Less is more: "Overtreated" by Shannon Brownlee

The campaign "Too much medicine" by the British Medical Journal wants to highlight the threat of over diagnosis to the health of individuals, and also expose the inherent waste of resources involved in inappropriate clinical practice. According to the BMJ, there is evidence that more and more people suffer from over diagnosis and overtreatment for a wide range of clinical circumstances such as cases of asthma, chronic renal failure or prostate and thyroid cancer. Through this campaign, the magazine plans to improve awareness among physicians of both the benefits and side effects of treatments and technologies, and thus find out how excesses can be reduced safely and properly.

The editor of the BMJ, Fiona Godlee, gives much attention to the campaign: “As medicine based on evidence, or clinical safety, were the movements of the previous decades, combating excess is a contemporary manifestation of an ancient desire: no harm when we want to heal".

To start talking about this campaign, I thought it would be appropriate to review the book “Overtreated" whose author, Shannon Brownlee is a science journalist who has published in Atlantic Monthly, New York Times, New Republic and Time.

Too much medicine

This is the title of the first chapter of the book, where she writes: “As most clinical practices have never been scientifically proven, when someone was faced with them, it turned out that many of them did not offer a good balance between damage and benefits, they only believed it and let’s review some clinical activities that, having had their base in the moment that have been evaluated, had to be rethought seriously such as tonsillectomies, hysterectomies, frontal lobotomies, radical mastectomies, arthroscopies knee arthritis, radiological screening for lung cancer, inhibitors of proton pump for stomach ulcers, menopause hormone therapy, high-dose chemotherapy for breast cancer, etc."

Impact of nurse staffing on clinical outcomes

In preparing this post, I invited Mireia Subirana, nurse and Director of Care Department at Hospital de  Vic (Catalonia), to present the contents of her doctoral thesis. It’s not a common occurrence for any nurse to get a doctor degree (University of Leeds). She now has a PhD degree and is a Fellow of the European Academy of Nursing Science.

But Subirana has not only been invited to praise her professional and academic career, but because I think it's worth explaining at exactly what point her research is at, having raised a hypothesis that affirms that if nurses from the hospital wards are well educated and the plans are well sized, this may have an impact on clinical outcomes of hospitalised patients. 

In the last ten years, research has established and endorsed the relationship between nurse staffing characteristics and clinical outcomes of hospitalised patients and thus objectifies the contribution of nurses in the care process. It remains to be found how this relationship is established, and the mechanisms that articulate it. This work, with a realistic methodological approach, identifies key factors in the process of care (monitoring, clinical trial, the level of training, experience and the tasks that they have not been able to do) along with the characteristics that define magnetic hospitals are articulated as possible mechanisms that could explain the impact of nurse staffing on patient outcomes.

Kaiser Permanente: the keys to success

Kaiser Permanente (KP) is an integrated managed care consortium, acting in California, and to a lesser extent on 8 other U.S. states. In the series of "Virtual Clinical Practice" I have already made ​​a brief presentation of the most relevant features of Kaiser Permanente to better understand the development of Health Connect, the electronic medical record of this insurer.

KP Results

What attracts us, European health managers, to KP are their excellent results, both in adjusted resource utilisation as well as in the quality of care which contrasts to the American environment where inequities in access, organisational and medical performance disorder prevails. To illustrate what I mean I have chosen this article:

Professional confederacy for clinical effectiveness

Clinical practice guidelines often struggle to implement a mandate in the world of real medicine. For this reason, the initiatives born in the professional world that rely on instruments within reach such as persuasion, training and clinical audit are genuinely remarkable.

To illustrate what I mean, I have chosen three projects from the sensitive field of hospital infections. The first is from a team of intensive care specialists in Michigan, the second of a group of Spanish intensivists lead by Mutua de Terrassa and the third of a multidisciplinary group from Sevilla.