Monday, 26 September 2016

When the overdiagnosis is politicized

Rudy Giuliani, the Republican mayor of New York, on that fateful September 11, at an election meeting said: "I had prostate cancer 5 or 6 years ago and I thank God to be an American citizen because here the probability of survival at five years for this cancer is 82%, while in the UK, due to socialized medicine, this value is only 44%." We must clarify that in the US, PSA screening is widespread while in the UK it’s not so. According to Gerd Gigerenzer (I have extracted this case from his book "Risk Savvy"); Giuliani’s words conceal a big mistake, because in reality, although it seems a contradiction, mortality from prostate cancer in the two countries is practically the same. So how is it possible that the survival rates are so different? To explain it, Gigerenzer describes two biases that encourage the intentional error of the conservative politician:

Monday, 19 September 2016

The patient will see you now, according to Eric Topol

Eric Topol, director of Scripps Translational Science Institute, published in 2012, The Creative Destruction of Medicine, and in 2015, The patient will see you now. The future of medicine is in your hands. I had this last book on my reading list for a while and I've finally been able to read it during the holidays. It’s an important book about technology seen from the point of view of a clinical practice with extensive knowledge. I found that this literary piece goes a little too far in some chapters and I struggled to follow the thread of the main thesis, nevertheless I have to admit that the contributions of the genomics professor (and cardiologist) are very relevant and deserve to be discussed.

Monday, 12 September 2016

Physical examination is reclaimed

Acute vestibular syndrome, characterized by dizziness, nausea and vomiting, is often due to a local neuritis of the inner ear, despite the fact that a doctor cannot overlook that with these symptoms he or she must first rule out the vertebrobasilar stroke, a less common aetiology, but obviously a lot more serious. I chose this health condition because the neurologist David Newman-Toker from Johns Hopkins (and the team) have systematized HINTS (Head Impuls, Nystagmus and a Test Skew), an examination that requires nothing more than some basic neurologist’ tasks: a) the patient is asked to move his head while focusing at the examiner’s nose; b) the nystagmus is measured on lateral gaze, and c) one of the patient's eyes is covered with the hand while the other eye will focus at the examiner’s  nose and then the other eye is suddenly uncovered. On the understanding that family physicians and emergency room doctors know how to do this (and they probably do) the essential neurological examination before a persistent vestibular syndrome, should be aware that the study published by the team Newman-Toker in the Stroke journal states that HINTS has shown 100% sensitivity and 96% specificity so that the doctor can rule out the vertebrobasilar stroke in people with acute vestibular syndrome, values exceeding those of nuclear magnetic resonance.

Monday, 5 September 2016

The road to excellence

Antoni Peris

We often ask ourselves whether we are still good professionals or whether we are stagnating; whether our work is good or whether it can be better; whether we treat our employees well or whether they’re taking the Mickey; In this case, can we ask more from them? How do we inspire them to do better?

Whiplash has been one of the best rated films of the season. The story of Andrew, an ambitious young man who wants to become the best jazz drummer, enrols in the world’s best school in New York and has to face a teacher who demands everything he has to offer and a lot more. Whiplash shows us the path to excellence, assumed by teacher and student. However I think it’s very far from what we need to think about in our organizations.