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EDITOR'S CHOICE: Fiona Godlee Careful what you measure BMJ 2007; 335: 0 [Full text]

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The meaning of good or bad is simply helping or hurting.

BM Hegde   (25 November 2007)

Uncertainty Principle.

Sergio Stagnaro   (29 November 2007)

The meaning of good or bad is simply helping or hurting. 25 November 2007
BM Hegde, Retd Vice Chancellor Mangalore 575 004, India Send response to journal: Re: The meaning of good or bad is simply helping or hurting.	Dear Fiona Godlee, I couldn’t agree more about the sentence in your editorial, “providing uniformly high quality of care is hard if not impossible, even within a dedicated service………………..performance on one measure may tell you little about performance on others.” The Hawthorne effect, first observed in the 1920s, which refers to improvements in productivity or quality resulting from the mere fact that workers were being studied or observed has been further studied in the 70s. The later studies detected many flaws in the methodology of the original study of 1920. However, the Howthorne effect is still being invoked, “even after being proved incorrect”! Professor Elton Mayo and associates F.J. Roethlisberger and William J. Dickson, were of the opinion that “it was the workers'feeling (that) they were being closely attended to which was the cause of the improvements in performance. Thus these experiments were among the first indications that any productivity model must factor in intangible attributes such as human behavior.” Two other laws make the outcome of Howthorne research more meaningful. The Yerkes-Dockson Law and the Law of Diminishing Marginal Utility. Whereas motivation does increase performance only to a certain point, any further increase in motivation, unless through different methods, might not be effective due to the point of saturation in human behaviour.(Lawrence Wrightsman, Social Psychology, 3rd Edition, Brooks/Cole and Kelly Shaver, Principles of Social Psychology, 2nd edition, Winthrop, 1981) This takes us to the most important point in your editorial. The vital factor that might improve patient care, that is CARING for the patient, could come from motivating doctors to motivate their patients in turn to obtain better results form the interventions. This boils down to the old saying “patient care is simply caring for the patient." All other measures on the bed side are of subsidiary importance. Doctor motivation might have to keep changing to be effective as suggested by the above cited authors. The final healing has to be done by the patients' immune system. Doctor only dresses the wound, but the immune system heals the same. Humane doctors should have a healer’s heart within. Yours ever, bmhegde Competing interests: None declared
Uncertainty Principle. 29 November 2007
Sergio Stagnaro, Researcher in Biophysical Semeiotics Riva Trigoso (Genova) Italy Send response to journal: Re: Uncertainty Principle.	Editors, in my opinion, you are speaking of Heisenberg's Uncertainty principle....at clinical level. Compliment! Competing interests: None declared