Q J Med 2000; 93: 639-640
© 2000 Association of Physicians
Correspondence |
Consensus strategy in suspected pulmonary embolism
Prescot, Merseyside
Sir,
We congratulate Dr Berghout and his colleagues on bringing some order out of chaos.1 For several years there had been agreement on the diagnostic techniques and treatment (consensus-based strategy), but this was of little value until the policy (guidelines, protocol) was stringently enforced (active implementation).
From 1962 to 1983, we had similar experiences when working in a district general hospital.2,3 We kept to the basics, but tackled widely differing problems; nutrition, asthma, intensive care and organ donation. Prior to 1978, antibiotic prescribing was chaotic. In an attempt to correct this, a total of fifteen policies were devised and distributed throughout the hospital.4 Again, it soon became apparent that these plans would come to nought unless they were enforced. This resulted in rational prescribing, and saved £36 000 in the first year.5
Enforced policies (i.e. rules) lead to the direct benefit of more accurate diagnosis and more rational therapy. In addition, there are indirect benefits. For example, Berghout et al. found that ‘it induces a rapid change in the diagnostic behaviour of physicians.’ This is as necessary today as it was 60 years ago—‘the practice of medicine from its very nature is destructive to consecutive thought ...’6 The methods we used to bring about change may be branded infringement of clinical freedom. Our answer is to quote from Professor J.R. Hampton: ‘clinical freedom is dead and should have been buried years ago.’7
References
1.
Berghout A, Oudkerk M, Hicks SG, Teng TH, Pillay M, Büller HR. Active implementation of a consensus strategy improves diagnosis and management in suspected pulmonary embolism. Q J Med2000; 93:335–40.
2. Gordon IJ, Jones ES. Effective clinical policies in a district general hospital. Health Care Anal1998; 6:295–304.[Medline]
3. Jones ES. Essential Intensive Care. Dordrecht, Kluwer Academic Publishers, 1978:491.
4. Wolfson DJ, Williamson PM. Prescribing restriction: implications and reactions. Drug Intell Clin Pharm1981; 15:594–7.[Abstract]
5. Wolfson, DJ. Financial implications of a set of antibiotic policies. Pharmaceut J1980; 224:706–7.
6. Lewis T. Research in Medicine and other Addresses. London, HK Lewis, 1939:19.
7. Hampton JR. The end of clinical freedom. Br Med J1983; 287:1237–8.
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