Friday, June 20, 2008

Getting a Seat at the Table

Quote of the day:
To invent, you need a good imagination and a pile of junk. - Thomas A. Edison

This from Consumer's Health  Care Choices

"There can be no more compelling testimony on what physicians are facing than the farewell address by Doctor Ian Bogle, when he stepped down as Chairman of the British Medical Association on June 30, 2003. The speech is really quite poignant because he indicates that physicians in Great Britain made the same mistakes that American physicians are in the process of making.

He says, "I accept, like all of us do, that national standards, quality markers and assessment of individual and team performance are essential in a modern, patient-centered NHS."

But this acceptance, the desire to get-along-by-going-along, the desire to "have a seat at the table," is precisely what brought about the bone-crushing regimentation of Medicine he bemoans in the rest of his talk.



Doctor Bogle goes on to describe what medicine is like in the UK Today -

  • Ministers and managers have muscled in on the doctor-patient relationship, and we now have a healthcare system driven not by the needs of individual patients but by spreadsheets and tick boxes.
  • Clinical decisions have been taken out of clinicians' hands and the fundamental NHS principle of care based on need and need alone has been superseded by the principle of care based on numbers.
  • Targets are set nationally without any appreciation of what they might mean for individual doctors sitting in consulting rooms with individual patients
  • If you set targets for the treatment of one group, you automatically disadvantage others whose clinical need may in fact be greater.
  • If you set targets for access to services, you encourage those providing the services to give more thought to throughput of patients than to what is actually wrong with those patients and what their individual treatment needs are.

It is an eloquent statement that should be must-reading for anyone in health policy today. But it must be said that all this was brought on by the naiveté and credulousness of Dr. Bogle and the British Medical Association that persists today. They continue to "accept national standards, quality markers and assessment of individual and team performance." And that is what enabled the bureaucrats to tell them how to practice medicine. It is the exact same mistake the AMA is making today - sacrifice your principles to "get a seat at the table."

British Medical Association.

Readers will find much more at Consumer's Health Care Choices

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