Clinical Experience and Quality of Health Care

Niteesh K. Choudhry; Robert H. Fletcher; Stephen B. Soumerai

doi:10.7326/0003-4819-143-1-200507050-00020

Letters |5 July 2005

Clinical Experience and Quality of Health Care

Niteesh K. Choudhry, MD, PhD; Robert H. Fletcher, MD, MSc; Stephen B. Soumerai, ScD

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IN RESPONSE:

Drs. Samuels and Ropper raise concerns that our search strategy was “not in the least systematic” and was “circuitous.” We identified studies from multiple sources and applied explicit inclusion and exclusion criteria; this process and its reporting are precisely what make our review systematic. We used methods recommended by the Cochrane Collaboration (1), which are similar to those frequently presented in the clinical literature.

Drs. Samuels and Ropper take issue with the outcomes we evaluated, asserting that “[p]atients do not seek consultation for a more fastidious application of standards.” We agree that many aspects of health care do not fit into clinical practice guidelines and that expert consultation by appropriately trained physicians probably leads to better care in these situations. However, an important aspect of quality is, in our opinions, application of the best available research evidence to the care of patients. This evidence is tailored to individual patients, to be sure, but applies to most patients most of the time.

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2005 American College of Physicians

Letters |5 July 2005

Clinical Experience and Quality of Health Care

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Letters |5 July 2005

Clinical Experience and Quality of Health Care

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