quinta-feira, setembro 27, 2007

getting better

Doctor, am I going to die? And other important questions

GONE are the days when patients of the National Health Service expected doctors to decide which treatment they would have, and where. Today's patients are meant to make up their own minds. Convinced that consumer choice is the key to improving health care, in 2005 the government launched “Choose and Book”, a computerised system that patients and family doctors could use together to select health-care providers.
But take-up has been disappointing. Only 40% of referrals are now made this way, far short of the government's target of 90%. Doctors say the system is slow and hard to use. In June the acting chairman of the British Medical Association described it as a “chaotic shambles”.
Such problems are worrying but should, over time, be fixable. More serious is the fact that patients—and indeed family doctors—lack much useful information on which to base their choices. Specialists do not have to make public how well they perform the treatments prescribed, and often do not know themselves how they measure up.
Slowly, this information drought is easing. Last year hospitals that perform heart surgery began publishing survival rates, along with the rates that, on Europe-wide calculations, they would have expected given the particular patients they treated. (The old and sick, unsurprisingly, usually fare worse, no matter how skilled the surgeon.)
Heart surgeons have taken a lead for two reasons. One is that results are easy to measure: a surgeon whose patient survives has already provided a significant proof of competence. The other is that the specialty was shaken by the findings in 2001 of an inquiry into the deaths of heart patients at Bristol Royal Infirmary. It concluded that between 1984 and 1995 at least 30 children died because of the unit's poor standards, and that although concerns had been raised repeatedly, nothing had actually been done.
Officials are working to offer similar information in other areas. June saw the launch of NHS Choices, a website where patients can compare health-care providers on several measures, so far mostly matters such as waiting lists and cleanliness rather than success rates. By April 2008 it will cover all specialties, and frantic work is being done to provide meaningful indicators in fields where mere survival is not a useful measure.
Some worry that there will be unintended consequences, no matter how carefully data are adjusted to account for differences among the patients treated. They point to school league-tables, which are often blamed for encouraging schools to push pupils towards easier subjects and to manipulate admissions so as to get rid of hard-to-teach children. No doubt there will be teething troubles. But patients need objective information if they are to take charge of their medical destinies and, incidentally, improve the country's health care with it.
The Economist 30.08.07