before we all get too carried away with this, i would ask a
question:
Can we be sure that a similar "patient" presenting with the
same verbal history would get better service from
alternative (eg face-to-face) consultations?
Remember that the public may feel concerned about the
reported scenario, but they also feel concerned about
recent high profile cases involving clinical practitioners
who made appallingly bad judgements on numberous occassions.
Perhaps a "controlled" trial as has been suggested would be
useful, but the result could just show that you are better
off phoning than consulting your GP. What i think we need
to do is to focus on the client/patient (and i take the
point of looking at a pc screen rather than listening to
the patient, although my GP did this with me a few weeks
back and it did'nt significantly affect the process), and
ensure that clinical decisions are as robust as they can
be, whatever the mode of delivery of advice/interventions
is. This, after all, is what the public and the
professions desire, unfortunately knocking these systems
does instill a sense of distrust in clinicians that is
not really useful or indeed justified.
Dave
On Tue, 8 Aug 2000 09:44:02 +0100 "A.J.O'rourke"
<[log in to unmask]> wrote:
> Thanks to Ted Harding for raising the news story on NHS Direct,
> very pertinent when it gets a big plug in "the NHS Plan" as key to
> the new NHS. Particularly from Ted's message:
>
> > Tailpiece: A spokesman for the NHS Direct setup said that "There were
> > serious design flaws in the study. There was no control, for instance."
> > [Control??? Do the Automobile Association, for instance, need a
> > Control Group when they investigate whether repair garages fail to
> > detect or properly or economically repair deliberately created faults
> > in test cars submitted for overhaul and repair? Forsooth.]
>
> Sounds like the "spokesman" had latched onto a bit of pseudo-
> scientific terminology to try and rebuff a embaraasing report.
> Maybe the ball is in their court to set up a proper study:
> *Research question: do patients using NHS direct have better
> outcomes that those using conventional methods.
> *Outcomes: ??patient satisfaction; resolution of symtpoms
> *Method: random allocation of patients with defined symptoms to
> a control group (?self medicate; ?call GP: ?do whatever you
> would do if NHS Direct didn't exist); intervention group (put through
> to NHS Direct)
>
>
> I have the uncomfortable feeling that because NHS Direct is such a
> flagship, the powers that be will not allow it to fail: they will
> produce an extreme version of the Whig View of history "everyday
> in every way it gets better and better: anything that suggests it
> isn't must be investigated and rebutted."
>
> When I went to a presentation on it in Jan, I recall bits like
> *Increased number of ambulance calls being cited as
> demonstrating its effectiveness (little attempt to decide if the
> ambulance calls were appropriate)
>
> *NHS Direct will go national: the evaluation is not to decide this,
> but merely to inform the final form (i.e we have already decided in
> advance it works: we are just tinkering with the details).
>
> Regards Alan O'Rourke
>
>
> Alan O'Rourke
> Information Officer
> Wisdom Centre for Network Learning
> http://www.wisdom.org.uk/
> Institute of General Practice
> Community Sciences Centre
> Northern General Hospital Sheffield S5 7AU
> Tel: 0114 271 5095 Fax: 0114 243 3762
> E-mail: [log in to unmask]
----------------------
Dave Lloyd
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