Comments on: Time to Care: Personal Medicine in the Age of Technology http://www.sciencebasedmedicine.org/?p=3745 Exploring issues and controversies in the relationship between science and medicine Tue, 07 Sep 2010 17:11:17 -0700 http://wordpress.org/?v=2.8.4 hourly 1 By: anoopbal http://www.sciencebasedmedicine.org/?p=3745&cpage=1#comment-42636 anoopbal Tue, 16 Feb 2010 13:19:09 +0000 http://www.sciencebasedmedicine.org/?p=3745#comment-42636 "No, relying on personal experience is a recipe for self-deception, and those practices need to be tested. There’s a danger in too much “personalization” of medicine: the doctor can be seduced into believing he is wiser than he really is and into rejecting science." The documentary below about Dr. Walter Freeman who invented lobotomy is a perfect example of a doctor "believing" in himself and rejecting science. http://video.pbs.org/video/1049423655/ “No, relying on personal experience is a recipe for self-deception, and those practices need to be tested. There’s a danger in too much “personalization” of medicine: the doctor can be seduced into believing he is wiser than he really is and into rejecting science.”

The documentary below about Dr. Walter Freeman who invented lobotomy is a perfect example of a doctor “believing” in himself and rejecting science.

http://video.pbs.org/video/1049423655/

]]> By: Science-Based Medicine » Checklists and Culture in Medicine http://www.sciencebasedmedicine.org/?p=3745&cpage=1#comment-42289 Science-Based Medicine » Checklists and Culture in Medicine Wed, 10 Feb 2010 14:40:27 +0000 http://www.sciencebasedmedicine.org/?p=3745#comment-42289 [...] represents the deepest strength of the medical culture – it is earnestly self reflective. Harriet Hall’s post from yesterday represents another example of this, reflecting on the need to optimize the human element of every [...] [...] represents the deepest strength of the medical culture – it is earnestly self reflective. Harriet Hall’s post from yesterday represents another example of this, reflecting on the need to optimize the human element of every [...]

]]> By: Plonit http://www.sciencebasedmedicine.org/?p=3745&cpage=1#comment-42278 Plonit Wed, 10 Feb 2010 13:26:04 +0000 http://www.sciencebasedmedicine.org/?p=3745#comment-42278 More time and attention invested in empathetic, compassionate patient-practitioner relationships also has an effect on outcomes in this elegantly designed study of components of placebo effects. http://www.ncbi.nlm.nih.gov/pubmed/18390493 More time and attention invested in empathetic, compassionate patient-practitioner relationships also has an effect on outcomes in this elegantly designed study of components of placebo effects.

http://www.ncbi.nlm.nih.gov/pubmed/18390493

]]> By: BillyJoe http://www.sciencebasedmedicine.org/?p=3745&cpage=1#comment-42270 BillyJoe Wed, 10 Feb 2010 09:25:41 +0000 http://www.sciencebasedmedicine.org/?p=3745#comment-42270 In Australia you cannot self-refer to a specialist, you must go through the GP, who is a "generalist" as the name implies. If your problem is beyond the jack-of-all-trades-master-of-none expertise of the GP, he refers you on to the appropriate specialist. So far there are no HMOs that decide what the doctor can and cannot do (except where work or traffic injuries are concerned - then the doctor has to convince the insurer that the procedure is needed). Only hospital treatment is covered by private insurance. Treatment by the GP or specialist is subsidised via Medicare which is funded by the Health Dept - and everyone (yes everyone) is covered. If you have an emergency medical condition you will get treatment as quickly and as expertly as anyone who is privately insured. The only advantage in private insurance is for elective surgery where there is no waiting list as there is for public patients. Overall it works better and at a fraction of the cost as health care for Americans. And it is much more personalised as a result. (However, the recent tend towards the amalgamation of small practices into multi-doctor superclinics will probably change all that in the future) In Australia you cannot self-refer to a specialist, you must go through the GP, who is a “generalist” as the name implies. If your problem is beyond the jack-of-all-trades-master-of-none expertise of the GP, he refers you on to the appropriate specialist.

So far there are no HMOs that decide what the doctor can and cannot do (except where work or traffic injuries are concerned – then the doctor has to convince the insurer that the procedure is needed).

