“In the 1930’s the idea of a National Health Service (NHS) was not then the source of my greatest enthusiasm. Anti-fascist activities (and in particular Spain) headed the list, but the NHS ranked high.”

A. Cochrane

Effectiveness and Efficiency, p. 1

FIGURE 5.2. Clinical and epidemiological interpretationsof distributions of quantitativebiological characteristics

Characteristic measured

Characteristic measured

Clinical

Epidemiological

Eficiencia: El uso óptimo de personal y materiales para obtener estos efectos.

Equidad: Diferencias en el cuidado médico entre ricos y pobres.

Efectividad: Efecto de una actuación médica en alterar la historia natural de la enfermedad (entendidos como los resultados de investigación, en lugar de los resultados obtenidos en la práctica clínica rutinaria).

Information ofimportance to patientchoice which is not evenpotentially of evidence-basedtype. E.g. Information aboutthe process of delivery ofhealth care

A

B

C

Area where there is currently goodevidence-based information which is ofimportance to patients in making choices

Information of importance topatient choice which is potentiallyof evidence-based type

A Information which is currently based on good evidenceB Information for which good quality evidence-based information could be available in due courseC Information which is potentially of importance to patients in making health care choices

FIGURE 1. The relationship between evidence-based medicine andpatient-centred medicine

Source: Hope T. ‘Evidence-based patient choice and the doctor-patient relationship’. In: But Will it Work, Doctor? Kings Fund, London 1997, 20-24.

“I believe that cure is rare while the need of care is widespread and that the pursuit of cure at all costs may restrict the supply of care, but the bias has at least been declared.”

A. Cochrane

Effectiveness and Efficiency, p. 7

“I was brought up in an older tradition. I was told “before ordering a test decide what you will do if it is a) positive, or b) negative, and if both answers are the same don’t do the test. At the other end of the scale is the most recent innovation whereby a package of results of a dozen tests arrive at the bedside almost before the signs and symptoms have been elicited. A. Cochrane

Effectiveness and Efficiency, p. 43

The inverse care law

“The availability of good medical care tends to vary inversely with the need for it

in the population served”

Julian Tudor Hart

Lancet 1971; i: 405