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US healthcare

William Cayley: Happy to be healthy

3 Aug, 16 | by BMJ

bill_cayley_2Drawing on a variety of demonstrated correlations between happiness (or “wellbeing”) and health, John Appleby recently argued that “improving individual, and hence national, wellbeing might best be achieved through improving people’s health.” While I appreciate any suggestion of policies or interventions that might boost health, I also think it worth considering whether the argument may actually work the other way round.

Does health produce happiness? Or does happiness produce health? The data documenting a relationship between happiness and health are dramatic, yet only document correlation—not causation. This leaves me wondering, which is the chicken, and which the proverbial egg? more…

Suzanne Gordon: Encouraging all members of a medical team to speak up

12 Jul, 16 | by BMJ


The oval, mahogany table dominates the center of the large conference room. A number of chairs circle the table and dot the perimeter of the room. Every week, a group of high level hospital administrators, physician leaders, and leaders of other professional and occupational disciplines—physical therapy, social work, clinical directors of nursing, housekeeping, etc—gather in this room to discuss hospital function. They call themselves a “team” and the gathering a “team meeting.” more…

William Cayley: Where lies greatness?

4 Jul, 16 | by BMJ

bill_cayley_2Recently while driving to work, I was bemused (or should I say, dismayed) to pass yet another presidential campaign poster promising to “make America great,” just as I was hearing on the radio a story about the worldwide 2016 Social Progress Index, which rates the US as 19th overall on measures of social and environmental performance and overall “inclusive growth.” Even more concerning, as noted in the radio report, the US is “the one major industrial nation that is significantly underperforming on its social progress, relative to its GDP.”

So what truly makes for greatness? Nationalistic sloganeering or being able to deliver on the foundations of true social and economic security, such as health, nutrition, education, and opportunity? more…

William Cayley: What happened? A US doctor on Brexit

27 Jun, 16 | by BMJ

bill_cayley_2What just happened? Sitting in my clinical office in rural Wisconsin, the outcome of the “Brexit” vote seems quite far away—yet the day after 23 June’s vote, the shock and surprise emanating from the news stories is almost palpable.

While I can’t claim to know much about the inner workings of British domestic politics, as I’ve followed recent news the parallels between the options facing voters in the UK and in the US are strikingly clear: one finds strength in rugged independence, in nationalism, and keeping “them” at bay; while the other side represents (or represented?) a choice for collaboration and for the (perhaps uninspiring?) status quo. more…

William Cayley: Whither the communication of evidence in the social media world?

14 Jun, 16 | by BMJ

bill_cayley_2Notwithstanding the epistemological inconsistency inherent in discussions of “my evidence” vs “your evidence” (after all, if “evidence” is not about an objectively verifiable shared reality, then it’s not evidence”), I appreciate the call by Douglas Badenoch and André Tomlin to “dramatically improve the way important new evidence is communicated to the people who need it most.”

While they helpfully argue for finding ways to use the continually evolving tools of social media to communicate evidence, we need to think carefully not just about platforms, but also about content. Reading tweets and blogs and email updates is certainly a quick-and-easy way to access information, but for those on the writing and dissemination side of the equation, there needs to be careful thought given to how that information is translated from complex findings into accessible “e-bites.” more…

Shelby Quast: Is cosmetic labiaplasty in adolescents just FGM under a different name?

1 Jun, 16 | by BMJ

shelby quastLabiaplasty in girls younger than 18 has become increasingly popular in the US in recent years. According to the American Society for Aesthetic Plastic Surgery, the number of girls aged 18 and younger having cosmetic genital surgery increased by 80% between 2014 and 2015 (from 222 girls in 2014 to 400 girls in 2015).

While some surgeries are carried out for medical reasons, this huge increase appears to also be driven by non-medical reasons, including insecurity caused by higher levels of exposure to porn and a lack of understanding that there can be huge variation in healthy female genitalia. more…

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…

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