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US healthcare

William Cayley: About what are we being precise?

25 Mar, 15 | by BMJ

bill_cayley_2I’ve been too swamped with the day to day realities of teaching, patient care, and just plain real life lately to be very reflective, but Zackary Berger and Dave deBronkart finally spurred me on to put fingers to keyboard, and put words to my thoughts on the nascent move towards “precision medicine.”

From the first, when I heard of Mr Obama’s precision medicine initiative, I was underwhelmed (at best) and fearful of more misdirected use of resources at worst. more…

Zackary Berger and Dave deBronkart: “Precision medicine” needs patient partnership

20 Mar, 15 | by BMJ

zack_bergerdave_debronkartUS President Obama recently presented the outlines of a US$215 million plan for “precision medicine” through support of research funded by the National Institutes of Health and National Cancer Institute. Presented as “healthcare tailored to you,” it would take into account “individual differences in people’s genes, microbiomes, environments, and lifestyles—making possible more effective, targeted treatments for diseases like cancer and diabetes.” A follow-up meeting is planned at the White House. more…

James McCormack and Mike Allan: Simply making evidence simple

20 Mar, 15 | by BMJ

james_mccormackmike_allanIn an ideal world in which shared decision making is practised with impunity, healthcare providers need—at their fingertips—an appreciation and understanding of (as well as access to) the best available evidence for the main medical conditions they see on a day-to-day basis.

Unfortunately, for many clinicians, this lofty and worthwhile concept often becomes derailed early on in practice because one’s first experiences with evidence are: more…

Elizabeth Loder: Has the American Board of Internal Medicine lost its way?

19 Mar, 15 | by BMJ

elizabeth_loderElizabeth Loder examines the emergence of organized US physician opposition to revalidation requirements.

Something remarkable is happening right now in American medicine. A unified physician movement has emerged that cuts across the varied interests of different specialties to focus on a specific cause of dissatisfaction. It has already forced concessions from one powerful organization, and it shows no signs of fading. The targets? None other than the American Board of Internal Medicine (ABIM) and other specialty certifying boards, including their umbrella organization The American Board of Medical Specialties (ABMS). more…

Carolyn Thomas: Yet another cardiac risk calculator?

17 Mar, 15 | by BMJ

carolyn_thomasTo see for myself how reliable the new NHS heart disease risk calculator is, I completed all required fields exactly as I would have answered seven years ago. That was just before I survived what physicians still call “the widowmaker heart attack,” caused by a fully occluded left anterior descending coronary artery. (By the way, note the gender biased semantics here: they don’t call my kind of heart attack the “widowermaker,” do they?)

The new risk calculator results were encouraging. Apparently, I could “expect to live to age 83 without a heart attack or stroke!more…

Alvin Chan: Chances are, you’re not sensitive to gluten

5 Mar, 15 | by BMJ

alvin_chanIn the medical community, there are certain conditions that fall under the fuzzy category of medically unexplained syndromes (MUS). These syndromes, like fibromyalgia, chronic fatigue syndrome, and somatoform disorder, present with odd constellations of symptoms that neither physical examination nor diagnostic tests can explain. [1] To some members of the medical community, these are not diseases in their own right, but rather, clinical manifestations of underlying depression or some other biological or psychological condition. Given all the attention gluten is getting these days, I’m beginning to wonder if gluten sensitivity belongs in this category of MUS or is simply a result of the gluten-free fad. more…

Tessa Richards: Big data—jam tomorrow

5 Mar, 15 | by BMJ

Tessa_richardsRest easy in your beds overworked doctors and ailing patients, for tomorrow, all will be well. Big data will revolutionise healthcare. Processes in creaky health systems will be streamlined, patients empowered, and outcomes improved. Upbeat messages permeated the air at the UK e-health meeting at Olympia in London this week ( E-health is more a joined up state of mind than a technology, a tweeter observed, and a smorgasbord was on offer. It included workshops on service transformation and informatics priorities, best practice cafes, “future zones,” “digital plenaries,” and numerous tech company stands. The programme listed 501 in total. Some with enticing names, such as Clarity Informatics and Co–ordinate My Care. But frustration was in the air too…. more…

Saurabh Jha: War on Death

3 Mar, 15 | by BMJ

Saurabh_JhaThomas Hobbes described life as pitifully “nasty, brutish, and short.” Thanks to the free market and the state, life is no longer a Hobbesian nightmare. But death has become nasty, brutish, and long.

Surgeon and writer, Atul Gawande, explores the medicalization of ageing and death in Being Mortal. Gawande points to a glaring deficiency in medical education. Taught to save lives and fight death, doctors don’t bow out gracefully and say enough is enough. We’re not taught about dying. We’re taught about not dying. more…

William Cayley: What are the (hidden) costs?

26 Feb, 15 | by BMJ

bill_cayley_2“The economics of education are changed dramatically by delivering online courses to large numbers, making expensive education much cheaper.” That line in Richard Smith’s blog post describing a proposed “global university” for healthcare workers caught my attention—especially since my own local statewide university system, of which I am an employee as a medical school faculty member, is facing a proposed $300 million budget cut over the next two years. more…

The BMJ Today: Childhood drowning outcomes—prevention is key

12 Feb, 15 | by BMJ

My Facebook feed was filled with complaints after the National Football League’s Superbowl broadcast last week. The target? A commercial from an insurer highlighting the importance of preventing childhood accidents. While commenters seemed to acknowledge the importance of the topic, they felt that the message was too dark for an event that is otherwise generally upbeat and fun (at least for fans of the winning team). Given the social media response the commercial did at least succeed in catching viewers’ attention. more…

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