Choice GP

Data, data, data. Give me peace and knowledge

There is a picture on p 862 that stuck in my mind the moment I first saw it some six months ago. It shows two people with a pile of 855 guidelines collected in general practices in the Cambridge and Huntingdon Health Authority. The pile is two feet high and tottering. Here in one image is the result of medicine's attempt to use guidelines to improve practice. "The mass of paper we collected," conclude the authors of the study, "represents a large amount of information, but it is in an unmanageable form that does little to aid decision making. Information must not be hidden in a load of paper but should be readily accessible and easy to use."

What we need, writes Muir Gray (p 832), is a chief knowledge officer to help clinicians caught in an information paradoxoverwhelmed with information but unable to find the knowledge they need when they need it. The chief knowledge officer will decide what knowledge comes into the organisation, how that knowledge should be distributed, and what knowledge should be exported from the organisation. "We have," concludes Muir Gray, "managed money and buildings and people and energy. Now we need also to manage the most precious commodity of the 21st centuryknowledge and know how."    GP choice

The chief knowledge officer of a general practice might want to look at the paper from the Netherlands that investigates which factors make it more likely that guidelines will be followed (p 858). Best are those that are non-controversial, clear and specific, evidence based, and fit with current practice. Interestingly, almost two thirds of the recommendations in guidelines were followed.

Andrew Dicker, a general practitioner from London, writes a passionate personal view in which he attacks medicine in general and general practitioners in particular for not responding well to the problems of drug addicts (p 892). "Most GPs," he writes, "refuse to have anything to do with junkies. A small group of doctors see junkies privately for large profits." Dicker argues that general practitioners are increasingly putting their own interests before those of their patients and that "looking after junkies is stressful, so doctors refuse to do it." Comparing the treatment of drug addiction with the treatment of diabetes, Dicker agues that the treatment of drug addiction is cheap and cost effective. Yet diabetes is mentioned throughout medical education whereas addictive behaviour is barely mentioned.

People say the test of a legal system is whether it can give a fair trial to terrorists. Maybe the test of a medical system is whether it can treat drug addicts.