Intended for healthcare professionals

Observations Body Politic

How do we get the measure of patient care?

BMJ 2008; 336 doi: (Published 31 January 2008) Cite this as: BMJ 2008;336:249
  1. Nigel Hawkes, health editor, the Times
  1. nigel.hawkes{at}

    The UK government’s latest plan is to try asking the patients rather than the doctors

    Death is an end point we can all understand. When reading the latest clinical trial, I always find my eyes drawn to the column that shows mortality. This may be a little morbid, but no other measure has the crisp finality of death.

    As a means of assessing the quality of care, however, it has many drawbacks. True, the heart surgeons have submitted to an audit of the number of their patients who die, enabling the public to weigh up the odds before going under the knife. But in most circumstances, mortality—even a run of bad results—tells us little about the quality of care.

    In recent months both Papworth Hospital near Cambridge and Glasgow Royal Infirmary stopped their heart transplant programme after a number of deaths—seven out of 20 at Papworth, and four out of 11 at Glasgow. Both resumed after close scrutiny found no common factors behind the deaths.

    I would be the last to criticise hospitals for taking precautionary action. It’s a lot better than dealing with the fallout if …

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