Dealing in extremes

doi:10.1136/bmj.39266.573056.47

BMJ 2007;335 (7 July), doi:10.1136/bmj.39266.573056.47

Editor's Choice

Editor's choice

Dealing in extremes

Fiona Godlee, editor, BMJ

fgodlee{at}bmj.com

In Michael Moore's film Sicko, reviewed this week (doi: 10.1136/bmj.39262.638588.59),a woman in Britain is surprised to be asked how much the birthof her baby cost. She has no idea. Meanwhile, the threat ofa $60 000 bill forces a man in America to choose which of hissevered fingers will be reattached. Moore wants the US to havea single payer system, and the response to his film (doi: 10.1136/bmj.39258.421111.DB)shows that he is far from alone. His polemic exposes the damageto individuals and society that is caused by a system in whichcompeting insurance companies have no reason to care what happensto unprofitable patients.

The film may prove to be a tipping point for US health carein the dog days of the Bush regime. But Moore's rose tintedportrayal of Europe's health systems will raise a hollow laughfrom anyone devilling with the detail of the NHS. At a recentKing's Fund meeting on "the patient of the future" we heardthat centrally funded systems reduce patients' engagement—shownby the woman with the baby in Moore's film. Why should thismatter? Because hard cash is involved. According to the 2002Wanless report on NHS funding, engaged patients are cheaper.

Angela Coulter and Jo Ellins agree (doi: 10.1136/bmj.39246.581169.80).Their systematic overview concludes that patient centred careis about far more than being politically correct. Where patientsare empowered—which is best achieved through a mix oforal and written information, with active support from clinicians—outcomesimprove and use of health services may fall.

Calls for greater empowerment of health professionals probablycan't be equally evidence based, but at least these calls arenow coming from groups other than the professionals themselves.As Nick Timmins explains (doi: 10.1136/bmj.39261.449097.AD),we don't yet know what Gordon Brown is planning for the NHS.But a report from the Cabinet Office on the Department of Healthshould be a priority for the attention for Alan Johnson, thenew health secretary, says Rudolf Klein (doi: 10.1136/bmj.39262.746238.47).The report acknowledges that morale within the NHS is low andthat the pace of change has disempowered staff. It warns thatthe department now needs to lead the shift from top-down targetsto locally driven healthcare systems. The crucial question,says Klein, is whether Alan Johnson will translate the politicalrhetoric into reality.

Michael Moore deals in extremes. So does the BMJ. Melita Gordongives her own take on targets after six years spent in Malawi(p 45; doi: 10.1136/bmj.39255.551458.94). After a gruellingbut highly efficient ward round—seeing 56 patients sharing32 beds in three hours—she is humbled by a patient's offerto share his meagre meal. "If our clinical targets crowd outwhat our patients can teach us about humanity, we are missingthe most important lessons of all."

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Relevant Articles

Training and careers in France: Herv Maisonneuve and Yves Matillon
BMJ 2007 335: 788. [Extract] [Full Text] [PDF]

Stance is worst type of spin: Roger H Jones
BMJ 2007 335: 465. [Extract] [Full Text] [PDF]

Public trust in doctors undented: Jon Ford
BMJ 2007 335: 465. [Extract] [Full Text] [PDF]

Sticking to standards, not together: Caroline Mawer and Douglas Russell
BMJ 2007 335: 465. [Extract] [Full Text] [PDF]

The future role of the Department of Health: Rudolf Klein
BMJ 2007 335: 2-3. [Extract] [Full Text] [PDF]

Effectiveness of strategies for informing, educating, and involving patients: Angela Coulter and Jo Ellins
BMJ 2007 335: 24-27. [Extract] [Full Text] [PDF]