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 […]
Category: US healthcare
Ted Alcorn: What we don’t know can kill us—confronting gun violence with data
In the United States, the intractable politics of gun violence prevention—and of gun violence itself—rest on a seeming contradiction: we give gun violence far more attention than other causes of preventable death, and yet we have learned far less about it. A single murder will be recorded by dozens of state and federal agencies, can […]
William Cayley: Social history on the back roads
Social context and relationships may shape what drives our patients, but sometimes the best way to ponder these is on a drive! En route to a home visit today, I was met at the edge of town by a road crew doing last-minute sealing work before the onset of winter (despite what you may have […]
William Cayley: Overdiagnosis, uncertainty, and epistemology
Many thanks to Anita Jain for reporting on the “Overdiagnosis” session at the Cochrane Colloquium—I wish I could have been there. The suspicion that overdiagnosis (or at least over testing) is driven in part by the quest for certainty, is corroborated by an implementation study of the Vancouver chest pain rule. When the Vancouver chest […]
William Cayley: Social history consultations and patient time vs patient time
Who are you, what do you need, and how do I figure out how to care for you? Fundamentally, those are the questions that drive every encounter between a doctor and a patient. A recent article in the New England Journal of Medicine calls for us to expand the “social history” facet of this to include […]
William Cayley: Thinking about Ebola from the sidelines
Recently I was staring at two dramatically different bits of “news” on my computer screen. Yet another story on the spreading Ebola outbreak was in one window, and the latest update on our practice’s clinical performance metrics was in the next window. News of an out of control plague, juxtaposed with little red and green numbers […]
William Cayley: Facing uncertainty
The first case of Ebola in the United States, a cluster of cases of “acute neurologic illness with focal limb weakness of unknown etiology in children,” and ongoing concern over enterovirus D68 in the US. As if economic uncertainty and ongoing conflicts around the globe were not enough to put one on edge, there is now […]
The BMJ Today: A new era in transparency
A new era in openness and transparency—and arguments over data—has begun with the publication of the first tranche of data made available under the US’s Sunshine Act. The act makes all drug, device, or biological manufacturers declare money they give to doctors (if it’s above $10), including cash in kind, i.e. food or drinks, even if […]
Richard Smith: Using data to improve care and reduce waste in health systems
Annual expenditure on healthcare in the United States is currently $2.8 trillion, and about a third of it is wasted, says the Institute of Medicine. The sum wasted is about five times the GDP of Bangladesh, a country of 160 million people. This is waste on a spectacular scale, and reducing it while improving the […]
Hugh Alderwick: The ups and downs on the road to health service improvement
Parallels between the successful transformation of the Veterans Health Administration (VA) in the United States and the changes needed in the NHS in England have been made for a number of years. But recent troubles at the VA offer some important lessons for the NHS in the future, as explored in a roundtable discussion held […]