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US healthcare

John W McEvoy on the Baltimore riots

30 Apr, 15 | by BMJ

john_mcevoyWhen I came to Baltimore from Ireland in 2008 many people said I was crazy. I often heard from friends and colleagues, “Be careful, that’s where they made The Wire.” However, as a young resident physician, an underserved city like Baltimore seemed to me like a great place to train. On my annual trips home this widely held perception of Baltimore as a dangerous place would often come up. However, after getting to know the place better, my typical response became, “It’s not like that; Baltimore is actually a great city.” To this very day, I still believe that Baltimore is a great city. But it also has some flaws. more…

Neal D. Barnard and Angela Eakin: Yes, cholesterol matters

28 Apr, 15 | by BMJ

In February 2015, the US Dietary Guidelines Advisory Committee reported that dietary cholesterol was no longer a “nutrient of concern.” According to the Committee’s report, “available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol….” In the ensuing media tempest, some food writers saw a green light for indulgence in eggs, sausage, and other high cholesterol foods. Others went further, exonerating high blood cholesterol levels, and patients began asking their physicians whether cholesterol matters.  more…

William Cayley: Are you depressed?

27 Apr, 15 | by BMJ

bill_cayley_2“Do you feel down, depressed, or hopeless? Are you bothered by little interest or pleasure in doing things?”

Now that the practice I work for is part of an accountable care organization, one more measure on which our (supposed quality of) patient care is being assessed, is our screening for depression. While that sounds initially good on the face of it (after all, who wants to be depressed?), in reality I fear it not only flies in the face of current best evidence, but also contributes to over-medicalization and “too much medicine.” more…

David Kerr: Dr Uber

23 Apr, 15 | by BMJ

david_kerr_2015picThe hot topic in the technology world at the moment is the so called “sharing economy.” A great deal of money is being made by companies, such as Uber and Airbnb, where the internet is used to match buyers and sellers without the need for the huge upfront costs of purchasing, for example, cars and properties. The question is whether the concept of a sharing economy could also be of value in healthcare? more…

William Cayley: Who are you?

14 Apr, 15 | by BMJ

bill_cayley_2“The Patient” is everywhere. He is in consult notes, she is in hospital admission notes, he is in letters, and she is even in my daily dictations and procedure notes. “The Patient” is that anonymous moniker that gets plopped, intentionally or not, into clinical documentation of our medical care.

This struck me today as I signed a procedure note. For some time, I have been working to deliberately refer to my patients by name when writing or dictating office notes and procedures, yet today I found that once again my dictation was “anonymized” by the transcriptionist, with the patient’s given name removed and replaced with “the patient.” more…

Neel Sharma: Does the cost of using technology in medical education unfairly disadvantage developing countries?

14 Apr, 15 | by BMJ

Medical education reform has seen significant changes since the days of the Flexner report. What remains true are the rigorous entrance requirements, the scientific method of thinking, learning by doing, and the need to undertake original research (1). The advent of technology over the past decade and more has meant that learning by doing has taken on a whole new meaning. more…

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_allan

This blog is part of a series of blogs linked with BMJ Clinical Evidence, a database of systematic overviews of the best available evidence on the effectiveness of commonly used interventions.

In 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…

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