THE BLOG
13/02/2015 07:42 GMT | Updated 14/04/2015 06:59 BST

Predicting Pratfalls

'There is little immediate prospect of a substantial fall, however. The Organisation of the Petroleum Exporting Countries (OPEC) has said it will defend $100 dollars per barrel of oil by reducing production if the price drops too far below that level."

I came across this paragraph in the autumn 2014 edition of a magazine produced by a famous, publicly quoted, wealth management company with over £52 billion, that's half the annual NHS budget, of client funds under its management. The paragraph was from an article lauding the stability of crude oil prices. Autumn 2014. The price fell through the $100 mark in September 2014 and continued to plummet to half that amount by the New Year. As far as predictions go this must rank alongside Decca Records' rejection of the Beatles with the haughtily dismissive; "We don't like their sound, and guitar music is on the way out."

We doctors know the perils of predictions only too well. After all, how often have we diagnosed a patient with a 'terminal' cancer only to see them hale and hearty jogging into our surgery years later? Or the bed-ridden hemiplegic stroke victim with the poor prognosis seen shopping in the supermarket? Or the infant with meningitis; now a strapping teenager? We have become cautious, as individuals, about predicting anything; a caution borne through personal experience that much of life is unpredictable and random.

Yet medicine as a whole has and is moving on an entirely opposite vector. The concept that ill health could be predicted has existed in a subjective form for centuries but it was only in the last quarter of the 20th that it became structured into a tool to manage disease.

The innovative Dundee coronary risk disc which used age, sex, smoking, blood pressure and cholesterol level to rank potential morbidity from cardiovascular disease was the first of a legion of subsequent calculators for a hugely diverse number of clinical conditions. The prediction tools evolved into algorithms spawning protocols which in turn moved from being helpful guidance to becoming mandatory clinical pathways that doctors had to follow. That cursed disc has become a hefty stick to beat ourselves over the head with.

The latest predictor tool- QCancer- currently being piloted in an effort to reduce cancer mortality in the UK even dispenses with the doctor altogether by allowing the participant to input their own data and, if they pass the first low-set hurdle, to refer themselves directly for a specialist opinion. No filter. One day you're fine; the next you are in a state of high anxiety booking your own funeral.

Despite the debunking of Nostradamus, soothsaying remains seductive. With an election looming, not surprisingly even politicians have entered the fray. NHS England's chief executive has predicted a £30 billion shortfall in NHS funding by 2020. Each party is predicting dire consequences for the NHS unless they are elected to govern. Suddenly, like the diagnosis and management of cancer we have entered a world where if we do not act on the predicted numbers immediately then it is likely to be too late to act at all. Every statement now has a hysterical sense of urgency. We are being panicked by the future.

In the first paragraph of this blog I highlighted how a FTSE 100 company looking after the savings of tens of thousands of investors got a really quite simple prediction wrong even as it was happening at that time. It is several levels of magnitude greater trying to predict the needs, or indeed the demise, of an infinitely more complex conundrum that is the NHS.

Leave the politicians to pluck millions from thin air. Let everyone else play the predictor game. We doctors are far too canny to join in. We know that whatever happens, the only thing that we can predict will be that Monday morning surgeries will always be a nightmare.