Mange foretrekker å ha kontroll over sin egen pasientjournal. Ill.foto: Bluberries, iStockphoto
Ph.d.stipendiat og spesialsykepleier i geriatri, Torunn Wibe, har som et ledd i sitt doktorgradsarbeid om ulike måter for pasientene å tilegne seg ny kunnskap om egen helse, skrevet diskusjonsartikkelen ”Why do people want a paper copy of their electronic patient record?”.
En av hovedårsakene til at pasienter ber om kopi av pasientjournalen, er at de vil forsikre seg om at viktig informasjon om deres helse virkelig blir utvekslet mellom helsepersonell. Det kan gjelde informasjon innen sykehuset, mellom sykehus og mellom sykehus og fastlege – eller ekstern spesialist.
Des Spence er allmennpraktiserende lege i Glasgow.
Recently I spoke at a conference on implementing evidence based medicine. In particular, I asked why the robustly evidenced NHS quality and outcomes framework (QOF) has had no effect on outcomes. Is there something wrong with evidence based medicine? I opened the presentation to the floor to list the hidden weakness of “evidence.”
Commissioning bias— “No research, no evidence” is the most basic flaw of all. Drug companies are the only organisations with the resources and incentives to conduct research, so therapeutics dominate all evidence based medicine. And the industry investigates a disease only if it can apply for a drug patent—“patentability bias.”
Study design—Study populations are biased by design. Only high risk, unrepresentative populations are studied because they are the most likely to show an effect. These data are then extrapolated to low risk populations of people who never benefit—statins are studied in Scotland and prescribed in Surbiton. The inverse care effect also means that people at low risk are more likely to seek treatment and comply with it.
Changing epidemiology—For example, the number of deaths from stroke is 10% of what it was 40 years ago. We have witnessed a change in the natural history of this condition. Therefore the numbers needed to treat are potentially 10 times higher today than in 1970. This is true of cholesterol, osteoporosis, and the rest. Our evidence is out of date.
