Cam Donaldson

Caveat emptor or blissful ignorance? Patients and the consumerist ethos

The notion that consumerist behaviour is, or should be, prevalent amongst individuals seeking health care has underlain recent United States and British governmental policy directives. Consumer groups make similar assumptions when exhorting individuals to treat health care like any other service. This paper enquires to what extent patients conceive of themselves and others as adopting consumerist behaviour when seeking and evaluating primary health care. Three hundred and thirty-three patients attending general practices in Sydney, Australia, were asked in open-ended questions to state why they chose their regular doctor, why they continued to visit that doctor, if they had ever changed their doctor, if they thought most people could tell if a doctor were good or bad, and what qualities they thought constituted a good and bad doctor. It is concluded that the patients surveyed tended not to think of themselves as consumers who should be wary of the quality of service offered by doctors. Rather they preferred to trust their doctor, and therefore did not devote effort to actively seeking out information about their doctor or evaluating his or her services.

Programme-specific qalys: A reply

The aims of our paper on whether QALYs should be programme-specific were two-fold: first, to raise questions about the validity and reliability of QALY scales through examination of the relative sensitivity of acrossprogramme and condition-specific measures; and, second, to raise doubts about the applicability to social care environments of across-programme measures which have been developed principally in health (or more specititally acute) care environments [Donaldson et al. (1988)]. We feel we have been successful in achieving both of these aims, a judgement reinforced by the content of the responses received by the Journal [Weinstein (1988); Williams (1989)]. We argue that one day we might have across-programme measures, but that day has not yet arrived. However, at least in the UK, the Rosser measures are being applied in some contexts as if all the problems they pose on validity, reliability and sensitivity have been solved. Our understanding of the literature is that many aspects of the Rosser measures are still experimental. There is also a problem of what is defined as a ‘programme’. Do we, for example, lump together social care with health care problems? We would argue that there is a difference between the ‘care’ element for long-term groups such as elderly people and the ‘cure’ element associated with acute care, and that this difference may be even greater when comparing people in