Word of the week; Thursday, Thursday
As a committement to the young clinicians of 2040 I will post a key term every Thursday. These will be from the Better Healthcare Glossary and present examples of the terms in use, often with more than one example of a single term, following the principles of my heroes Ludwig Wittgenstein and James Murray. Unlike Murray i wll not attempt to write my own definition but I may include an example from my own published work if i cannot find a suitable example from another author; this is very uncommon
Following the first meeting of 2040 here are some networking terms
Network and node
“a network is a set of interconnected nodes. A node is a point where the network intersects itself. A network has no centre, just nodes. Nodes may be of varying relevance to the network ..A network is defined by the programme that assign the network its goals and rules of performance . The program is made up of codes that include the valuation of performance and criteria for success or failure”.
Networking
“Networking is a broad concept referring to a form of organized transacting that offers an alternative to either markets or hierarchies. It refers to transactions across an organization’s boundaries that are recurrent and involve continuing relationships with a set of partners. The transactions are coordinated and controlled on a mutually agreed basis that is likely to require common protocols and systems, but do not necessarily require direct supervision by the organization’s own staff.”
Source: Child, J. (2005) Organization. Contemporary Principles and Practice. Blackwell Publishing. (p.15).
I will be doing a webcast on 2040 from the RSM tomorrow (thurs 29th) at 3.30pm please joins us on the web and distribute to others who may be interest please click here to book on
the bookshop is now open
please browse around the bookshop but we do not yet have the shelves and the reviews organised
The reason I want to see more information for patients and to be cautious about the growth in medical intervention rates is not to do with money but with ensuring that the patient gets all the information they need to make the right decision
i was taught that we should always operate on hernias; theevidence is different now
‘a strategy of watchful waiting is a safe and acceptable option for men with asymptomatic or minimally symptomatic inguinal hernia’
‘Fitzgibbons RJ et al (2006)
watchful waiting vs repair of inguinal hernia in minimally symptomatic men
jama 295; 285-292
‘surgeons are increasingly appreciating that chronic pain after hernia repair may affect 5 to 20% of patients and occasionally requires chemical or surgical neurectomy’
Flum d r
the symptomatic hernia; if it’s not broken dont fix it
jama 295 328 329
‘Axe falls on NHS services’
S Telegraph headline but it is not all about money. Foer me it is about appropriate care; some people are getting operations with a low probability of benefit, a probability of harm , and they dont know it when they consent to treatment- more is not always better
SS2
Staring things stopping, is very difficult to do from outside the clinical professions but doctors are pretty good at doing it them selves whaen they are motivated to do so . This isone reason why we want to introduce programme budgetting to get better value investment; high value in lower value out
Here is a picture of a system
SS1
stopping things starting
I am not a Luddite and welcome innovation but the innovation should
1. conform to conventional standards of cost effectiveness
2. be funded by reducing interventions of lower value for the same group of patients
SS SS SS SSR
Life in commissioning consists of
Stopping things starting
Starting things stopping
Stopping things stopping
Starting things starting right
This is what population medicine is
Population medicine is a way of clinical practice , analogous to evidence based or patient centred care in which the clinician has a concern for the population they serve that is of equal intensity to their commitment to the individual patient. Just as they feel responsible for providing safe, effective and empathetic care to the individual the clinician feels responsible for making the best use of the resources available for all the people with the health problem for which they have expertise in the population they serve.
