Showing posts with label Less is more. Show all posts
Showing posts with label Less is more. Show all posts

Monday, 8 February 2016

Hunting zebras in Texas or why doctors order so many tests


Bayes’s theorem estimates the probability of an event occurring if another one occurred before. If we hear thunder, it’s very likely that soon it will start to rain. However, biomedicine is more interested by the inverse probabilistic formulation because often when an observation is made we look for the cause: "If, for example, you find yourself on a ranch in Texas and hear the sound of trotting horses, what is the probability that a herd of zebras will approach? ”Dr. Saurabh Jha, radiologist, blogger and contributor to the BMJ, says that we hunted zebras in Texas for long enough. "The clinical reasoning of many doctors today - explains Dr. Jha - forgot the Bayesian thinking and embraced instead the thesis that it’s better to manage a false positive than a false negative."

When, in the second decade of the last century, he was asked why he wanted to climb Everest, George Mallory, an English mountaineer, replied that it’s because the mountain was there. According to Dr. Jha, many doctors feel the same as Mallory: they ask for tests because they can. In his article in the BMJ, the radiologist explained the case of a patient of Dr. Watson, a well read doctor emerged from a refined education who pays a lot of attention to detail but lacks the deductive ability of the famous Sherlock Holmes’ assistant. If you have a chance to read the letter, you will see how for the study of this case, nothing seems elementary to Dr. Watson, to the extent that for every horse he sees an opportunity for a zebra hunt. "Zebras are intellectually exciting," Dr. Jha ends up saying.

Monday, 24 August 2015

When less is more: a strategic agenda








Dr. Joan Figueres, expert in the evaluation of health services, announces with his tweet, of the publication of a post signed by Shannon Brownlee and Vikas Saini, Vice President and respectively President of Lown Institute, along with Christine Cassel, President of ABIM Foundation. This post was published on the blog of Health Affairs on 25 April and in total agreement with Dr. Figueres, I also find it remarkable as I believe that the article does a good overview of the current grade of clinical waste outbreaks and suggests some strategies for engaging physicians, patients and the media in improving the situation, and I will focus on the latter:

Monday, 27 October 2014

More material against low value clinical practices








Dr. Joan Escarrabill is the Chronic Care Program Director of the Clínic Hospital. As a pulmonologist, he trained and developed his career in Bellvitge Hospital, where he had the opportunity to exercise various responsibilities in the field of clinical management. And now he has given us the selected tweet that leads to "Mayo Clinic Proceedings".

If you click on the two links from Dr. Escarrabill’s tweets, you’ll reach a project (and the introductory editorial) which reviewed over two thousand articles published over 10 years in the New England Journal of Medicine with the rank of "Originals". This work has identified 146 studies that advise stopping certain medical practices that are failing to demonstrate expected clinical outcomes.

Therefore, Dr. Escarrabill with his tweet, offers us a new key to strengthen programs calling for clinical practice to focus only on the actions that are known to add value to the health of people (see posts from: "Too much medicine", "Less is more", "Choosing Wisely", "Do not do" and "Projecte Essencial"). This movement of clinical containment led by professionals is taking shape in the United States under the name "The Right Care Alliance".

Monday, 4 August 2014

The parsimonious medicine








I started the last Mondays’ post with the "Too much medicine" campaign from the British Medical Journal but in this one I want to talk about the "Less is more" article from "JAMA Internal Medicine" that began in April 2010 with the aim of bringing to our attention the side effects of diagnostic tests and treatments that from the outset are not expected to add any value.

Parsimonious medicine versus spending cuts

Dr. Jon Tilburt, an internist and researcher in biomedical ethics at the Mayo Clinic, and Dr. Christine Cassel, president of ABIM Foundation (see the Video that presents the "Choosing Wisely” campaign), in an article published in JAMA, attempt to differentiate between the ethics of "no budget and therefore I can’t request a test" and those of "this test does not suit you, it will not contribute anything new to what we already know, and additionally, the test itself carries risks that do not outweigh the expected benefits". According to the authors, as at the moment the two ethics are competing on the same stage, an effort must be made to explain them better from a professional point of view.