Declan wrote:
>snip<
>As for EBM? Been there, did all that years ago, moved to GP and saw that
>life was not black and white like it is in RCT land and realised that such
>heresies as learning by anecdote, sometimes putting the patient's feelings
>ahead of the medicine and varying the treatment according to the
>circumstances were not only permissible but also necessary.
One of the quintessential properties of a good 'healer' regardless of school
of 'medicine' followed, is the appreciation of a human person and his/her
particular condition that result in a successful 'treatment'.
Patient-centred does not preclude applying the principles that we can learn
from EBM, it's the degree to which we pursue them that matters.
I imagine an NHS lite to evolve from a core of guideline based therapies,
limited generic prescribing (to curb cost) and first point of access to be a
nurse practitioner, who can then triage to GP consultation as necessary
(following protocols, of course).
Whether or not the patient would find this objectionable will depend on the
skill of the consulter and matching each others' demands, I.e. very little
to do with their current perception of primary care.
In short, NHS lite can be as black and white as we wish, but for the
infinity of grey in between there is a price. We have to choose if we are
prepared to pay it, because it seems we can no longer afford to provide it.
Regards
Anita
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