Improving patient care
BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39217.615637.BE (Published 17 May 2007) Cite this as: BMJ 2007;334:0All rapid responses
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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
Competing interests: No competing interests
How to improve patient care in a country where General Practice is less developed?
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
(b) A medical audit process that will check effectiveness in targeted and
selective groups of patients, including those with common problems or at
high risk
(c) Efforts to measure the pre-test and posterior diagnostic probability
at the general practitioner’s office, using simple measurements or
diagnostic questions
(d) An evaluation meeting with patients to identity barriers to health
care needs and dissatisfaction from doctor’s performance
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
Competing interests: No competing interests