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 […]
Category: Columnists
Richard Smith: How to fill the void of evidence for everyday practice?
Some even most (depending on how you measure it) of what doctors do lacks strong evidence. Even when evidence exists it often doesn’t seem to be relevant to doctors—because their patients or their circumstances are so different from those in the trials that produce the evidence. This is especially true in low and middle income countries […]
Jeffrey Aronson: When I use a word . . . Get shorty
Abbreviation of a word or phrase to a letter or two is the most extreme form of breakage that it can undergo. The process has variants: initialisms, contractions, and acronyms. An initialism is a single letter standing for a whole word, or a string of such letters. B, for instance, stands for bachelor, baron, and […]
The BMJ Today: Patient centred outcomes research
• A research paper looks at the association between warfarin treatment and longitudinal outcomes after ischaemic stroke in patients with atrial fibrillation in community practice, using a large registry of patients admitted to US hospitals with acute ischaemic stroke. The study found that new prescription of warfarin in patients with atrial fibrillation after stroke was associated with […]
Jeffrey Aronson: When I Use a Word … Backslang
Back-formation , forming words by shortening other words, should not be confused with backslang, the formation of words, not by breaking them up, but simply by reversing them. A yob is a [backward] unruly boy. Naff, as in “naff off”, may be from fanny, the back or front version, but could just be a variant […]
Richard Smith: Science and journalism threatened in the high court
I wrote this piece some six weeks ago after giving evidence in a libel case reported by The BMJ and published on 30 July 2015 . I’ve had to wait until the case was over to post the blog. I’ve just finished giving evidence for a day and a half in the high court in […]
Jeffrey Aronson: When I use a word . . . Back breaking
Words typically develop from a root of some sort, and derivatives are formed from a primary word by changing or adding something. You can do this in many ways. You can form adjectives, for example, from other words by adding prefixes or suffixes, such as un– and dis–, or –ed, –ful, –ive, –less,–y, –ic, –al, […]
William Cayley: Ethics and professional wisdom
The recently publicized news that the American Psychological Association (APA) “colluded” with US governmental agencies to create ethical guidelines permitting psychologists to participate in “harsh interrogations” of military detainees is appalling. According to the APA’s own press release, the guidelines were “based at least as much on the desires of the US Department of Defense as […]
Billy Boland: Time for a new definition of quality?
I’ve been troubled by our modern concepts of quality in healthcare recently. In these austere times, we are all taking a harder look at the care we deliver and are asking ourselves, is it worth it? Driving down cost to improve services is widely recommended and pursued. Donald Berwick’s “Triple Aim” of improving services involves […]
Richard Smith: Making patient data available—the risks are easy to understand, the benefits opaque
“We seem to spend all our time talking about the downside of making patient data available and little about the upside,” said a frustrated researcher at last week’s Sowerby eHealth Symposium organised by Imperial College’s Institute of Global Health Innovation. The problem seems to be that the downside—somebody’s health records being made public—is horrible, concrete, […]