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What (exactly) are we paying our doctors for?

Regular readers will know that I have often asked why doctors fail to follow national guidance when diagnosing and treating patients. The most glaring example of this is the persistence of GPs in prescribing anti-psychotics to people with dementia even though study after study has shown that doing this significantly shortens life and that the latest national guidance is very clear that such medication should only be used when there is clear evidence of psychosis in addition to dementia. There are many, many areas where evidence-based best practice is not followed by some clinicians. At first I attributed this to professional arrogance ("I've trained for x years and practised for even longer, I don't see why my practice should change just because of some quango") but I've now come to the unfortunate conclusion that this is also down to laziness.

This realisation has been prompted by recent work at hospitals run by North West London Hospitals NHS Trust which has now been published by the British Medical Journal. Care bundles were introduced into the hospitals in the hope that following these would reduce death rates. Care bundles are an American innovation consisting of a checklist for a particular condition. I assumed that these would be fairly technical and detailed but in fact they contain a step-by-step list of things that should be done. Bundles relating to the following conditions were used-

central venous catheter/line asepsis;
diarrhoea and vomitting;
stroke;
ventilator acquired pneumonia;
meticilin resistant staphylococcous aureus infections
heart failure;
surgical site infections;
chronic obstructive pulmonary disease.

The bundles were introduced in 2007-8 and resulted in 174 fewer deaths from the targeted conditions than the year before (the overall reduction across the Trust was 255). This represents a 14.5% decrease in actual deaths. This is obviously good news and it shows that following basic clinical standards has a beneficial effect. The question that needs to be asked is why do highly trained (and paid) doctors need a check-list to get them to practice as they should? Should we as both patients and taxpayers be content with highly paid professionals behaving in a way that leads to avoidable (ie needless) deaths. The care bundles are not overly detailed, nor do they contain complex/ambiguous information, it is frankly unacceptable that we should continue to revere those practitioners that behave in such an arrogant and negligent manner.

I am happy to accept that some doctors and consultants practice appropriately and pay close attention to accepted best practice. The huge variation in hospital mortality figures around the country demonstrate that many doctors simply can't be bothered.

John Armstrong. Benefitsnow Ltd. April 5th 2010.

Comments

At 10/07/2010 8:38:36 AM