can leave out the oxy- bit.

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