Social context and relationships may shape what drives our patients, but sometimes the best way to ponder these is on a drive! En route to a home visit today, I was met at the edge of town by a road crew doing last-minute sealing work before the onset of winter (despite what you may have […]
Category: William Cayley
William Cayley: Overdiagnosis, uncertainty, and epistemology
Many thanks to Anita Jain for reporting on the “Overdiagnosis” session at the Cochrane Colloquium—I wish I could have been there. The suspicion that overdiagnosis (or at least over testing) is driven in part by the quest for certainty, is corroborated by an implementation study of the Vancouver chest pain rule. When the Vancouver chest […]
William Cayley: Social history consultations and patient time vs patient time
Who are you, what do you need, and how do I figure out how to care for you? Fundamentally, those are the questions that drive every encounter between a doctor and a patient. A recent article in the New England Journal of Medicine calls for us to expand the “social history” facet of this to include […]
William Cayley: Thinking about Ebola from the sidelines
Recently I was staring at two dramatically different bits of “news” on my computer screen. Yet another story on the spreading Ebola outbreak was in one window, and the latest update on our practice’s clinical performance metrics was in the next window. News of an out of control plague, juxtaposed with little red and green numbers […]
William Cayley: Facing uncertainty
The first case of Ebola in the United States, a cluster of cases of “acute neurologic illness with focal limb weakness of unknown etiology in children,” and ongoing concern over enterovirus D68 in the US. As if economic uncertainty and ongoing conflicts around the globe were not enough to put one on edge, there is now […]
William Cayley: My Chief Complaint
My chief complaint . . . is with the chief complaint. One of the hallowed concepts in medical history taking and documentation is the “chief complaint.” Supposedly a way to set the agenda for a medical visit, in current practice it often gets both distorted and treated as a boundary setter. Ideally, in medicine, we […]
William Cayley: Resilience, obstreperousness, and grit
Some people keep going, and going, and going . . . and some don’t. What makes the difference? I’m not sure we know, but I think it has something to do with resilience, obstreperousness, and grit. This week there has been a bit of a debate going on in our department over appropriate blood pressure […]
William Cayley: Awkward is when they need us
“I just hate this sort of thing.” When I overheard that at a recent funeral, as we waited in line to greet the bereaved family, I thought to myself, “How sad . . . and how true.” Sad, because times of grief are when others need us most, but also true, because most of us find […]
William Cayley: EBM—curing and comforting
A recent article in The BMJ on the crisis in evidence based medicine (EBM) did a great job of both summarizing challenges that have developed over the past 20 years, and proposing some ways forward in delivering better evidence based care to our patients. Unfortunately, I think one piece of the evidence based puzzle is still […]
William Cayley: “If you build it, they will come”
“If you build it, they will come!” So went the catchphrase of Field of Dreams, in which an Iowa farmer is inspired by voices to build a baseball diamond in his cornfield. And, indeed, “they” do come—the movie ends with an endless line of people in cars coming to see a ball game in his […]