The shared clinical decision is a two way street

Peter Ubel is a doctor specialized in the field of bioethics and the research of human behaviour. As he confesses in his blog, he likes to explore the dialectic of rational and irrational forces that affect the people’s health, their happiness and the way society works.

I attached a promotional video for his book "Critical Decisions" which delves into the realm of shared clinical decisions. "The attitude of people to the risk of contracting a disease, argues Dr. Ubel in this video, does not depend on whether they understand the numbers explained to them, but on how they interpret them and, thus, very often important clinical decisions are taken based on the subtlety of perception." For example, many patients are more inclined to opt for an intervention with a 90% survival rate than for one with a 10% mortality rate. Given a risk, fear always wins over reason.

Safety daily huddle meetings

I had the opportunity to visit the Scottish NHS hospital group Ayrshire & Arran in the context of a professional event. The meeting, as expected, was very helpful, and one of the things that I took home was a working tool that for me, was as novel as it was simple: "Hospital Daily Safety Huddle," which roughly means the daily meeting of "circle time" for the patient’s safety. The management of the Crosshouse Hospital, the largest in the group, satisfied with the functioning of the experience, invited us to attend their huddle, that since June 30, 2014, they hold every day at 8:15.

What is a huddle?

According to Wikipedia, the huddle concept comes from the world of team sport. It’s joining in a circle, in the same area, standing, concentrated and often intertwined with the aim of remembering together the strategy and tactics that they have learned but also with the purpose of becoming more motivated for the game. Therefore, you see that "circle time" meeting is an approach of the concept of huddle.

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.

"Nature" echoes the unpublished biased research

"Social sciences suffer from severe publication bias" says Nature http://t.co/jA6gmQbxSP pic.twitter.com/MT8WeUlPpl

— Matthew Hankins (@mc_hankins) 28 agost, 2014

The British epidemiologist, Matthew Hankins, leads us to an article in Nature, but before going, I think it's worth commenting on the graph illustrated in his tweet. Note that from almost half a million studies published in Nature, the number of results without statistical significance (p> 0.5) is almost testimonial.

Chronic Elderly Patients: new evaluative proposals for community programs

Marco Inzitari

In recent years, we have witnessed the implementation of various community programs based on proactive monitoring and secondary prevention interventions aiming to improve the health of chronically ill patients and reduce costs to the system, such as avoiding unnecessary hospitalizations. But when studies have been conducted to evaluate the effectiveness and efficiency of these studies, the results have been rather poor.

Some of these disappointing results were presented during the Congress of the European Union Geriatric Medicine Society (EUGMS). The symposium called "Strategies in primary care to promote the autonomy of frail elderly people" presented the preliminary results of three large randomized cluster studies (cluster Randomized Clinical Trial) of the Netherlands:

Contradictions of today’s medicine according to Dr. McCartney

Dr. Margaret McCartney, a Scottish family doctor and regular contributor to the BMJ, is the author of "The Patient Paradox" a book with a critical scientific view written in the office. I regularly follow Dr. McCartney’s contributions and two of her tweets have already been selected as tweet of the week in this blog. "Cancer: Are military metaphors appropriate?" and "If we don’t die of cancer, what do we die of?". On June 17 I had the opportunity to listen to her at the inaugural conference for the Catalan Society of Clinical Pharmacy seminar. The thesis of her speech: "Too much medicine for the well and not enough for the sick" seemed very much to the point, therefore I decided to read her book; and I must say that I liked it so much that if I was an editor, I would order a Spanish translation right now.

What is the paradox that Dr. McCartney refers to? 

This paradox is no more or less than the thesis of her speech in Barcelona. If one is sick one must be persistent in order to receive the appropriate care (booking an appointment with the family doctor, limiting oneself to a little timeframe to explain what's wrong, putting up with long waiting lists to receive specialty care, etc). But if one is well, then the situation is reversed and the risk of overacting prevails, such as that in a screening or a health review, one is placed in the patient’s or in the pre-patient books thus occupying the position of a patient at risk and therefore, to receive preventative treatments for pathologies that may never occur or to be treated to combat a disease that one does not have.

Can health community work be of any use?

Great @nytimes article on need for community health workers #CHWs featuring my colleague @prabhjotsinghNY... http://t.co/wShbXqQl46

— Leana Wen, M.D. (@DrLeanaWen) 29 agost, 2014

Dr. Leana Wen, the chosen tweet author and author of the book "When doctors don’t listen", warns her followers that Tina Rosenberg has published an article in the New York Times about what Community Health Workers in the US do. After reading Rosenberg’s article, I thought that this tweet was not a good choice for our readers, as the American reality is a lot different from ours (in Spain). They have a much messier model and therefore they need low cost professionals who can lend a helping hand; in short, poorly paid quasi-volunteers working for charities helping the management of issues such as medication and habits of people living in poverty.