Other Blogs: Less Is More | An index of evidence-based, “less-medical” patient care

More "Less is More"!

Dr Bill Cayley Jr has started a Wordpress Blog, "Less is More EBM" to review studies that explore situations in which less involved/invasive/expensive/difficult/novel/etc. care is actually best for patients.

He writes, "This index is currently a personal (and extremely part-time!) project aiming to catalog literature documenting when “less is more” in a searchable and accessible format." It has just started, but there are already insights on papers about overuse of arthroscopy, the best treatment for paediatric upper respiratory infection, and creative solutions for low resource areas (eg. mosquito nets instead of mesh for hernia repair).

It's great to see interest booming. More people are writing books and blogs, talking at conferences, changing the care they deliver, and asking questions of their health care provider. The movement – still known by many names, a few of which are highlighted in the glossary – is growing!

If you are particularly interested in blogs, look at the left sidebar column, and under 'Similar Blogs' you'll find others writing about similar issues as you'll find on this site. Check 'em out!

Source: https://lessismoreebm.wordpress.com/

On “Why your doctor always keeps you waiting” & Wellness vs Work [Cross Post from @DrOttematic]

THIS IS A CROSSPOST (from DrOttematic)

A friend shared this article, “Why your doctor always keeps you waiting”. Take a look.

It perfectly sums up the struggle of a day in clinic for a primary care physician (family doctor). I can identify strongly with the author, Dr Sanaz Majd. She’s thorough, she’s dedicated, she cares about her patients, she doesn’t mind that much missing a lunch, and she cannot live with doing anything less than her best.

Trouble is, this kind of care is not sustainable. It is a recipe for burnout.

Is the answer to see fewer patients? Yes, that might help but then many Canadians would be without a doctor, we would not earn the money required to pay overhead, malpractice insurance, to attend conferences, or to live well. We have worked hard and a lot of us (those who aren’t yet burnt out) take a lot of our work (figuratively and literally) home with us.

Are we greedy? Maybe. But if someone got into medicine to make money, they are in the wrong field! Most clinicians are book-smart enough to succeed at business or investing or something else that is less personally demanding, but we enjoy medicine because it is a challenge not just intellectually, but emotionally. It is an opportunity to do something to help others while at the same time feeling stimulated and productive.

I get paid well, and I appreciate that is recognition for the intensity and length of my education, for the responsibility I assume, and for the fact that is is not “just a job” but a life and I cannot turn off ‘being a physician,’ ever.

In addition to lots of journal article reading to keep up to date, I also spend about 20 hrs a week working (without pay) on my project, Less is More in Medicine. This involves reading related articles, spreading the word on twitter, attending conferences, preparing lectures, networking, teleconferences, etc. all on my own time. I do it because I am passionate about it and feel I have a duty to make the health care system better. If I could get paid for it, that would be great! In fact, that’s a dream.

If I was paid to do the advocacy work that I feel is so important, then I could have more time to practice the “wellness” that I preach to patients. Constantly I am bombarded with messages from friends and family to “slow down.” My very patient partner has advised me that I need to view this advocacy work as ‘work,’ and take time for myself, but I haven’t done very well at listening. He suggests I take one week off each month, which technically I do (I keep it free from clinical work) but (he’d tell you) I fill it with meetings and writing and preparing for conferences. Plus I work some of the nights and weekends during the rest of the month, so I wind up doing as much clinical work as anyone else, and I enjoy this also. Whether paid or not, I will continue my advocacy work, because I cannot let go.

There are a lot of mixed messages. On the one hand, I hear I should make sure I am well: As a physician I advise exercise, healthy eating, meditation/self-reflection, and community involvement. I have seen burn-out and suicide and hospitalization of my colleagues thanks to the pressures of this profession. Numerous groups, like The Physician Health Program of BC have talks and booths at conferences, reminding us to take care of ourselves before we take care of others. Parents and partners worry.

