Whats wrong with the regulators?

#GPFUQ 177  What’s wrong with the regulators? A paradox of the new regulation of professionals like GMC Revalidation and the Care Quality Commission (CQC) that aims to reduce unacceptable variations in their performance is that the regulation itself can create unacceptable variations in regulation with poor quality assurance of both the structure and process of regulation creating variable outcomes. 

#GPFUQ 178  When is it the best treatment to stop medicines? If it improves patient outcomes. Risk can outweigh benefit when too many medicines are prescribed in patients with too many co-morbidties. Reducing and stopping drugs can then become the best treatment. There are 5 steps (1) check  all drugs the patient is taking and the reasons for each one; (2) consider the overall risk of drug-induced harm in individual patients before a  deprescribing intervention; (3) assess each drug in regard to its current or future benefit potential compared with current or future harm or burden potential; (4) prioritize and agree with the patient the drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes; and (5) implement a discontinuation regimen and monitor patient  for improvement in outcomes or onset of adverse effects.

#GPFUQ 179  What’s the problem recording shared-decision making (SDM)? The use of electronic templates to gather data for whatever reason has shifted consultations from being patient-centred to computer-centred. The paradox is that the more time we spend recording SDM, the less time we have to actually do it.

#GPFUQ 180 When shouldn’t we ask for extra money for health care? If we are already spending money doing something pointless, or if we are looking for technical solutions to existential problems.