Regarding evidence-based approaches and tension between the clinical practice vs. healthcare commissioning perspectives, our sector is not the only nor even the first to investigate this conflict. Is there good evidence to suggest that asking GPs to serve as the unpaid gatekeepers of health care systems works? Perhaps it is more reasonable to expect them to advocate for individual patients while those in public health advocate for individual populations, both using critical appraisal of pertinent evidence?
Recent comments posted by list members bring to mind what a colleague in public administration wrote a few years ago in reference to a 1980 paper: "Why should a father in his family and a government in Ottawa agree on proposed action in the face of risk? If they don't, why should a father acquiesce?" One of his several other publications provides an interesting overview on this clash of perspectives in search of ways to make analytic approaches helpful (Dobel R. The Arithmetic of Risk: Analytical problems and political solutions. POLICY OPTIONS 1980;4(2):53-58.).
As the cliche states, data unites - theories divide.
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David Birnbaum, PhD, MPH
Adjunct Professor
School of Nursing
University of British Columbia
Principal, Applied Epidemiology
British Columbia, Canada
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