Rude Health: Game on
The World Health Organisation's decision to diagnose Gaming Disorder is a questionable one for Maurice Gueret as he eyes up a politician-in-waiting
Just a game
Conscientious objectors are few in medical circles. I'd like to register a lonely dissent to the World Health Organisation's recent decree that gaming disorder is a new condition. The capacity for humans to become obsessive, compulsive and addictive is nothing new. You only have to look at mobile phone behaviour. Two years ago, a study found the average smartphone user was touching the screen over 2,600 times a day. Doctors of a proscriptive persuasion have a tendency to over-attribute psychiatric labels to everyday behaviour of the young. On the radio recently, I heard a former champion snooker player suggesting that his video-gaming addiction damaged his career on the green baize. Oh, the irony! Psychiatrists will point out that a true disorder is one that lasts a year, and impairs family, social or work life. But one person's disorder or impairment could be another man's dream. Many a spouse would be pleased if the WHO also recognised golfing disorder, or TV sports mania, aka Sky Sports-itis. And anyway, sure isn't it madness for the country to be fretting about kids losing themselves in Minecraft, when now, parts of Ireland haven't a single child psychiatrist at all?
I have a great admiration for Dr John Hillery, the psychiatrist son of the late former President Paddy. John has worked for years in the unsung field of learning disability, and also led the Medical Council through some difficult years. I am not privy to John's career plans, but he could do great service to the people of his native Co Clare if he stood again for election. He has that rare decency, warmth and common sense that are often lacking in today's politicos and medicos. He recently likened high-handed regulation of healthcare facilities by Hiqa to whack-a-mole machines in amusement arcades. John has opened up an important debate about what many see as one-way regulation of hospitals and nursing homes with its culture of 'blame and shame'. We need to hear much more of what he has to say about who is regulating our regulators.
The Choosing Wisely movement in medicine began six years ago in the United States. It's a useful campaign led by senior medics in each field, who recognise that doctors and patients are similar in one important way: they can overstate the benefit of medical interventions, and underestimate the harm. The movement aims to reduce unnecessary tests, and to encourage doctors and patients to question whether everything they do is absolutely necessary. The mission is spreading across many countries, with over 540 recommendations now for doctors to improve their practice, and tips for patients on how to engage better with their medical options. There is a free Choosing Wisely app for the phone, which I'd highly recommend to medics and patients. Here are just a few of their recommendations. We shouldn't be diagnosing asthma without doing spirometry first. Patients with low back pain for under six weeks may not benefit from an X-ray if there are no other red-flag symptoms. There is no benefit to having an annual ECG test on the heart in low-cardiac-risk patients. Nursing bodies are also involved in choosing wisely. Among their many useful suggestions for nurses is that patients in hospital should not be woken for routine care, unless their condition requires it. Sounds very wise to me.
Irish GPs are a demoralised lot these days. Resources follow scandals in Irish healthcare, and family doctor scandals pale beside those in HSE and hospital circles. There is no incentive to keep patients out of hospital settings. Managing things at home only heaps more work on an already under-resourced family doctor service. The perennial fear of being sued encourages family docs to refer patients to hospital casualty departments for tests routinely refused to GPs. A new study in England has shown that one-and-a-half-million emergency admissions to hospital could be prevented each year if better care was provided outside of hospitals. England, unlike here, has some pretty good care outside of hospitals. Thirty years ago, Irish GPs were regarded as the Cinderellas of the health service. But mass retirement of that generation is now under way. The great fear now is that only their brooms will be left behind.
Dr Maurice Gueret is editor of the ‘Irish Medical Directory’ drmauricegueret.com