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US healthcare

William Cayley: Complexity and care

5 Feb, 16 | by BMJ

bill_cayley_2Words that sound wonderful can come back to haunt you.

As a case in point, I recently responded to Elizabeth Wortley’s eloquent blog “Please refrain from using that kind of language” with the question: What if we decided to try to become “experts” in treating the difficult (patients)?

That sounds great in a conversation, but those high sounding sentiments were followed (for me) by an overly full week of complicated inpatient and outpatient care that left me feeling overwhelmed and quite inadequate. more…

Deborah Kirkham: Abortion in America—are church and state really separate?

5 Feb, 16 | by BMJ

deborah_kirkhamNever talk about religion, politics, or sex the old adage goes. The continuing debate about abortion covers all three, which may go someway to explaining the fervor with which all sides defend their viewpoint.

Planned Parenthood in America appears at first glance to be an unremarkable organisation. It offers contraception, testing, and treatment of sexually transmitted infections, screening for cervical and other cancers, and sexual and reproductive health education and outreach programmes. In November 2015, a man entered a Planned Parenthood clinic in Colorado shooting and killing three people, and wounding nine others. Two months earlier a clinic in Washington was victim to a targeted arson attack. Since 1994, Planned Parenthood clinics have been the site of a stabbing, two episodes of bombing, and a further shooting leading to two fatalities. This “domestic terrorism” is because, in addition to the services above, Planned Parenthood is also an abortion provider, carrying out 327,653 abortion procedures in 2013. It is the subject of some debate as to what proportion of its services are dedicated to abortion. Planned Parenthood claim it is only 3%, and there is no mention of abortion at all on their “about us” web page. more…

Ohad Oren: Roots in Israel, branches in the US—A medical intern’s awakening

3 Feb, 16 | by BMJ

ohad_oren_2016It is six months into my internship in America’s first hospital and the chasm between my former (Israel) and new (Pennsylvania) medical milieu seems as wide as the ocean. The clinical diseases I see may be similar, the physical examination may look alike, but the two country’s utilisation of the 21st century alphabet of medical information is as far as the east is from the west.

My first day of work at the primary care clinic provided me with a fresh reminder of that gap, when I met three young women all aged under 30. They all came for a routine check-up. As I was talking with each of them, reviewing their medical history, I was struck to learn that they had all undergone a particular operation. more…

William Cayley: Out with the old (and practical) and in with the new (and techie)?

29 Jan, 16 | by BMJ

bill_cayley_2Out with the old and in with the new? Improvements in the quality and portability of electronic diagnostic equipment have led to increasing discussion of late over the possible demise of the stethoscope. News outlets for the general public and for medical professionals have noted the growing debate over whether portable and handheld ultrasound, as well as other electronic diagnostic devices, should replace the traditional tool and icon of the physician: the stethoscope.

I tend to be a bit of a skeptic about the alleged wonders of the latest and greatest technology, and admittedly have a bent towards sticking with what is proven to work. So, to further investigate the potential merits of the stethoscope and its competitors, I had a brief (and admittedly limited) look for quality studies addressing the question. more…

David Kerr: A bump on the road to mHealth utopia?

28 Jan, 16 | by BMJ

david_kerr_2015picA recent clinical trial’s finding that digital health technology (also known as mHealth) failed to reduce healthcare costs is raising eyebrows on this side of the Atlantic. For naysayers the results will most certainly reinforce their belief that mHealth is a fad, which distracts from the real business of medicine, and that more investment in staff is preferable to wasting time on smart new shiny things. On the other side of the argument, however, the study had major flaws: it had a small number of participants (3998), had a very short duration, and was already out of date when it started—given the rapid pace of technology development.

Where I live on the west coast of the US, only a few hours’ drive down from Silicon Valley, there is indeed a widespread belief that technology will change the future and much sooner than for previous generations. more…

William Cayley: Christmas thoughts

23 Dec, 15 | by BMJ

bill_cayley_2The Christmas holidays annually are a time for jolliness, cheer, and fun—from “Ugly Sweater” events to “White Elephant” gifts, and even The BMJ Christmas issue. It’s all in good fun, it can be especially helpful at this (often grey and gloomy) time of year, and it all seems to somehow make sense when one thinks of Christmas originating with a message of “peace and goodwill.”

Yet none of us need reminders that the daily news is filled with news of people sorely in need of peace and longing for goodwill. Refugees continue to flee persecution, insecurity, and death (and, sadly, are sometimes met with more of the same). more…

William Cayley: Is the Good Samaritan the wrong metaphor to use for doctors?

9 Dec, 15 | by BMJ

bill_cayley_2A story from the Christian New Testament has provided the literary namesake for countless medical facilities, as well as legal and ethical principles guiding care for those in need, but it may be the wrong illustration—or at least, not an adequate one.

The “Good Samaritan” story is told in the book of Luke to answer the question “who is my neighbor?” After a traveler is beaten, robbed, and left for dead, he is helped and cared for not by either of the two religious professionals who pass him by, rather he is given aid by a stranger from a socially suspect group of outsiders. The point of the story is that “neighborliness” has to do with actions (caring, compassion), not simply with social proximity, respectability, or status. more…

William Cayley: To doctor is to diagnose—part two

12 Nov, 15 | by BMJ

bill_cayley_2Having recently posted some thoughts on the continuing centrality of diagnosis in doctoring, I was happy to see the recent Institute of Medicine (IOM) report “Improving Diagnosis in Healthcare.” I especially appreciated the IOM’s clear statement that “Improving the diagnostic process . . . represents a moral, professional, and public health imperative.”

The IOM describes a helpful conceptual model of the diagnostic process, and makes eight practical recommendations for moving forwards. I think all eight recommendations sound sensible, and some (such as “enhance healthcare professional education and training in the diagnostic process” and “establish a work system and culture that supports the diagnostic process”) are particularly helpful, however, I fear these steps may only address the “icing” and not the “cake.” more…

William Cayley: The value of the tweet

6 Nov, 15 | by BMJ

bill_cayley_2I’ve only recently begun tweeting, but have already been struck by the challenge of sometimes trying to convey complex ideas in 144 characters or less. The combinations of abbreviations, “hashtags,” and “@’s” can add complexity, but also confusion—the challenge is how to get the right balance of complexity, yet clarity.

Writing the “perfect tweet” is reminiscent of another short form, the 55 word story. Here, the challenge is to tell a narrative that is meaningful, motivating, or inspirational using precisely 55 words. Finding just the right combination of words to reach a total of 55 can be a challenge to one’s creativity far more than the demands of a larger project. more…

Claire McDaniel: Mixing business with medicine

2 Nov, 15 | by BMJ

claire_McDanielTwice a week, in the evenings, I cheat on one of the greatest loves of my life.

I sneak away from my friends, slip out of the library, and leave the responsibilities of medical school strewn across my desk. I don’t respond to texts. I ignore emails. I miss meetings.

I’m exhausted because of it. It’s all I can do to keep up with my work, and let’s not talk about the bags under my eyes. The ladies at Sephora have told me that covering those up is a lost cause.

Twice a week, I go to my accounting and managerial statistics classes. You see, I may be a medical student, but I am also pursuing my masters in business administration. more…

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