Quality of care of musculoskeletal conditions

B. M. Rothschild

Northeastern Ohio Universities College of Medicine, 5500 Market, Youngstown, OH 44512, USA

SIR, The article by Roberts et al. [1] may well represent UK primary care physicians' perspective of the state of the rheumatological care they deliver. At least 50% of these physicians seem quite comfortable with their musculoskeletal condition management skills.

However, it may be premature to assume a relationship between comfort level and management skills. Claude Bernard and Mark Twain have rightly stated [2] that it is not so much what we don't know that gets us into trouble, as what we know that isn't so. Perhaps there is a difference in medical training between the UK and USA, but Smith et al. [3] did document poor musculoskeletal disease training in US training programmes. Rothschild [4] relates the US problem to limited curriculum time. He demonstrated a minimal requirement of at least 40 full ‘exposure days' in rheumatology to establish ability to actually start managing musculoskeletal disease.

It is impressive that 50% of surveyed UK general practitioners expressed a desire to ‘sit in with a consultant in clinic’ [1, p. 503]. Hopefully, a mechanism will be established to provide an effective programme to provide such motivated individuals with the necessary clinical experience. Their desire might also be considered a wake-up call to medical schools and residency programmes, suggesting curriculum modification to provide more effective musculoskeletal training.

References

  1. Roberts C. Adebajo AO, Long S. Improving the quality of care of musculoskeletal conditions in primary care. Rheumatology 2002;41:503–8.[Abstract/Free Full Text]
  2. Spodick DH. On experts and expertise. The effect of variability in observer performance. Am J Cardiol 1975;36:592–6.[ISI][Medline]
  3. Smith MD, Walker JG, Schultz D et al. Teaching clinical skills in musculoskeletal medicine: The use of structured clinical instruction modules. J Rheumatol 2002;29:813–7.[ISI][Medline]
  4. Rothschild BM. Relationship of length of clinical rotation to achievement of skills necessary for clinical management of musculoskeletal disease. J Rheumatol
Accepted 9 October 2002





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