Djulbegovic, Benjamin wrote:
> No doubt what you described is likely one of the reasons for
> increasing use of referrals. However, our (educational)
> organizational structure is such that we are still insisting on
> individual physicians proficiency (e.g. typically in the US you need
> at least 30-50 annual CME, take your specialty exam every 7-10 years
> depending on your specialty etc). So, tremendous effort goes into
> building your individual knowledge base in order to refer your
> patient to a number of other consultants? ben
>
>
Well, I guess that all the effort will come useful to understand the
report from the consultant.
It is possible that all this effort is more about reading and
appraising, rather than writing their own report. That is, as you say,
about knowledge rather than about building skills.
About the balance between time and variety of patients, I don't know if
there is any relevant data available.
From other types of business, it seems that a good team is more
efficient than many independent workers. Think of the Ferrari racing
team, where each one has a very specific and limited task, but still the
"patient" (the racing car) is at the center of the process.
And sure, while each member of the team is highly responsible for his
task, still must have a full understanding of what the others do.
regards,
Piersante Sestini
> -----Original Message----- From: Piersante Sestini
> [mailto:[log in to unmask]] Sent: Monday, August 31, 2009 2:41 AM To:
> Djulbegovic, Benjamin Cc: [log in to unmask]
> Subject: Re: EBM and increasing requests for the use of
> consultants...
>
> I am not sure whether the number of referrals did increase in Italy
> over the last 10 years, but they certainly did enormously over the
> last 20 or 30 years. As you suggests, this has more to do with the
> way the health industry works that with the availability of
> systematic reviews and guidelines. Medicine is less and less seen as
> an individual business and more as a collective, interprofessional
> teamwork. The reason is probably the same that lead to the success of
> EBM: the enormous increase in information to be managed and of needed
> skills.
>
> If a physician has to care for many patients with a large variety of
> possible disorders, she cannot get enough expertise on most of them
> to be confident to treat them, even if she has the time of reading
> some relevant guidelines: you don't get skills by reading a
> guideline. Of course, no conscientious physician would treat a
> patient just based on a quick browsing through a guideline and a few
> checklists, without having a good confidence of her skills and
> understanding of the underlying condition.
>
> Thus, IMHO guidelines are more likely to be useful to improve the
> practice of different teams, than to be used by every single
> physician of each team.
>
> regards, Piersante Sestini
>
>
>
>
>
>
> Djulbegovic, Benjamin wrote:
>> Dear all
>>
>> It has been my impression that the rise of EBM (along with
>> proliferation of systematic reviews (SR) and guidelines, critical
>> attitudes toward health care claims etc) has not reduced the
>> requests for the use of experts (consultants). Paradoxically, the
>> last decade has seen ever increasing use of consultants. In the US,
>> at least, an explanation for this trend in ever increasing requests
>> for "consults" is related to the incentives to see more and more
>> patients with the consequence that doctors do not have time to look
>> up the guidelines, SRs etc. As a result, doctors just ask for yet
>> another consult. I wonder what has been trend in other countries?
>> Do physicians elsewhere also consult more often than, say, 10 years
>> ago? If yes, why is this so? What is the purpose of developing all
>> these guidelines if only experts will use them (and who will
>> typically deviate from the guidelines)? What is an average number
>> of physicians that the patients typically see?
>>
>> I would appreciate some thoughts on this issue, which is actually
>> not a trivial one as it may appear on the first blush.
>>
>> Thanks
>>
>> ben
>>
>> Benjamin Djulbegovic, MD, PhD
>>
>> Professor of Medicine and Oncology
>>
>
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