{"id":37415,"date":"2016-09-16T16:19:00","date_gmt":"2016-09-16T15:19:00","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37415"},"modified":"2016-09-16T16:19:00","modified_gmt":"2016-09-16T15:19:00","slug":"william-cayley-systems-wisdom","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/09\/16\/william-cayley-systems-wisdom\/","title":{"rendered":"William Cayley: Systems wisdom"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/07\/bill_cayley_2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-31912\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/07\/bill_cayley_2-243x300.jpg\" alt=\"bill_cayley_2\" width=\"115\" height=\"141\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/07\/bill_cayley_2-243x300.jpg 243w, https:\/\/blogs.bmj.com\/bmj\/files\/2014\/07\/bill_cayley_2.jpg 551w\" sizes=\"auto, (max-width: 115px) 100vw, 115px\" \/><\/a>In a recent <em>BMJ<\/em> blog Steve Ruffenach made\u00a0<a href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/09\/15\/steve-ruffenach-on-accepting-technology-in-medicine\/\">some excellent points<\/a>\u00a0on the importance of balancing \u201caccept\u201d and \u201cexcept\u201d in approaching \u201cTech\u201d in medicine.<\/p>\n<p>However, as we continue to feel the pressure of realizing\u00a0\u201c<a href=\"https:\/\/www.healthit.gov\/providers-professionals\/meaningful-use-definition-objectives\">meaningful use<\/a>\u201d of electronic medical records (often with attendant requirements for documentation, reporting, and ad-nauseam clicks of different buttons in each patient\u2019s chart), I\u2019ve been intrigued by growing evidence suggesting we need rather to focus on \u201cwise use.\u201d<\/p>\n<p>Some seem to feel that the more systems (usually supported by \u201ctech\u201d) that we implement in medicine<!--more-->, the better and safer our patient care will be . . . but I am not so sure:<\/p>\n<p>\u2022 <a href=\"http:\/\/www.jabfm.org\/content\/29\/5\/613.long\">Just this month, a study<\/a> in the <em>Journal of the American Board of Family Medicine<\/em>\u00a0documented an association between implementation of a web based patient portal and <em>increased<\/em>\u00a0patient phone calls to the office. So much for using web based platforms to streamline patient communication.<\/p>\n<p>\u2022 <a href=\"http:\/\/www.annfammed.org\/content\/14\/3\/221\">Another study earlier this summer<\/a> in the <em>Annals of Family Medicine<\/em>\u00a0found that asking patients to address their \u201cQuality of Life Goals\u201d in pre-visit paper questionnaires (no electronics here) led to reduced expressions of physician empathy during the office visit.<\/p>\n<p>\u2022 And when it comes to the process of care itself, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26824223\/\">a Cochrane review\u00a0found that<\/a> opportunistic risk assessment and case finding of cardiovascular disease (CVD) and associated risk factors may be associated with the same reduction in all-cause and cardiovascular mortality as systematic screening. All those \u201cpreventive\u201d outreaches may not prevent much after all.<\/p>\n<p>I\u2019ve posted before my thoughts on whether we are \u201c<a href=\"https:\/\/blogs.bmj.com\/bmj\/2013\/06\/04\/william-cayley-are-we-getting-too-systematic-for-our-own-good\/\">getting too systematic for our own good<\/a>\u201d\u2014and these bits of evidence shed more light on the picture. We need to be attentive to those instances in which efforts to systematize healthcare not only seem to add no benefit (as may be the case with CVD screening), but may in fact lead to poorer patient care (quality of life questionnaires?), or unwittingly add to our already heavy workload (patient portals).<\/p>\n<p>Systems have their place, but that place is not everywhere. We need to think clearly, study carefully, and implement wisely those systems that may help improve care\u2014and learn to abandon those that add nothing or make things worse.<\/p>\n<p><em><strong>William E Cayley Jr<\/strong>\u00a0practices\u00a0at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.<\/em><\/p>\n<p><strong>Competing interests:<\/strong>\u00a0&#8220;I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In a recent BMJ blog Steve Ruffenach made\u00a0some excellent points\u00a0on the importance of balancing \u201caccept\u201d and \u201cexcept\u201d in approaching \u201cTech\u201d in medicine. However, as we continue to feel the pressure [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/09\/16\/william-cayley-systems-wisdom\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1357,14769],"tags":[],"class_list":["post-37415","post","type-post","status-publish","format-standard","hentry","category-us-health-care","category-william-cayley"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>William Cayley: Systems wisdom - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/09\/16\/william-cayley-systems-wisdom\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"William Cayley: Systems wisdom - The BMJ\" \/>\n<meta property=\"og:description\" content=\"In a recent BMJ blog Steve Ruffenach made\u00a0some excellent points\u00a0on the importance of balancing \u201caccept\u201d and \u201cexcept\u201d in approaching \u201cTech\u201d in medicine. 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