Re: Silly survey

On 7 Jun 2007 22:49:22 +0100, michaeld <michaeld@xxxxxxxxxx> wrote:
Ian Smith wrote:

On Wed, 6 Jun, Michael J Davis <?.?@trustsof.demon.co.uk> wrote:

In some areas of 'corrective surgery' the fashion
seems to change for doing it and not doing it.

Sometimes very rapidly.

Consider tongue-ties. This is where the flap of skin along the
centreline of the underside of the tongue extends to the tip of the
tongue, meaning the person so affected can't put the tip of their
tongue past their teeth. This makes breast-feeding very difficult,
and impedes speech, though affected people do learn to speak, but with
different muscular movements. If they have corrective surgery after
learning to talk they need to re-learn several sounds.

I wonder why the standard practice isn't to cut immediately in all cases.
Are there significant associated risks?

It seems not. In the past and currently it's routine cut-by-default
by midwives. In the intervening period, I don't really know the
justification. The local midwife that referred us to Southampton said
she could do the operation (as in, was qualified to do, and had done
it in the past) but it was policy not to. As noted, it was apparently
policy not to practically everywhere.

If you're bottle-feeding tongue-tie isn't an immediate problem. It's
probably a consequence of policy being set by older doctors, and the
diabolically low rate of breast-feeding in the UK until quite
recently (in fact, still diabolically low, but improving).

At Southampton there was a continuous stream of days to weeks old
babies - in the lift we we met the one two operations before us
leaving, we sat in the waiting room while a nurse went through the
paperwork with the people ahead of us, then she moved on to us
while those people went off to get the operation. We spent longer
with the nurse filling paperwork than with the doctor getting it done
(and 90% of the time with the doctor was skimming through the
paperwork and confirming things). As we left, there was another
couple doing paperwork. So there seemed to be demand.

The cynic in me suggest that if there wasn't a performance target for
resolving tongue-tie, hospital staff were better off (so far as
managers and funding are concerned) repeatedly weighing children than
actually treating them. (There is a performance target for weighing
children - which is why you cannot go into a hospital for any sort of
treatment for a child without them spending time getting weighed).

regards, Ian SMith
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