Intended for healthcare professionals

Letters

Broader definitions of clinical effectiveness are needed

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7008.808 (Published 23 September 1995) Cite this as: BMJ 1995;311:808
  1. Marc Rowland,
  2. John Shanks
  1. General practitioner Jenner Health Centre, London SE23 1HU
  2. Consultant in public health medicine, South East London Health Commission, London SE1 7NT

    EDITOR,--We are impressed with the move to evidence based medicine and clinical effectiveness. We strongly urge that the concept of clinical effectiveness1 should be broad enough to include the alleviation of patients' anxiety and their satisfaction with care, not just improvement in clinical status. This broader view of effectiveness might be termed “doctor effectiveness.”

    The skill of doctors is not only what they do but the way they do it. Spending more time with a patient may be the most clinically effective procedure if they feel a “second opinion” from the accident and emergency department unnecessary, or that they don't need a scan or their prostatectomy yet.

    Primary care has put greatest effort into this area, so far with results that are difficult to interpret. The potential gains include an improvement in patient satisfaction and understanding and a reduction in unnecessary referrals and treatment. Let's look at “doctor effectiveness”--but perhaps someone can think of a better term for it.

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