Published 21 April 2009, doi:10.1136/bmj.b1578
Cite this as: BMJ 2009;338:b1578

Feature

This House believes doctors are neglecting their duty to lead health service change: Proposer

doi:10.1136/bmj.b1555doi:10.1136/bmj.b1572doi:10.1136/bmj.b1577doi:10.1136/bmj.b1573

The first 150 words of the full text of this article appear below.

At worst the doctor should do the patient no harm. At best they should practice EBM—in this case, economics based medicine—by focusing on the comparative cost effectiveness of competing interventions.¹ EBM requires doctors to recognise the universal issue of opportunity cost, where a decision to treat one patient involves the denial of treatment to another patient. It also obliges the doctor to focus on value: the value of what they give up when they treat a patient (cost) and the value of what is gained as a result of treatment—hopefully improved length and quality of life for the patient. Clinical practice should be driven by the pursuit of EBM, conditioned by humane consideration of the patient’s needs, particularly at the end of life.

From Barbara Castle in 1976² to Ara Darzi in 2008,³ there has been political and policy focus on variations in clinical practice and a failure by the . . . [Full text of this article]

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