Is primary care really the future? I’d like to say “Yes,” but I’m not so sure… (at least in the USA). There has been much talk and writing about the growing need for primary care physicians to serve our population, and one “promise” of the Affordable Care Act is “its potential to make primary care […]
Category: William Cayley
William Cayley: Medicine—too fast, too slow, or just right?
“Slow Medicine” is getting more and more attention. The authors of several recent books have got readers thinking more and more about taking time, truly listening to the patient, focusing again on the thorough history and physical, and building relationships—among the good (and inspiring) reads on this are God’s Hotel, Out of Practice, and What […]
William Cayley: Muddling “margin” and “mission.”
“There is mission without margin.” I’ve heard that sentiment time and time again, used to convey the idea that in the healthcare business, while we all agree we want to take care of people, we must after all, stay financially viable in order to do so. In short, if we don’t succeed as a business, […]
William Cayley: We have met the enemy
“We have met the enemy and he is us.” (Pogo) Manica Balasegaram makes a number of excellent points in his recent post, but his conclusion that “the system is broken” only addresses part of the problem. I read the piece at the MSF website on “Looking for alternative models” with interest, but I do not […]
William Cayley: It’s not just the patient’s story that matters
Each patient’s story matters. It tells us who the patient is, and how he or she came to the present point or predicament. The story gives nuance, meaning, perspective, and context to all the medical information and data points that each patient presents. The story introduces us to the patient as a person. Beyond our […]
William Cayley: Evidence based medicine and practice change—get out front and push!
We’d hoped evidence based medicine (EBM) would improve patient oriented outcomes and clinical processes, but some fear the “EBM” movement is broken. However, it may not be just “EBM” as a movement that is broken—I am starting to wonder more and more about clinicians’ willingness or ability to apply evidence in practice, when it runs […]
William Cayley: Evidence based medicine—it’s time to be critical
“If it ain’t broke, don’t fix it” goes the aphorism—and so would say any who trust complacently in the exponential growth of “evidence based” this or that in medicine. Des Spence, for one, disagrees. In a recent BMJ editorial he argues evidence based medicine (EBM) is broken, it is “now the problem, fuelling overdiagnosis and […]
William Cayley: Doing more with less in healthcare
The newer the better—or so it seems in much of commercialized medicine. At least in “developed” or “higher income” countries, medical innovation seems inextricably tied with commercial endeavors, which often translate to more expensive ways to do the same things (sometimes, even if we’re not sure the outcomes are truly better) The Bulletin of the […]
William Cayley: Can you show that you care?
“Can’t I just fake it? Can’t I pretend to care, even if I don’t.” So an anonymous physician is reported to have responded during a workshop on caring communication with patients. My colleagues and I all scoffed with appropriate indignation when this story was told, as the same training was presented to us—but I’ve started […]
William Cayley: The patient’s story comes first
Once upon a time, there was a pain, a positive test, and “a possibly abnormal x-ray requiring clinical correlation.” As they travelled the world, no one could figure out where they came from. Many physicians racked their brains, but they remained a mystery, until one wise person said, “tell me your story.” Our three travelers […]