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what sort of evidence do we need in medical regulation ?
- Oliver R Dearlove (10 April 2006)
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Oliver R Dearlove, Consultant Anaesthetist Royal Manchester Children;s Hospital M27 4HA
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I would not dream of saying I told you so Criticism that starts off as off-the-wall, becomes the orthodox line. This is not the first time something like this has happened. When Dr Godlee’s predecessor embraced without question, the principle of Evidence Based Medicine, various persons such as myself (1), asked what evidence there was, that evidence based medicine worked. You can read the shocked replies that of course it did or of course it must do (2). At that time, there was no evidence. Even now, Hospitals do not advertise, “we practise EBM and our patients do better.” The data base of EBM in surgery is very small. There is a clear parallel with regulation. We doctors who pay for regulation are asking the GMC what evidence there is that the measures to be used for revalidation will actually achieve their objects in selecting “a good doctor”. Sir Donald Irvine says that everyone wants a good doctor but hasn’t told us anything about how to achieve it other than that things were better when he was president. (3) We could do it like Modernising Medical Careers, and try it and see – in the case of failure only the juniors doctors will suffer and no-one cares about them. However readers may realise that in both the PMETB and MMC, the politicians’ eye was not on the product of better doctors or better trained doctors, but more on introducing change whatever. Of course saying, “We have no idea if it works or not. Lets try it anyway!” is OK in doctors’ training or doctors’ regulation but may not be acceptable to patients when it comes to their health care. Ten years ago Dr Colovic [personal communication] commented that after a randomised controlled trial, what one really needed to do what try it on a large series of one’s own patients and audit the results. The results should reflect the treatment group in the trial. If they do not they at least one has the answer that it is not helpful in one’s own local population. And now here is an editorial saying exactly that. It seems obvious that RCTs are but one way of showing the way forward. What you really need is how it will affect ones own case – but it has taken 12 year for the intellects to realise it. This editorial is a good start. Oliver R Dearlove FRCA These views are my own. I have been peripherally involved in drug trials and centrally involved in several GMC cases. Drug trials for all their myriad defects are probably conducted better, although in both cases you frequently don’t get near the truth.. Refs 1. Dearlove O Sharples A O’Brien K Dunkley C Evidence based Medicine, British Medical Journal 1995 311 257-8 2.Rosenberg W Donald A Authors reply BMJ 1995 311 259 3.Irvine D – a short history of medical regulation Medical Education 2006 40 202 et seq Competing interests: as script |
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