Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Consistency is the last refuge of the unimaginative.
- BM Hegde (18 May 2007)
-
How to improve patient care in a country where General Practice is less developed?
- Christos Lionis (8 June 2007)
|
|
|||
|
BM Hegde, Retd. Vice Chancellor Mangalore 575 004, India
Send response to journal:
|
Dear Editor, Yes, no one will question the need to improve patient care. There is never the best method in patient care; there could always a better one en route to our destination to “cure rarely, comfort mostly, but console always.” In the last half a century we have had so much “progress” in the field of modern drugs and interventions with the much talked about evidence based management of patients that it is time now to audit all those vis-à-vis patient satisfaction, morbidity relief and mortality reduction. After reading your editorial, I listened to Richard speak in Barcelona. It was quite inspirational. Our efforts in medicine have several similarities with social movements of the past. When Wilberforce started in England in the 1770s and said that slavery should end in the empire, no one took him seriously, as the nation’s economy depended on that. Many advised him to pack up and go home, as there were some very powerful slave traders out there that were not going to go with it. The idea was laughed off as very unrealistic. He did not give up; the fight went on for half a century before slavery was abolished legally. Modern medicine is also in the grips of the powerful lobbies today. For well meaning journals like the BMJ I think it would be a very good idea to commission articles by the thought leaders on audits of our interventions in the last fifty years with the results of the efforts of our predecessors before that. One or two examples come to mind. Halstead, the father of Breast cancer surgery in the US, used to have sanatoria for breast cancer patients and used minimal surgery without the present day chemotherapy or radiation added. It would be a very fruitful exercise to see if his results were worse or better than our present efforts. Similarly, Christy’s in Manchester once did an audit on a common cancer, chronic myeloid leukaemia, in two slots of time, 1900-1940 and 1950-1990. It would be an education to have a re-look in that area. Many other areas might throw more light for future guidance like the hot area of cardiac revascularization procedures. Even our efforts in CPR need an audit with the new insights into brain death and cardiac muscle death, the latter occurring more often with immediate reperfusion than with ischaemia! I know that many of your readers might think these are crazy ideas not worth pursuing. I make an appeal all the same.Oscar Wilde was right when he said that consistency is the last refuge of the unimaginative. Yours ever, bmhegde Competing interests: None declared |
|||
|
|
|||
|
Christos Lionis, Associate Professor of Social and Family Medicine School of Medicine, University of Crete, Greece, Zip Code 71003, P.O. Box 2208
Send response to journal:
|
Responding to the Editor’s key message that appeared in the BMJ editorial of May 19, and considering this question in countries without capacity for quality of care measurements and clinical governance, such as Greece, I would like to suggest four key aspects that could be easily initiated and implemented by individual GPs, rather than the health care system: (a) The introduction of a self-assessment process during GP
consultation
Empirical and experimental research is expected to fully explore the feasibility and effectiveness of the suggested GP-based initiatives on quality improvement. Competing interests: None declared |
|||