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the Outcome in the final sentence - The final diagnosis was that he
had features of the metabolic syndrome including probable non-alcoholic
fatty liver disease and had about a 40% likelihood of developing diabetes
within four years - does not help the patient at all, but does illustrate
the inability to say it as it is to the patient.
This is "you are 27.5 Kg overweight, go away and sort that out" then
he would not have mixed hyperlidaemia or metabolic syndrome or a raised
After the initial history and baseline bloods no more investigations
are needed. The NHS could have saved a lot of money - or with the money
saved on not doing an oral GTT or ultrasound, bought him a bike to
facilate the weight loss.
He does show more sense than the medical profession with regard to
worrying about his family history which brought him into contact with the
medical profession. QRISK2 has the cut off of age 60 with regard to family
history, but the presumed narrowing to his brother's coronary arteries
takes more than 3 yrs to develop.
Rational testing does not equal rational management of the patient