It has become fairly clearly established that a strong primary care system is associated with better overall health for a society and a more equitable distribution of health in the population. A recent modeling study in the Annals of Family Medicine, which evaluated the “primary care paradox” (lower levels of evidence based care for individual diseases, […]
Category: US healthcare
Ted Alcorn: America’s daily routine of gun violence
Speaking hours after another high profile mass shooting—this one perpetrated at a community college in Oregon by a young man who shot 18 people, killing nine, before shooting and killing himself—President Obama seemed to be at the end of his rope. On at least 10 previous occasions, he had stood behind the podium emblazoned with […]
Tracey Koehlmoos on working as a policy adviser in the US Marines
And so…after two years and seven months at the Pentagon as the Special Assistant to the Assistant Commandant and Senior Program Liaison for Community Health Integration in the United States Marine Corps, I moved on without fanfare to a new position with an equally long title within the Department of Defense. It was a tremendous […]
William Cayley: Life saving science?
This past week saw the interestingly coincident publication of a reanalysis of “Study 329” in The BMJ and an opinion piece in the New York Times, calling for more rapid dissemination of news about “medical breakthroughs.” “Restoring Study 329” reanalyzed data from the (controversial) 2001 study and demonstrated that, lo and behold, paroxetine and imipramine may not […]
William Cayley: Comfort always and advocacy for the vulnerable
Reading the Monday morning paper, I was greeted by stories about ongoing fights over whether or how to undo the Affordable Care Act (“Obamacare”) and controversies over solitary confinement. Later, while driving to work, I heard more news on the challenges facing those in eastern Europe who are confronted by a rising influx of immigrants. One final check […]
William Cayley: Ethics and professional wisdom
The recently publicized news that the American Psychological Association (APA) “colluded” with US governmental agencies to create ethical guidelines permitting psychologists to participate in “harsh interrogations” of military detainees is appalling. According to the APA’s own press release, the guidelines were “based at least as much on the desires of the US Department of Defense as […]
Muriel Gillick: When life gives you lemons—the 2015 White House Conference on Aging
In the heady days of the early 1960s, when the oldest of the baby boomer generation were teenagers and only 9.2% of the population were age 65 or older, the US held its first White House Conference on Aging. This was by all accounts a grand event, a national citizens’ forum designed to “focus attention […]
David Kerr: The for profit company will see you now
When you hear hoof beats, think of horses not zebras, is the aphorism coined in the 1940s by Theodore Woodward to explain that common conditions occur commonly and rare ones rarely. Most physicians involved directly in patient care will have seen the occasional “zebra” blood test result that is so unexpected when taken into clinical […]
William Cayley: Diagnosis—what it’s not . . .
“Phew! At least you don’t have something bad.” “I know doc, but what is it?” I’m afraid that in medicine, we too often focus on the former, and not enough on the latter. How often do we see patients admitted to hospital to “rule out” an acute coronary syndrome? How often do we do a […]
William Cayley: Planning for uncertainty
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 […]