Only hospital treatment is covered by private insurance. Treatment by the GP or specialist is subsidised via Medicare which is funded by the Health Dept – and everyone (yes everyone) is covered. If you have an emergency medical condition you will get treatment as quickly and as expertly as anyone who is privately insured. The only advantage in private insurance is for elective surgery where there is no waiting list as there is for public patients.

Overall it works better and at a fraction of the cost as health care for Americans. And it is much more personalised as a result. (However, the recent tend towards the amalgamation of small practices into multi-doctor superclinics will probably change all that in the future)

]]> By: Harriet Hall http://www.sciencebasedmedicine.org/?p=3745&cpage=1#comment-42249 Harriet Hall Tue, 09 Feb 2010 23:30:29 +0000 http://www.sciencebasedmedicine.org/?p=3745#comment-42249 pmoran, Yes, he had a close-to-primary-care relationship with his patients, and he did a lot of general internal medicine through the years, not just cardiology. He did private practice where the patients paid him directly. Yes, that's why I chose family practice for my specialty. It is unfortunate that today many patients lack a close, enduring relationship with a primary doctor who feels a responsibility for their entire medical care. pmoran,

Yes, he had a close-to-primary-care relationship with his patients, and he did a lot of general internal medicine through the years, not just cardiology. He did private practice where the patients paid him directly.

Yes, that’s why I chose family practice for my specialty. It is unfortunate that today many patients lack a close, enduring relationship with a primary doctor who feels a responsibility for their entire medical care.

]]> By: pmoran http://www.sciencebasedmedicine.org/?p=3745&cpage=1#comment-42243 pmoran Tue, 09 Feb 2010 22:06:17 +0000 http://www.sciencebasedmedicine.org/?p=3745#comment-42243 Interesting that a cardiologist should have the kind of practice base that would prompt the writing of such a book. Would I be right in assuming that he would be seeing a lot of self-referred patients and adopting a close-to-primary-care role with them, as opposed to the consultative role that cardiologists might have in some medical systems? (In my country most specialists are technicians and expected to be applying "best available evidence", and it in the area of family practice that the "real" doctoring goes on . A good medical system should enable close, enduring relationships of patients with family doctors, but with the ability to choose the one that suits .) Interesting that a cardiologist should have the kind of practice base that would prompt the writing of such a book.

Would I be right in assuming that he would be seeing a lot of self-referred patients and adopting a close-to-primary-care role with them, as opposed to the consultative role that cardiologists might have in some medical systems?

(In my country most specialists are technicians and expected to be applying “best available evidence”, and it in the area of family practice that the “real” doctoring goes on . A good medical system should enable close, enduring relationships of patients with family doctors, but with the ability to choose the one that suits .)

]]> By: cervantes http://www.sciencebasedmedicine.org/?p=3745&cpage=1#comment-42230 cervantes Tue, 09 Feb 2010 20:37:16 +0000 http://www.sciencebasedmedicine.org/?p=3745#comment-42230 Whoops, that's "hear" not "here." Whoops, that’s “hear” not “here.”

]]> By: cervantes http://www.sciencebasedmedicine.org/?p=3745&cpage=1#comment-42229 cervantes Tue, 09 Feb 2010 20:36:49 +0000 http://www.sciencebasedmedicine.org/?p=3745#comment-42229 Perhaps what he's referring to with the "5%" is the well-known adage that 90% of complaints physicians here will get better on their own -- self-limiting infectious diseases, muscle pulls and strains and mild tendinitis, moderate depression, etc. ; 5% there really isn't a whole lot medical science can do about; and 5% are susceptible to effective treatment. I don't know know if that's quantitatively true, but it's that the 90% -- or whatever the number is -- is the reason why competitors to science-based medicine have no trouble satisfying customers. Perhaps what he’s referring to with the “5%” is the well-known adage that 90% of complaints physicians here will get better on their own — self-limiting infectious diseases, muscle pulls and strains and mild tendinitis, moderate depression, etc. ; 5% there really isn’t a whole lot medical science can do about; and 5% are susceptible to effective treatment. I don’t know know if that’s quantitatively true, but it’s that the 90% — or whatever the number is — is the reason why competitors to science-based medicine have no trouble satisfying customers.

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