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 […]
Category: US healthcare
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 […]
Elizabeth Loder: US medical specialty boards: accountable to whom, for what, and how?
Elizabeth Loder examines charges of lax oversight and governance at organizations that assess doctors. The medical specialty boards that test and certify US doctors are facing a tough test of their own, with plenty of reasons to worry about the outcome. 24 specialty boards administer the tests doctors must pass in order to say they […]
Art Cohen and Selwyn Ray: The lessons of late April in Baltimore
After years of suffering and resignation about disrespect and mistreatment at the hands of local police, young and older African-American residents of inner city west and east Baltimore, joined by others, came together these past two weeks to say: “we’ve had enough.” The spark for this was the fatal injuring, while in police custody on […]
John W McEvoy on the Baltimore riots
When I came to Baltimore from Ireland in 2008 many people said I was crazy. I often heard from friends and colleagues, “Be careful, that’s where they made The Wire.” However, as a young resident physician, an underserved city like Baltimore seemed to me like a great place to train. On my annual trips home […]
Neal D. Barnard and Angela Eakin: Yes, cholesterol matters
In February 2015, the US Dietary Guidelines Advisory Committee reported that dietary cholesterol was no longer a “nutrient of concern.” According to the Committee’s report, “available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol….” In the ensuing media tempest, some food writers saw a green light for indulgence in eggs, […]
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 […]
David Kerr: Dr Uber
The hot topic in the technology world at the moment is the so called “sharing economy.” A great deal of money is being made by companies, such as Uber and Airbnb, where the internet is used to match buyers and sellers without the need for the huge upfront costs of purchasing, for example, cars and […]
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 […]
Neel Sharma: Does the cost of using technology in medical education unfairly disadvantage developing countries?
Medical education reform has seen significant changes since the days of the Flexner report. What remains true are the rigorous entrance requirements, the scientific method of thinking, learning by doing, and the need to undertake original research (1). The advent of technology over the past decade and more has meant that learning by doing has […]