When threatened, respond with facts

When I was President of the British Society for Rheumatology I was telephoned by a colleague at another hospital who told me that their department was to be closed, as the local PCT had decided not to fund patient referrals.

I paid a visit. I asked for some departmental statistics, like numbers of new patients, follow-ups, casemix and so forth. They had none. Surprised, I asked how many patients were on biologic agents (at that time all such patients were being entered on the BSR Biologics register). They didn’t know. By now appalled I suggested that they needed to get this information, and pretty damn fast, for otherwise they had no way of defending themselves.

I myself have kept some sort of database since I started as a consultant, beginning with an exercise book noting names of new patients, their diagnoses and GP. As a result I was able to provide myself with some simple statistics, and indeed a collaborative paper came out of it (1) . I stopped recording when it became apparent after 10 years that the casemix was not changing much (although that itself was to change later) and by now sensible computers had come along, so I ditched my BBC B and migrated a follow-up database onto a machine in the hospital’s Respiratory lab. It was huge. It had a gigantic hard drive of 20Mb! This was 1985… Later still when Microsoft released Excel and desktop machines came to outpatients I developed a follow-up database listing patients by name, birth date, date first seen and date most recently seen (to calculate follow-up duration), and drugs used and date to next appointment (to calculate follow-up interval). As part of this I was able to check the mean methotrexate dose, biologic exposure and all sorts of other things. There were separate sheets for little projects such as reviews of new patients and their outcomes (useful for assessing who was to be followed up or who was “one stop”). Three further presentations followed (2,3,4) .

But the bottom line was that when any managers came by asking me to change what I did, or asking – usually with a furtive grin that suggested they knew I wouldn’t be able to answer their query – I had all the information at my fingertips and could provide better and more useful statistics than the hospital database. Mostly they slunk away with tails between legs to lick their wounds.

The moral of this is that if you want to win battles you need to prepare for them better than the opposition. I have suggested to medical students that two important books that will come in useful are Machiavelli’s “The Prince” and Clausewitz’s “On War” (5). Bernard Montgomery was a great proponent of the sand table when planning battles. Presentations should be well prepared and rehearsed. No data, and no background, and you are dead.

[1] Bamji AN, Dieppe PA, Haslock I and Shipley ME. What do Rheumatologists do? A Pilot Audit Study. Br J Rheumatol 1990, 24, 295-8

[2] Litwic A, Bamji AN. Follow-up or discharge? A new patient outcome analysis. BSR Annual Meeting 2008, Abstract 417

[3] Bamji AN, Lane J. Impact of a community-based rheumatology clinic on a hospital department. BSR Annual Meeting 2010, Abstract 96

[4] Bamji AN. New: follow-up ratios: Dogma or Design? BSR Annual Meeting 2011, Abstract 59

[5] I was accosted by a trainee while I was collecting some stuff from the Postgraduate Centre after I had retired. He asked if I was Dr Bamji, and on my confirmation told me how he had been much influenced by the after-dinner talk I had given in Cambridge four years earlier, and both books were now in his library. I was much flattered.


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