I read this book recently:
This book reminded my of a protocol issued by an NHS Board in Scotland:
As a doctor who tries his best to follow evidence-based medicine, I argued against this approach. I found that neither this NHS Board nor indeed NHS Scotland shared my concerns:
With the recent publication of the Care Standards for Older People, the Chair of Healthcare Improvement Scotland confirmed:
It would appear to me that this “screening instrument” has been re-labelled by Healthcare Improvement Scotland.
The 4AT was developed and promoted as:
Recently the 4AT has been re-labelled as:
The authors 4AT describe its key features:
(1) “brevity” (takes less than 2 minutes”), and
(2) that “no special training is required”
I should confirm that I use rating scales with patients as part of my daily professional life.
However I would never start out with a rating scale. To me, that would seem most disrespectful.
Rating scales can add to wider medical understanding. This is why, despite my awareness of any intrinsic shortcomings, that I continue to feel that they can be helpful.
The 4AT has recently been re-branded an “assessment test”. The 4AT was promoted for several years, with the support of Healthcare Improvement Scotland, as a “screening tool”. The validation studies, still underway, describe the 4AT as a “screening” tool.
Given that there has been no change to the test itself, I would suggest that this is re-labelling.