It’s the conference season and I seem to have ended up talking a lot with doctors about multimorbidity and polypharmacy. There’s pretty much universal agreement that there is too much medicine. I hear tales of wholesale crossing out of drugs from lists of medicines and how much better everyone is………and I do an “Oh really?” […]
Category: Neal Maskrey
Neal Maskrey: What will replace QOF?
The 2004 UK GP contract contained the Quality and Outcomes Framework (QOF), the boldest pay for performance scheme in healthcare ever attempted anywhere in the world. Eleven years on and its in trouble. The QOF was seen as offering the promise of a quantum change in performance rather than an incremental one. It was driven […]
Neal Maskrey: Words matter
Me and mine all like Claire. She’s talented, works hard, and recently took a big chance going self-employed. It seems to be paying off. We chatted about her imminent holiday, and I was more interested in the plane she was going on than the exotic destination. The latest Boeing 787 is “The Dreamliner.” Carbon fibre […]
Neal Maskrey: Treating the patient and not the disease
It was the biggest turnout for many a year. In our small coastal town in the north west of England, 5000 of us stood together bare headed for an hour on a magnificently clear but cold November morning. The Salvation Army brass band was muted but played beautifully, and there was pomp and circumstance aplenty. But […]
Neal Maskrey: How do we become an expert?
We humans often use analogies to help us solve problems. From our memory, we identify a problem similar to—but not exactly the same as—the one we are currently faced with, and apply the previous successful approach to the new problem. It’s called analogical reasoning. Sometimes we get great results, sometimes not so much. I recently […]
Neal Maskrey: When paradigms shift
When paradigms shift it’s always disconcerting. Thomas Samuel Kuhn published The Structure of Scientific Revolutions in 1962 and it’s become a decisive text on the nature of science. He used the term “paradigm” to describe the belief system that underpins puzzle solving in science. Far from discovering any absolute “truth,” normal science progresses routinely within […]
Neal Maskrey: Tipping the balance towards individualised care
I don’t really get the horror genre. Even as a young boy, the flaky plots and a world working to different rules than the one I was becoming more familiar with every day all seemed laughably improbable. Science takes us incrementally and logically from one discovery to another, building on the shoulders of giants. In […]
Neal Maskrey: Feeling the force of the QOF
It’s the season for graduation ceremonies. Proud parents and partners, relieved graduates, and a lump in everyone’s throat as that enormous rite of passage is eased by impressive ceremony, thoughtful words, cheap university wine in plastic glasses, and finally by long, late, cheerful family lunches. My generation began their medical careers in a different world, […]
Neal Maskrey: The importance of kindness
We seem to have a little hit on our hands. The BMJ published our Analysis article “Evidence based medicine: a movement in crisis?” and within a few days, the social media channels were humming. Returning to the original concept of EBM, which was all about the holistic care of individual patients, seems to have struck a […]
Neal Maskrey: Seeing the world through a patient’s eyes
Captain Hawkeye Pierce of the 4077th MASH unit is one of the great fictional doctors. Battered by the US army, and brutalised by death and disfigurement in a war far from home, he made mistakes, he was human, he cared. We laughed, cried, and loved him. Alan Alda and the rest of the cast of […]