Health Care - the Wrong Metrics

Today the BBC reports that the the Government intends to reduce the waiting lists for patients. Whilst the sentiment is right (everyone would like to see fewer ill people around) the approach is wrong. The government should not be measuring the length of the queue, but should be looking at the repeat visits. It is incredibly easy for a Doctor to see a large number of patients and prescribe drugs to treat the condition (take Asthma for example where inhalers that are very expensive and not as effective as other treatments) rather than spending more time to understand the cause to reduce or ideally eliminate the need for the poor patient to return to the surgery.

We must encourage the Doctors to investigate the underlying cause and treat that instead of fobbing patients off with ineffectual treatments for symptoms in the hope that the problem will go away. There are too many people with chronic problems that really should not be the case.

Measuring the number of repeat cases will quickly help to understand if the treatments are addressing the cause or symptoms.

 

Review of Scientific Work

In the UK the law-makers (our MPs) have looked into the publication of scientific work and believe that the peer-review process can be improved. This is sensible as there is a lot of work being produced that needs objective assessment. They unfortunately also suggest/recommend formal training. This is very disappointing as this will do nothing to improve the review process.

Most journals or conferences provide guidelines for a reviewer and the review process IS ALREADY part of the training of all researchers. When one takes a degree or PhD one is encouraged to assess work of ones peers critically and objectively in order to understand the relevance of ones own work in that area. 

Formal training in this case will do nothing to help apart from waste more of the dwindling pot of money allocated to research and, what is even more worrying, waste researchers time.

 

Insurance

I have come to realise that I don't understand insurance. Not at all. Let me try to explain it to you. First, we take out insurance on an item in the unlikely event that something bad will happen to it. Now, any right-minded person would say that the unlikely event is perhaps so remote that spending a non-negligible amount of money to someone is perhaps foolish. 

Then there is the argument that perhaps the negligible event is so catastrophic that it would cost a lot to recover the item. And, there are lots of examples of terrible events around the world that we would be even more foolish not to insure against those events. That may be. But, in those places that have had terrible events the insurance is, well, prohibitive and only in places that will never suffer those events is the insurance affordable.

So, I have come up with a question that should help you and your insurance racketeer to assess whether it makes sense to insure your item or whether it make sense to use the money yourself for something more sane:

1) Is the probability of a whale destroying my item greater than the event for it is to be insured against?

1a) If so what is that difference in probability and what is the error?

Did you vote for this?

I've been thinking. These days we vote not just for policies (in most cases that doesn't even enter into the equation), but we vote on a person's personality and popularity. The Italian prime minister Mr Berlusconi is a case in point. Many vote not for the policies, but the person. They vote for the person.

Why not? That seems as good a reason as any. But, Mr Berlusconi has had the builders in. He has had some work done. He has false teeth, nose-job, face lift/tuck, someone else's hair, etc. There is so much change that there is the real question as to whether the person that is currently occupying the bedrooms in the prime minister's residence in Rome is the same one that won the election. In fact, one could argue that perhaps the person needs to be relected since most people voted on his personality to understand whether that personality is still in fashion/favour.

The Italian public need to call for an election to see if the new clown is the same or better than the old  clown that was voted in. In fact, perhaps there needs to be an election after each piece of work that is done. At some point there is the real danger that Mr Berlusconi will cease to be human and Italy will have voted in the first extra-terrestial as head of government. 

We watch with interest.

Power and Responsibility

What are we doing when we vote? From what I understand what we are doing is attempting to select a body that best fits our own personal needs. In the case of governments we hopefully vote for the group who's manifesto best suit our current and predicted needs. Once we've voted the party that wins has an obligation to implement its manifesto as best it can - and deviations from that manifesto must be explained to the general public.

The party that wins should not view themselves as being in power, but should view themselves in a position of great responsibility to do their uttermost to implement the manifesto on which they were elected.

So, it is terribly disappointing - in fact it's very disturbing to see politicians believing that they are 'in power' (see for example this article) because this belief manifests itself as an implementation of policies that nobody voted for with little explanation to the general public. It manifests itself as a disenfranchisement (perhaps ostracization is a better word) of the general public who feel the government is disconnected from the people that put it there.

So, for me it would be very welcome to see the politicians start to use words (ideally with conviction) that show that they recognise what a government is supposed to do.