BMJ 1995;311:808 (23 September)

Letters

Broader definitions of clinical effectiveness are needed

EDITOR,--We are impressed with the move to evidence based medicine and clinical effectiveness. We strongly urge that the concept of clinical effectiveness1 should be broad enough to include the alleviation of patients' anxiety and their satisfaction with care, not just improvement in clinical status. This broader view of effectiveness might be termed "doctor effectiveness."

The skill of doctors is not only what they do but the way they do it. Spending more time with a patient may be the most clinically effective procedure if they feel a "second opinion" from the accident and emergency department unnecessary, or that they don't need a scan or their prostatectomy yet.

Primary care has put greatest effort into this area, so far with results that are difficult to interpret. The potential gains include an improvement in patient satisfaction and understanding and a reduction in unnecessary referrals and treatment. Let's look at "doctor effectiveness"--but perhaps . . . [Full text of this article]


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Relevant Article

Evidence based medicine
Frank Davidoff, Brian Haynes, Dave Sackett, and Richard Smith
BMJ 1995 310: 1085-1086. [Extract] [Full Text]

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