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US healthcare

Shared appointments: Medical utopia or dystopia?

18 May, 16 | by BMJ

david_kerr_2015picIn simple supply and demand terms, there are now more people living with chronic disease than there are doctors and other professionals around to help them. So how can the practice of medicine respond to this particular challenge?

Here in the United States, there is growing interest in exploring the potential value of shared medical appointments, whereby a group of individuals with the same underlying long term condition are seen in the same room by a physician (albeit for much longer appointments than the traditional 8-10 minutes twice a year). more…

William Cayley: Evidence based medicine—are we really there yet?

17 May, 16 | by BMJ

bill_cayley_2People almost invariably arrive at their beliefs not on the basis of proof, but on the basis of what they find attractive.” Blaise Pascal

Can we make evidence based medicine work if we don’t understand the evidence?

I appreciated this week’s BMJ analysis piece by Margaret McCartney et al, which gave recommendations for ways to make “evidence based medicine work for individual patients” more…

Jeanne Lenzer: The Backstory—Is US healthcare a frontier for a new civil rights movement?

13 May, 16 | by BMJ

jeanne_lenzerWhen the Lown Institute first signaled its plan to build a “movement” four years ago, it seemed to be an unlikely group to succeed. The founding conference was attended largely by academic doctors—and no matter how concerned doctors are about what is happening to healthcare, movements are only successful when driven by the people who carry the burden of harms. But from the start, the Lown Institute has recognized that changes within the house of medicine will not be sufficient. As long as industry owns politicians and creates its own rules, it will be impossible to forge substantive change; and to make those changes, there needs to be a movement. more…

William Cayley: If it ain’t broke, don’t fix it

6 May, 16 | by BMJ

bill_cayley_2If it ain’t broke, don’t fix it.”

One commonly hears the mournful refrain that American healthcare is “broken”—whether demonstrated by reports “hospitals have been gaming the system to make their re-admission numbers look good,” the paradox that our escalating healthcare expenditures produce only average life expectancy outcomes, or (what may seem more mundane to policy makers) the ongoing noises over physician overwork and burnout.

As frustrating (perplexing? challenging? infuriating?) as those problems are, they do not of themselves demonstrate a “broken” system. more…

Suzanne Gordon: The future of the Veteran’s Health Administration

29 Apr, 16 | by BMJ

suzanne_gordonBy the end of this year, the US will have a new president as well some new members of Congress. The results of the 2016 election will not only effect the further implementation of the Affordable Care Act (Obamacare), but the future of the country’s largest healthcare system—the Veteran’s Health Administration. That’s because most of the Conservative Republicans running for President—as well as many of those running for or already serving in Congress—are not only determined to repeal Obamacare. They are also committed to dismantling the largest and only publicly funded, fully integrated healthcare system in the US—the Veterans Health Administration (VHA). Even many Democrats are not fully supportive of the VHA. While Hilary Clinton says she does not support privatization of the VHA, only Bernie Sanders (D. VT) has demonstrated a deep understanding of what the VHA does and how it actually works. more…

Jeanne Lenzer: The Backstory—How I got the Cuba HIV story wrong

13 Apr, 16 | by BMJ

jeanne_lenzerI recently reported on the World Health Organization’s announcement that Cuba was the first country in the world to halt mother-to-child transmission of HIV, an accomplishment praised by WHO’s director-general, Margaret Chan, as “one of the greatest public health achievements possible.”

As I sat in the semi-circle of doctors who treat pregnant women in Matanzas, Cuba, I asked a question that had long concerned me: Did children who were exposed to antiretroviral drugs in utero and/or during infancy have a higher rate of congenital or developmental problems than other children? more…

William Cayley: Will mid-level practitioners replace primary care physicians?

5 Apr, 16 | by BMJ

bill_cayley_2I recently asked whether, in light of the relative drop in the number of trainees entering family medicine in the US compared to other specialties, we can continue to find ways to bolster the strengths of primary care, both in medical education and practice—since we know that primary care “helps prevent illness and death.”

Some have suggested that the best way to strengthen primary care systems, if physicians are in short supply, is to focus on further development of training for “mid-level” practitioners—for example, nurse practitioners and physician assistants.

There is certainly evidence that mid-level practitioners are an asset to a primary care team. more…

William Cayley: What’s in the future for US family medicine?

31 Mar, 16 | by BMJ

bill_cayley_2Once again, after waiting with bated breath, hope, and anxiety, medical students and residency programs alike have received the results of the annual residency “match.” After months of seemingly endless interviews and paperwork, and the submission of preference lists to the computer based algorithm at the National Residency Matching Program (NRMP), we finally know what the future holds . . . at least in part.

For graduating medical students, match results determine where (and in what specialty) they will spend the next few years of postgraduate education. For residency programs, the results tell us who we will be teaching in the coming years (and whether enough applicants “liked” us in order to fill an incoming class). And for each specialty as a community, match results tell us something (we think) about the current and future prospects for our area of medicine. more…

Jeanne Lenzer: The Backstory—The New York Doctors’ Riot

23 Mar, 16 | by BMJ

jeanne_lenzerHarriet Washington, a medical ethicist and author, opened a recent talk saying, “Alexander Hamilton and John Jay, heroes of the newly minted American Republic, did not spend 15 April 1788, penning the Federalist papers, nor were they holding forth on the virtues of a free press while bedecked in morning coats and powdered wigs. Instead they crouched, bleeding profusely, behind members of the state militia on the outskirts of New York City. Bodies lay scattered and blood pooled in the street as hordes of shrieking, outraged New Yorkers fled the militia’s bullets in a chaos of fear. Many of the fleeing were badly wounded, but the city’s doctors couldn’t help them: Nearly all were in jail.” more…

Steve Ruffenach: Electronic health records—time for machines to start sharing

10 Mar, 16 | by BMJ

steve_ruffenachLas Vegas hosted the Healthcare Information and Management System Society (HiMSS) annual meeting again last week. With more than 45,000 people in attendance, it is at once intense and unwieldy. It is also the meeting where every company and organization that controls, distributes, or touches medical information of any sort or in any way shows up to hawk its wares, brag about its effectiveness, and deliver promises of healthcare information management nirvana. more…

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