Djulbegovic, Benjamin wrote:
> But what is cost-effectivness of the high-power Ferrari teams? The
> ratio must be huge (for comparison, in the American professional
> football there are 20 coaches for 50 players; so, if we are willing
> to pay this much for the sport, perhaps we should be equally willing
> to pay for costs of health care?) best ben
>
Well, I guess that they consider it more cost-effective than having them
working individually. For a small Fiat, however, I agree that a single
mechanic is usually enough (and needed often).
But please consider my first argument:
1) Maybe the use the knowledge to understand the report from the
consultant, but they are not trained to write their own report
2)To obtain what you suggest, one should provide interventions more
directed to acquire competence, rather than aimed to knowledge
As a respirologist, I teach every year to 6 cardiologists (among
others). At the beginning, they already know a lot of theory about blood
gases, but still they want me to write a comment to every blood gas
analysis.
I then gather them in a classroom with a bunch of 50 fabricated blood
gas exams, and ask each of them in turn to give a formal report (first
oxygenation, then ventilation, then gas exchange, last acid/base),
correcting them when needed.
At the beginning they are very uncertain, but at the end of the exercise
they are very good at it. And after, they don't bother me anymore....
Maybe is this the kind of training that should be provided to make
someone autonomous.
cheers,
Piersante
>
> -----Original Message----- From: Piersante Sestini
> [mailto:[log in to unmask]] Sent: Monday, August 31, 2009 3:22 PM To:
> Djulbegovic, Benjamin Cc: [log in to unmask]
> Subject: Re: EBM and increasing requests for the use of
> consultants...
>
> 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
>>>
>
>
|