Who do you care about? The authors of guidelines? The producers of evidence? Those who audit your practice? Or perhaps your patients? Sophie Cook’s recent post on consultation skills finally provided the impetus for me to put pen to paper (or rather, fingers to keyboard) regarding my own recent ponderings on these issues. I trained […]
Category: William Cayley
William Cayley: Does uncertainty and fear of the unknown drive overdiagnosis?
Edward Davies hits the nail on the head: “The fear of both patient and doctor can sometimes override the best knowledge, research, and information known to man.” I do not think, however, that it is just fear of getting sued that drives us physicians towards over-testing and overdiagnosis. Rather, it is existential fear of uncertainty, […]
William Cayley: Measurement—at the expense of success
“Doc, how’s my blood pressure? What about my cholesterol? How about my weight?” “There’s room for improvement,” I say. “How much do you exercise? How many fruits and vegetables do you eat?” “Oh, I’m too busy right now for exercise—and I have to eat what I can get when I’m on the road. But I […]
William Cayley: Resistance is futile (?)
Recent years have seen a lot of optimistic talk and writing about the “Patient Centered Medical Home”, the promise of population registries and electronic health records for preventing and managing chronic disease, and the ideals of training the personal physician for the 21st century. The goal of integrating personal care with the best that technology […]
William Cayley: Continuity—in and out of hospital in the US
We’re seeing a resurgence in primary care in the US—or are we? In a recent post, Domhnall MacAuley comments on the way primary care seems to have “emerged from the shadows as central to the development of universal and sustainable healthcare in the US.” While the resurgence of primary care seems to get much press, […]
William Cayley on the value of learning to practise in resource limited settings
“When life gives you lemons, make lemonade” goes the saying. Recently I was bemoaning with a physician friend the ease with which learners often default to “expert” interpretation for imaging, rather than relying on or trusting their one x-ray interpretation in light of clinical judgment. As we shared back and forth our stories of radiologist […]
William Cayley: Are we getting too systematic for our own good?
“We need to standardize our systems of practice to improve our quality metrics and do a better job of caring for our patients.” Such was the thrust of a recent management meeting, yet it left me wondering whether or not we are headed in the right direction. Increased public reporting of quality “metrics,” focus on […]