BMJ should notify doctors whose practice is criticised in interactive
http://www.100md.com
《英国医生杂志》
EDITOR—The BMJ recently published an interactive case report from a general practitioner about a patient with itching and gall stones.1 2 Readers were invited to comment on the case using the rapid response feature on bmj.com, and three weeks later the outcome and summary of the responses were published.3
From the responses posted from three continents the interactive case report was educational and can be judged to have been successful. Naming the patient and giving the general practitioner's address essentially identified the hospital responsible. But we, the hospital clinicians involved in the secondary care of the patient, were neither consulted nor informed that the case was to be published. Is this fair or wise?
Some of the comments addressed the diagnosis. Well and good. Some respondents criticised the advice given by one of us to the general practitioner. The patient received a diagnosis and treatment within 17 days of the general practitioner contacting the hospital. Do the respondents truly believe that this is an inadequate service? Or were their remarks made without knowing the facts? If so, is the format of the interactive case reports satisfactory?
The patient reported her experience. The BMJ and we agree that we cannot make available the clear hospital documentation of the information provided, or our views of the exemplary care offered by the specialist registrar, because of the laws of patient confidentiality.4 These preclude us from answering some of the criticisms expressed.
The week after the case report finished Smith praised the ethos and working of the NHS in Editor's choice.5 The interactive case report provoked international criticism of the care we provided under the NHS. The service of all health care should be examined critically, but we believe those who criticised our management did so without adequate information. That they were prepared to openly publish judgments while ignorant of all the facts suggests a lack of intellectual rigour. That the BMJ enabled them to do so is deplorable.
To have the care you offer openly and internationally criticised when you have not been invited to inform the debate is most disheartening.
John Hunt, consultant gastroenterologist
john.hunt@bromleyhospitals.nhs.uk
Maxwell Asante, consultant gastroenterologist, Shamsi El Hasani, consultant surgeon
Bromley Hospitals NHS Trust, Princess Royal University Hospital, Farnborough Common, Orpington, Kent BR6 8ND
Competing interests: None declared.
References
Heathcote J. Interactive case report. Abnormal liver function found after an unplanned consultation: case presentation. BMJ 2004;329: 273. (31 July.)
Heathcote J. Interactive case report. Abnormal liver function found after an unplanned consultation: case progression. BMJ 2004;329: 342. (7 August.)
Heathcote J. Interactive case report. Abnormal liver function found after an unplanned consultation: case outcome . BMJ 2004;329: 500-3. (28 August.)
Hunt J. My perspective as the gastroenterologist for the patient. Electronic response to: Abnormal liver function found after an unplanned consultation: case outcome. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7464/500#74122 (accessed 3 Feb 2005).
Smith J. Editor's choice. Why Britons should be grateful for the NHS. BMJ 2004;329: 0. (4 September.)
From the responses posted from three continents the interactive case report was educational and can be judged to have been successful. Naming the patient and giving the general practitioner's address essentially identified the hospital responsible. But we, the hospital clinicians involved in the secondary care of the patient, were neither consulted nor informed that the case was to be published. Is this fair or wise?
Some of the comments addressed the diagnosis. Well and good. Some respondents criticised the advice given by one of us to the general practitioner. The patient received a diagnosis and treatment within 17 days of the general practitioner contacting the hospital. Do the respondents truly believe that this is an inadequate service? Or were their remarks made without knowing the facts? If so, is the format of the interactive case reports satisfactory?
The patient reported her experience. The BMJ and we agree that we cannot make available the clear hospital documentation of the information provided, or our views of the exemplary care offered by the specialist registrar, because of the laws of patient confidentiality.4 These preclude us from answering some of the criticisms expressed.
The week after the case report finished Smith praised the ethos and working of the NHS in Editor's choice.5 The interactive case report provoked international criticism of the care we provided under the NHS. The service of all health care should be examined critically, but we believe those who criticised our management did so without adequate information. That they were prepared to openly publish judgments while ignorant of all the facts suggests a lack of intellectual rigour. That the BMJ enabled them to do so is deplorable.
To have the care you offer openly and internationally criticised when you have not been invited to inform the debate is most disheartening.
John Hunt, consultant gastroenterologist
john.hunt@bromleyhospitals.nhs.uk
Maxwell Asante, consultant gastroenterologist, Shamsi El Hasani, consultant surgeon
Bromley Hospitals NHS Trust, Princess Royal University Hospital, Farnborough Common, Orpington, Kent BR6 8ND
Competing interests: None declared.
References
Heathcote J. Interactive case report. Abnormal liver function found after an unplanned consultation: case presentation. BMJ 2004;329: 273. (31 July.)
Heathcote J. Interactive case report. Abnormal liver function found after an unplanned consultation: case progression. BMJ 2004;329: 342. (7 August.)
Heathcote J. Interactive case report. Abnormal liver function found after an unplanned consultation: case outcome . BMJ 2004;329: 500-3. (28 August.)
Hunt J. My perspective as the gastroenterologist for the patient. Electronic response to: Abnormal liver function found after an unplanned consultation: case outcome. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7464/500#74122 (accessed 3 Feb 2005).
Smith J. Editor's choice. Why Britons should be grateful for the NHS. BMJ 2004;329: 0. (4 September.)