Martin Marshall could not have said it better in his recent blog—the idea of the 10 minute consultation is a travesty . . . except that sometimes it is not. With the increasing demands on and increasingly complex expectations of GPs and family physicians, expecting everything to fit into a 10 minute visit is simply […]
Category: William Cayley
William Cayley: To doctor is to diagnose
I appreciated Richard Smith’s recent discussion of mental models—too often, I think, we simply carry on with practice as usual (or, “life as usual”) without sufficient critical attention to the paradigms on which we rely to organize our thinking and doing. I would beg to differ with him, however, on the argument that “diagnosis is […]
William Cayley: Less is more
Both seasoned clinicians and learners in today’s medical environment receive both explicit and unspoken messages that the best medicine involves advanced technology, the latest medications, and highly specialized care. Evidence based medicine, on the other hand, advocates the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual […]
William Cayley: Are you depressed?
“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 […]
William Cayley: Who are you?
“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 […]
William Cayley: About what are we being precise?
I’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 […]
William Cayley: What are the (hidden) costs?
“The economics of education are changed dramatically by delivering online courses to large numbers, making expensive education much cheaper.” That line in Richard Smith’s blog post describing a proposed “global university” for healthcare workers caught my attention—especially since my own local statewide university system, of which I am an employee as a medical school faculty […]
William Cayley: “Enjoy in struggling”
“Struggling is the meaning of life. Victory and defeat are in the hands of God, so one must enjoy in struggling.” The saying above the doorway caught my attention as I settled in at my friend’s home for a weekend visit. I was a medical student, rotating at a mission hospital in rural Africa, and […]
William Cayley: Meeting our patients in the midst of their chaos
“Not again . . . ” The mom with the troubled teen is late for their appointment . . . “Not again . . . ” The elderly widow needs me to explain, one more time, why and how to take her medications . . . “Not again . . . ” The middle aged […]
William Cayley: Thanks for what?
This has been quite a year . . . but then again, what year is not? Each passing year seems to bring a fresh crop of challenges, crises, obstacles, and frustrations. Being a doctor or, perhaps especially, being a GP is not what it used to be. It’s sometimes hard to tell whether medicine is […]