One of the things that frustrates me about clinical epidemiology (which goes by the name “evidence based medicine”) is how often it seems detached from the real world. Whilst researchers and statisticians pore over reviews of randomised clinical trials, real people with real problems turn up each day in the doctors’ consulting rooms. In the British Medical Journal there’s a regular column entitled “From the Frontline” and it’s written by a Glasgow GP called Des Spence. I always read his column because so often it reflects the daily reality I used to experience as a GP and which I still experience as a Glasgow hospital doctor. This week his column was particulary good – a healthy, realistic alternative view of the government’s “Quality Outcomes Framework” within which all UK GPs now practice.
It is not just the huge financial opportunity cost, nor the well made unwell, but the wanton consumption of our medical energies that I take issue with. Our energy has been spent bean counting the measurable while dismissing the most valuable aspect of medical care, the immeasurable. Perhaps I am wrong. But I will stand my ground of absolute scepticism until some redcoat finds real evidence to run through my Jacobean heart.
Well said, Des!
I especially appreciate your succinct “Our energy has been spent bean counting the measurable while dismissing the most valuable aspect of medical care, the immeasurable.” It’s a daily sadness to me that we increasingly pay attention to the measurable while dismissing the immeasurable in health care.
Great article. You are right, it is completely immeasurable. Especially when you get bowl of spaghetti patients like me who seem to have issues that can not be pigeonholed.
We have to remember that each body is completely unique. There are similarities, but there is that special difference in each one of us that makes medicine a challenge. No two people are alike. You can’t treat two individuals in the same way. Doesn’t work.
As usual, thank you for a very interesting post.
Des Spence should be a Health minister or at least a mentor to all health workers …I find his observations of life to be spot on and he continually illustrates the insanity of many aspects of current health care practice …..I love this piece he wrote regarding risk , i hope others enjoy it too.
http://www.bmj.com/cgi/content/full/330/7491/607
Thank you for this post. It came to me through Neil’s Google Reader series.
I have put up a post – http://professionalservicesmanagement.blogspot.com/2008/11/scottish-doctor-reservations-about.html.
If you have time, I recognise that you are busy, I would be interested in your responses to the argument that I am trying to put forward about the need to develop a discipline of pratice that spans professions.