Choice GP

Getting things wrong

Images of people getting things wrong pervade this week's issue. Andrew Whitehouse sets the tone in his letter (p 53), in which he likens a previous correspondent's disparagement of appraisals for consultants to the attitude of 19th century surgeons, "who were said to sharpen their scalpels on their boots to show their contempt for the microbe theory."

Undoing such misconceptions often takes painstaking work, as the study by Noam Trieman and colleagues shows (p 13). In many countries community care for long term psychiatric patients "has been demonised by the media as causing homelessness, freeing dangerous people, and increasing the risks of self harm and suicide." Their long term follow up of patients rehoused in the community after the closure of a psychiatric hospital in London shows that 90% were still living in the community five years later and that crime and homelessness presented few problems. In the light of these findings, they say, a change towards institutional care "is not a rational policy."

It's a widely held belief that that the internet is full of bad information, particularly when it comes to health. Yet Hogne Sandvik's analysis of the information available on female urinary incontinence suggests that this isn't always trueand that the web's opportunities for interactivity provide patients with information that is hard to come by in other ways (p 29). Sites mostly provided accurate information, she found, though few were comprehensive, and commercial sites provided less "balanced" information than others. Much valuable information came in email replies to "Molly Jones's" description of her symptoms, including personal experiences from other sufferers.

One difficulty about getting things wrong is admitting itand politicians seem to have particular difficulties here. One of the most wrong things that the current British government is pursuing is the private finance initiative (PFI), or "perfidious financial idiocy," as Richard Smith calls it (p 2). The previous government invented the private finance initiative as a means to fund new hospitals, and the new government has stuck to it. It may prove one of the most expensive "free lunches" in history as it destroys the NHSas a series of articles beginning today illustrates in chilling detail (p 48). Next week the BMA's annual meeting will debate seven motions critical of the initiative. One, capturing the thinking of many, "questions the Government's commitment to the NHS while it continues to support and promote the PFI scheme." It's time for the government to turn on this one, and the Scots (always people to listen to on financial matters) are already showing signs of doing so.

Footnotes

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