"Arrogant doctors" not to blame for variability in drug prescribing
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《英国医生杂志》
The national cancer director, Professor Mike Richards, defended doctors against the charge that their "arrogance" was to blame for the variability in cancer drug prescribing, when he appeared before the Public Accounts Select Committee last week.
Gerry Steinberg, Labour MP for the City of Durham, said that, in his view, doctors were "very arrogant" and that variability in prescribing was due to the fact that they thought they "knew best."
But Professor Richards denied the charge. "The culture among doctors has changed from one of paternalism to working in partnership with patients," he said.
Under questioning from the committee, Professor Richards conceded that differences in cancer survival rates and new drug prescribing between England抯 34 cancer networks were unacceptable, but said that doctors?prescribing habits was just one factor that accounted for the variability (19 June, p 1453).
In response to a question about the future of cancer care in England from Edward Leigh, the select committee chairman, Professor Richards said, "I think there will be further improvements in mortality and survival rates. I am confident because of the reduction in smoking prevalence and the introduction of bowel cancer screening."
Professor Richards told the committee that he expected to see a 20% reduction in the death rate, shorter waiting times, a reduction in drug prescribing variability, patients with more information, and, since survival rates were improving faster, that England would close the gap with other European countries in survival rates.
Several MPs were concerned about the variability between poorer and more affluent parts of the country. Edward Leigh asked, "Does this mean the NHS is not doing enough for people in deprived areas?" Professor Richards agreed that the gap in survival rates had widened but that rates were better across the board and that smoking related cancer was a key factor in the disparity.
Jon Cruddas MP referred to concerns raised by the Men抯 Health Forum about the specific health needs of men, and asked whether it was right that there were no male-specific cancer targets or male outreach strategies. Professor Richards said that the most common cancers affected both sexes and there had been campaigns on prostate cancer, but it was important to look at how to reach different groups.
When asked about the problems of staff shortages, Professor Richards said that there was a "bottleneck" in the system but, "We have increased the number of people in training, and I am confident that the number of radiographers will go up."
Professor Richards was appearing alongside Sir Nigel Crisp, NHS chief executive, as the Public Accounts Select Committee took evidence on the National Audit Office report Tackling cancer in England: Saving More Lives (BMJ 2004;328:659)(BMJ Bruno Rushforth)
Gerry Steinberg, Labour MP for the City of Durham, said that, in his view, doctors were "very arrogant" and that variability in prescribing was due to the fact that they thought they "knew best."
But Professor Richards denied the charge. "The culture among doctors has changed from one of paternalism to working in partnership with patients," he said.
Under questioning from the committee, Professor Richards conceded that differences in cancer survival rates and new drug prescribing between England抯 34 cancer networks were unacceptable, but said that doctors?prescribing habits was just one factor that accounted for the variability (19 June, p 1453).
In response to a question about the future of cancer care in England from Edward Leigh, the select committee chairman, Professor Richards said, "I think there will be further improvements in mortality and survival rates. I am confident because of the reduction in smoking prevalence and the introduction of bowel cancer screening."
Professor Richards told the committee that he expected to see a 20% reduction in the death rate, shorter waiting times, a reduction in drug prescribing variability, patients with more information, and, since survival rates were improving faster, that England would close the gap with other European countries in survival rates.
Several MPs were concerned about the variability between poorer and more affluent parts of the country. Edward Leigh asked, "Does this mean the NHS is not doing enough for people in deprived areas?" Professor Richards agreed that the gap in survival rates had widened but that rates were better across the board and that smoking related cancer was a key factor in the disparity.
Jon Cruddas MP referred to concerns raised by the Men抯 Health Forum about the specific health needs of men, and asked whether it was right that there were no male-specific cancer targets or male outreach strategies. Professor Richards said that the most common cancers affected both sexes and there had been campaigns on prostate cancer, but it was important to look at how to reach different groups.
When asked about the problems of staff shortages, Professor Richards said that there was a "bottleneck" in the system but, "We have increased the number of people in training, and I am confident that the number of radiographers will go up."
Professor Richards was appearing alongside Sir Nigel Crisp, NHS chief executive, as the Public Accounts Select Committee took evidence on the National Audit Office report Tackling cancer in England: Saving More Lives (BMJ 2004;328:659)(BMJ Bruno Rushforth)