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US healthcare

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…

Saurabh Jha: Saving Normal

26 Oct, 15 | by BMJ

Saurabh_JhaThe iconoclastic psychiatrist Thomas Szasz said that mental illness was metaphorical, not real, because mental diseases lacked biological substrates. The absence of a substrate predisposes psychiatry to overdiagnosis and avoiding overdiagnosis is psychiatry’s biggest challenge. This challenge has been taken up by Allen Frances in Saving Normal. Like Szasz, Frances writes in cultured, erudite prose. Unlike Szasz, Frances believes that psychiatric illnesses are real. To save the mentally ill, to save psychiatry from itself, Frances says we must save normal. more…

William Cayley: Neither complementary nor conventional

26 Oct, 15 | by BMJ

bill_cayley_2I appreciate Timothy Caulfield’s exploration of the “straw men” set up in many a discussion over integrative, complementary, or alternative medicines (CAM for short). However, I think we need to take the argument one step further. As he makes clear, many of the arguments proposed by “CAM-ers” against “conventional” medicine also apply to and undercut the claims to validity of CAM. This comes through most clearly anytime one hears in conversation the question: “Do you believe in . . . oils, herbs, meditation, etc.?”

If the question is one of “belief”—whether in CAM, or the (dubious) wonders of what “Big Pharma” has to offer, or the necessity of a “medical approach” (for example, the opinion that a test tells us more than history taking or examination)—then one truly is talking in religious terms and not the terms that should be used to define inquiry and healing in modern healthcare. more…

David Kerr: Don’t move fast and break things

21 Oct, 15 | by BMJ

david_kerr_2015picNew technology companies need the oxygen of someone else’s money to survive and grow, that’s how capitalism works. Here in California, multi-million dollar investments and eye-watering billion dollar company valuations are everyday news. The ultimate goal of new technology companies is to gain “unicorn” status as rapidly as possible i.e. be valued at more than $1 billion. In reality, the process of achieving such a lofty status by wooing investors invariably involves hyping the product as soon and as much as possible. In the rarified atmosphere of Silicon Valley venture capital, where money follows money, this means offering to “change the world.”

In tech speak all aspects of human health are fair game for “disruption.” more…

William Cayley: Continuity over efficiency

19 Oct, 15 | by BMJ

bill_cayley_2It has become fairly clearly established that a strong primary care system is associated with better overall health for a society and a more equitable distribution of health in the population.

A recent modeling study in the Annals of Family Medicine, which evaluated the “primary care paradox” (lower levels of evidence based care for individual diseases, but healthier populations, less use of resource, and reduced levels of health inequality), suggests that this is because primary care leads to increased disease prevention visits and reduced illness visits in disadvantaged neighborhoods. Other research has suggested that individualized management of new symptoms and chronic conditions may be the key advantage of primary care. more…

Ted Alcorn: America’s daily routine of gun violence

15 Oct, 15 | by BMJ

NEW YORK, NY - JUNE 15: (L-R) Americans For Responsible Solutions Communications Director Mark Prentice, Everytown For Gun Safety Research Director Ted Alcorn, and The Brady Campaign President Dan Gross attend the HBO screening of "Requiem For The Dead" at HBO Theater on June 15, 2015 in New York City. (Photo by Stephen Lovekin/Getty Images for HBO)

Speaking hours after another high profile mass shooting—this one perpetrated at a community college in Oregon by a young man who shot 18 people, killing nine, before shooting and killing himself—President Obama seemed to be at the end of his rope.

On at least 10 previous occasions, he had stood behind the podium emblazoned with the presidential seal and consoled the nation after an act of horrific gun violence. This time he betrayed an unusual degree of exasperation, his voice rising, his words clipped. He seemed almost as unsettled by the too familiar motions of sorrow and regret and disgust as he did by the latest tragedy: “Somehow this has become routine: the reporting is routine, my response here at this podium ends up being routine, the conversation in the aftermath of it . . . We’ve become numb to this.” more…

Tracey Koehlmoos on working as a policy adviser in the US Marines

29 Sep, 15 | by BMJ

traceykoehlmoosAnd so…after two years and seven months at the Pentagon as the Special Assistant to the Assistant Commandant and Senior Program Liaison for Community Health Integration in the United States Marine Corps, I moved on without fanfare to a new position with an equally long title within the Department of Defense. It was a tremendous opportunity to serve a great leader and to work with “the few, the proud, the Marines.” I learned a great deal about their health systems, research, and policy challenges, and before moving on and beginning to focus exclusively on the new position, I would like to share what I did because there are so many questions about “what does a special assistant/policy adviser do?” more…

William Cayley: Life saving science?

22 Sep, 15 | by BMJ

bill_cayley_2This past week saw the interestingly coincident publication of a reanalysis of “Study 329” in The BMJ and an opinion piece in the New York Times, calling for more rapid dissemination of news about “medical breakthroughs.”

Restoring Study 329” reanalyzed data from the (controversial) 2001 study and demonstrated that, lo and behold, paroxetine and imipramine may not help depressed adolescents, but may, in fact, hurt them (neither treatment was better than placebo, but both were associated with adverse events). more…

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