The Worried Well

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I had just finished my talk yesterday on the latest treatments for varicose veins at the European Congress of Radiology when a fellow speaker and well known Professor of Radiology came up to me and we got chatting. The first thing he said was “You still treating the worried well?”

This did not particularly surprise me but it did upset me. I did my best to explain, as I had in answer to a question from the floor, that most patients who seek our help at Veincentre have significant symptoms and are not just suffering from a cosmetic problem. Many also have very nasty ulcers from which they have suffered for years with no effective treatment being offered.

Many people who have a say in the treatment of varicose veins are misguided of the same opinion that these patients are just the “worried well” and less deserving of NHS help than someone suffering from a “proper disease”. They seem to think that varicose veins are just a minor cosmetic issue that people should just put up with.

Unfortunately these attitudes have led to rationing of varicose veins treatment, which has been with us a long time in the UK. In the past, it tended to be by the building up of long surgical waiting lists and veins always settling down at the bottom of the priority pile. More recently the bodies that hold the purse strings, the PCTs and lately the CCGs, have stopped paying for varicose vein treatment altogether. Even private health insurers are refusing to pay for vein treatment unless there are features of advanced disease.

It seems rather bizarre and hypocritical for Aviva (for example) to trumpet the amazing advances in the treatment for varicose veins but then to refuse to pay for the treatment! This is leaving thousands of patients suffering with pain, throbbing, constant itching and so on with nowhere to go.

If varicose veins were invisible and did not cause unsightly large worms under the skin I believe attitudes would be different and the symptoms would be taken more seriously and treatment more readily offered. As it is many influential people think they are just a cosmetic problem and further that patients make up their symptoms just to improve the appearance of their legs.

Despite the latest NICE guidance on the management of varicose veins: Varicose veins in the legs: The diagnosis and management of varicose veins and Varicose veins in the legs, most patients in the UK are still denied treatment.

I can see the irony of a private provider who undoubtedly has more business as a result of this situation complaining about it but we do our best to provide quality treatment for all those affected by keeping our prices reasonably affordable. This is in stark contrast to many private hospitals and clinics, which charge outrageous fees and try to justify them by statements like “You get what you pay for”.

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