+ smart + connected = + effective

Michael Porter has published another anthology document, in this case for the industry; and the question raised is paramount, the one regarding the interconnectivity of products. According to the authors, the main value that industries of the last century conveyed to consumers was the quality, or the durability, or the performance of their products; but with the advent of computers, the value of adjustment to the circumstances took hold. Hybrid cars and robotics are examples of this. But Porter and Heppelmann explain that now the products, besides being smart, should come embedded with interconnectivity of origin, and argue that in the future this will be the differential value for competitiveness.

"Smart and interconnected products -the authors say- will change the consumers’ perception, but so will the rules of the competition game, so the industry will be affected by this new setting. The new wave of information technology improvements will result in disruptive improvements in the capabilities of products and services, which will result in radical changes in the world economy and human relations".

A British vision of family medicine for 2022

The British Royal College of General Practitioners has published a major document about their vision on the medical profession for the next 6 years. Remember that, just over two years ago, the Royal College of Physicians came forward with a report regarding the future of hospitals. As I documented at the time, the matter was not without controversy, because family doctors complained that the forecast was too focused on the hospital itself; and maybe that's why we are now seeing another document on the future from the perspective of primary care. Therefore, we welcome the controversy.

The new report from the General Practitioners (GP) is very comprehensive and we should pay attention to it, therefore here are some hints to encourage reading it in its entirety:

Why should we prioritize primary care over the specialist care?

End of life: the outstanding professional debate

A twisted argument against end-of-life care http://t.co/6jQJCdotWP

— Kevin Pho, M.D. (@kevinmd) 28 d’octubre de 2014

@kevinmd’s tweet takes us to a post signed by the oncologist James Salwitz, a professional who’s very active on the internet and has his own blog: “Sunrise Rounds”. Although I feel that I've devoted a lot of attention to the issue of end of life, I have decided to choose the letter from Dr. Salwitz because it seems to me that he has managed to go straight to the point on a professional debate that we have not yet solved, nor are we close to solving.

Dr. Salwitz explains that in a workshop on pain and depression control, one of the participating general practitioners raised his hand and said: "I believe that this drift towards palliative medicine will send us back to the dark ages as we will forget to defeat disease while medical research will no longer make sense, which may be the end of modern medicine and of the way of life specific to our society." The dilemma, then, according to this colleague is crystal clear, as Dr. Salwitz says: "Either we fight with all our strength against death, injecting chemotherapy to all patients, regardless of their view on life, or we surrender to the evidence that we are mortal and we accept the Darwinian principles of species while preparing to die with dignity."

Could the cancer numbers be better explained?

Cristina Roure explained in a post in her blog series "Pantone", an experience that Gerd Gigerenzer, Director of the Max Planck Institute for Human Development in Berlin, wrote in the book "How to know when numbers deceive you", where more than half of the surveyed gynaecologists did not estimate, after seeing published scientific data, what was the probability to have cancer of an asymptomatic woman’s with a positive screening mammogram. In fact the error of most of the colleagues was monumental: they said it was 90% when in fact it was 10%.

In a recent post, I commented on the book of Peter Ubel "Critical Decisions", in which the author showed what the emotional force of numbers was, both for patients and for the doctors. In this certainly worrying line, I want to give you a shred of hope. There are ways to show the numbers in order to reduce the reigning confusion. Many experts are warning us to flee percentages, the ineffable pies and the relative risks, and we have to get used to talking to patients of real numbers, pictograms with people and absolute risks. To make myself understood, I include a couple of graphics from the Harding Center for Risk Literacy, a centre which is in the orbit of Gigerenzer and Max Planck. The first is a pictogram on the evaluation of prevention programs for prostate cancer based on PSA controls and anal touch of the gland.

Will the mobile become a health folder?

By Josep M. Picas

Recently converted to the world of Apple, I was surprised that my iPhone displayed, without requesting my acceptance, a very basic health app but boasting a great potential. After a few days of mulling over the applicability of the tool, I read the news that Mayo Clinic of Rochester announced that its strategy of personal clinical record will from now on pass through this app from Apple, which means dismantling the current one and maintaining it only for  Android. Mayo Clinic is one of the American hospitals, along with Cleveland Clinic who understand very clearly that the new health is global.

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.