Well Mac, it's difficult to add to that.

what exactly does that mean ?


I guess that we could argue about the merits of critical appraisal all day.

I must say, I do feel a little bruised at the suggestion that the quality of care I give to my patients is poor.

I would like to think that the opposite is true, and this has certainly been reflected in the objective measures in place to ensure this. (Although sometimes difficult to measure in primary care.)

For the record, I don't work in hospital, but I am involved with commissioning their services, so it is essential, not only from a clinical view point, that I have a grasp on what is effective, and what is innefective.

From my own personal experience, I find that most of my secondary care colleagues do realise the benefits of working with us in primary care, to thrash out effective, evidence based care pathways, referral guidelines etc, but unfortunately the occasional dinosaur does exist- thankfully most of these have left the NHS or are close to retiring.

I have heard the story of the water pump, but I'm not sure what an appartchick is.

I note from your profile/history that you live a long way from the UK, but I'd be more than happy for you to visit my practice to gain a further insight into the workings of primary care in the UK. I think you'll find that things have moved on a bit.


Cheers and good health:)