Some comic relief in a day of stupid paperwork: Medical Reconciliation forms must be filled out when patients are admitted in order to make none of their usual medications are missed. This is important.
The pharmacist was upset that I left this page, a prescription for a generic erectile dysfunction drug (like Viagra), blank.
"Just doing my job," I know, I know. But what a system we would have if people kept only "just doing my job."

On the other hand, I should work harder and do more with less: patients are upset they can’t find a GP taking patients, they complain about waiting in the office or in the ER, colleagues ask for their shifts to be covered, emails come in constantly seeking locums, while in the middle of telling someone their loved one is dying a nurse calls and ask “when are you going to come and see this patient?!”, hospitals grow more crowded and we are seeing people in hallways, the public tells doctors we are paid to much and work too little and I’m to blame for everything that is wrong with their health, despite electronic records the pile of paperwork only seems to grow, the government of Quebec tries to pass legislation to (#PL20) forcing doctors to work more hours and take on more patients.

These messages are hard to reconcile, which is why we need to challenge the status quo. (I learned this formally, once). We need to change the way health care is delivered. We need a revolution in primary care, and we can only do this by using our time outside of clinical hours.

We must be brave and tackle conflict and embrace controversy. This makes life more difficult, but how can we – the thorough, the dedicated, the caring, the hungry, the unwilling to give less than 100 % – live any other way?

The Lown Institute: great Right Care resources, updates

The Lown Institute represents the strongest collective voice of the Right Care movement. They've spearheaded the Right Care Alliance, conferences that have transitioned from "Avoidable Care" to "Right Care," and the Declaration of Principles. The redone website is easy to navigate and has some great new features!

Today they sent a great summary e-mail of their recent work and initiatives. I've updated some Lown Institute details in the Less is More Medicine projects section and I shamelessly endorse them here by sharing some snippets (edited for brevity) from the update I received:

New Website

Our website www.lowninstitute.org has gone through an overhaul, complete with new design and user experience. Added features include Overuse 101 , the Overuse Library, and invitations to Sign the Declaration of PrinciplesTell Your Story, and Join the Right Care Alliance.

Right Care Weekly

We have launched a regular Right Care Blog feature called Right Care Weekly. Right Care Weekly is a round-up newsletter that highlights the most important news of the week as it relates to overuse, underuse, and misuse of medical tests and treatments.

Right Care Regional Events

In partnership with Right Care Alliance members, we are hosting regional conferences to promote right care across the country.  We have confirmed a regional conference in Denver, Colorado on Oct 11, 2014; planning for the Washington, D.C., San Francisco, and San Marcos, California area is underway.  Regional conference updates can be found on our website.

2015 Lown Institute Annual Conference

The third annual Lown Institute conference is slated for March 8-11, 2015 at the Omni Hotel, in San Diego, California. The aim of the conference is to share progress made since the 2013 conference, renew our collective voice for change, and inspire Right Care Alliance organizing efforts. Unlike previous years, the conference is open invitation. Registration will begin this summer.


Believing in Treatments That Don't Work

Dr David Newman considers the example of Beta-Blocker medication use in patients with heart attacks. Studies show that using these medications might make patients with heart attacks go into heart failure, rather than protecting the vulnerable heart. He cites numerous other examples of treatments that make sense by deductive reasoning, but aren't in fact beneficial.

Ideology trumps evidence . . .

Treatment based on ideology is alluring. Surgeries to repair the knee should work. A syrup to reduce cough should help. Calming the straining heart should save lives. But the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.

Read more on the Well Blog of the NY Times.

Source: http://well.blogs.nytimes.com/2009/04/02/t...

Can defensive medicine ever be stopped?

In a blog post, Skeptical Scalpel highlights the problem of defensive or "C.Y.A." medicine, indicating that a massive cultural shift of patient expectations and modelling of appropriate (rather than defensive) care practices by physicians is necessary.

assumptions made by some analysts that defensive medicine is not an important facet of the high cost of health care may be wrong. . .

about 2/3 of doctors in both the low and high risk states admitted to practicing defensive medicine.

Read more at KevinMD.

Source: http://www.kevinmd.com/blog/2013/12/defens...