Be prepaired.
In Holland (and Britain) we face:
-a rise of the number of older patients needing more medical care
-a shortage of GP's, nurses, specialists. To few are alllowed to enter
training.
- Improvements in Medicine . Resulting in more expenses
- people demanding more results in a shorter time
- a government who reduces the amount of money spent on medical care.
All leading to the situation that to many need care and to few who will be
able to afford it.
They -the government- won't dispence the scarce medical product.
So we- the physicians- will be in the frontline and decide who gets what
because of limited resources.
And Trevor is right.
We face this task.
And we will have the dilema.
There is no escape.
Greetings
GF
At 7:17 PM -0500 3/22/98, TreforR wrote:
>Minerva writes in the BMJ 1998 316:948 reporting Sir Douglas Black writing in
>J Roy Coll. Physicians of London (1998;32:23-6) who has some doubts about the
>infallibility of evidence based medicine. He (Sir Douglas) quotes a Robert
>Platt who wrote " The art of medicine remains the art of identifying the
>patients problem (which is something more than merely diagnosing his
>disease.)"
>
>Rationing makes the situation worse. With a shortage of resources, who gets
>the evidence based medicine, or more realistically; which evidence based
>medicine should one choose on a cost limited budget. Statins for secondary or
>primary prevention, or hip replacements or anticoagulation for AF or what?
>
>I have a real fear that the Primary Care groups emerging in the UK will force
>clinicians on the ground into making such rationing decisions. I have resisted
>becoming involved with the rationing of care for 5 years. I have tried to
>apply the reasonable, up to date standards of care with the result that
>despite an 80% generic rate I have exceeded the suggested drug budget every
>year and my drug costs are growing.
>
>I realise that there are no quick fixes, but why should my clinical decisions
>be influenced, not only by the best in evidence based medicine but also by the
>irrational, non evidence based, rationing of care by random events and
>personal prejudices. The patient in front of me deserves the best evidence
>based medicine, but if society cannot afford it, I am surely not the one to
>decide if they get it or not.
>
>Dr Trefor Roscoe
>Beighton Health Centre
>Queens Road, Beighton
>Sheffield S20 1BI
>
>http://members.aol.com/beighton/main.htm
Gerard Freriks,huisarts, MD
C. Sterrenburgstr 54
3151JG Hoek van Holland
the Netherlands Telephone: (+31) (0)174-384296/ Fax: -386249
Mobile : (+31) (0)6-54792800
ARS LONGA, VITA BREVIS
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