Archive for the ‘How people make decisions’ Category

Prostate Cancer Screening: Are we supposed to be screened or not?

Wednesday, March 3rd, 2010

By Evan Falchuk

The American Cancer Society says that men over 50 need to seriously consider whether they really ought to get screened for prostate cancer.  According to them, the risks of getting tested may outweigh the benefits of detecting the cancer, especially for younger men.  They say it’s a “complex issue,” but they understate how complicated it really is.

Like the recent controversy over breast cancer screening, the new recommendations add to the swirling morass of conflicting messages and priorities around health care in America.

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RIP Hooper

Wednesday, February 10th, 2010

By Evan Falchuk

Yesterday, I was sitting on the floor about two feet away from where I am now.  I was holding our wonderful chocolate lab, Hooper, in my arms as he died.

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On Really Living

Tuesday, January 19th, 2010

By Evan Falchuk

One late afternoon, some summers ago, I was at the beach.

I was with our dog, a Labrador retreiver.  He was playing fetch with a stick I was throwing into the ocean.  Every time I threw it, he darted into the ocean to find it.  Swimming through the waves, he would get the stick and carry it back proudly to shore.  He would drop it in front of me, shake off some of the water soaking his coat, and stare at me, heaving, begging me to throw it in again.

We did this for a while, and it was always the same.  He was joyous.  Eventually I had to stop, even though I loved seeing him that way.  He would have kept doing it until he drowned.

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On Being There

Tuesday, December 29th, 2009

By Evan Falchuk

Why  do people or organizations let you down?  It’s hard to generalize.  But most of the time I think it happens because most of  us are too busy thinking about ourselves to think about the impact our actions have on others.

Cary Tennis, writing in Salon a few years ago describes it well:

Aw, shit. People fail you, they do, they let you down when you need them, they get suddenly dense when you need them to be smart, they fold when you need them to open up, they close right before you get there and sleep through your honking horn in the snow. “I know she’s in there, where else could she be? Why doesn’t she come to the door?” People fail you, they do, they let you down when you need them. They don’t say they’re sorry because they don’t even know. That’s how dense they are.

I guess it’s easy to criticize people who fail you when you need them.   But you know what?  They deserve it.  You’re trying to figure out how to take care of a sick parent or child or loved one and you naturally turn to friends or family or institutions and expect them to help you find the way.  Instead, it’s, gosh that sounds terrible, but you know I’m a little distracted here, too, can I get back to you?  The people who are there when everything is fine, but run for cover as soon as trouble arrives.

Still, not everyone is like that.

I’ve seen people spend hours at the hospital trying to help struggling friends cope with a crisis.  I’ve known people who have taken in troubled children and raised them as their own.  I’ve seen communities rally around families as they try to make it through tragedy.  And I’ve known acquaintances who became close friends because they reached out their hand to help.

I suppose there is something in human nature that compels people to help others.  But we fail at it too often for it to be that simple.  I think in most cases it’s a choice – someone you know is in trouble, what do you do?  There are no easy answers, and not every situation is the same, but still, you have to choose.  How you choose over the course of your life defines the kind of person you are, whether or not you are, Lt. Col. Frank Slade would say, a person of character.

Now I have come to the cross-roads in my life. I always knew what the right path was. Without exception, I knew, but I never took it. You know why? It was too damn hard. Now here’s Charlie. He’s come to the cross-roads. He has chosen a path. It’s the right path. It’s a path made of principle that leads to character. Let him continue on his journey.

We all face these cross-roads, and must make choices.   Try to do what’s hard.

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My Reaction to “Putting Patients First”

Tuesday, July 21st, 2009

By Evan Falchuk

A blogger at the event put it simply: As bad as it is being sick, there are many things in our system that make it worse.

All of the clinicians who spoke at the event understood this, and talked about ways to improve the doctor-patient relationship.

But the problem is worse than the clinicians may think, and it’s not something health care reformers are talking about.

Let me share some data with you so you can see what I mean.

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How Atul Gawande is Being Misunderstood

Friday, June 12th, 2009

By Evan Falchuk

Everyone is reading Atul Gawande’s article in the New Yorker about health care costs. But I think most people misunderstand Gawande’s major point.

Everyones At It

Everyone's At It

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Is this Really How We Should Measure Quality?

Wednesday, June 3rd, 2009

By Evan Falchuk

The OSHA-ization of health care quality continues.

A research group and a consulting firm have been hired by the state of Massachusetts to head up a new initiative to publish cost and quality information on Massachusetts doctors.  But the quality measures they will use are the same old ones we have seen for a long time.  They mean very little to most patients, and even less to doctors as a measure of how good their work may be.

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Get Pathology Out of the Basement

Thursday, May 21st, 2009

By Evan Falchuk

The first thing you see when you enter the Toronto General Hospital’s Pathology Department is a prominent sign bearing a quote from Sir William Osler.  “As is your pathology, so goes your clinical practice,” it says.  It’s the first clue that there is something special happening here.

Dr. Silvia Asa is the Chief of the department and has built a remarkable facility in downtown Toronto.  With a team of nearly 40 full-time pathologists in a multi-specialty setting, and dozens of residents and fellows, her department reviews thousands of samples a week.  Walking the halls where the doctors do their work, you might think you were in a law firm, except for the massive microscopes adorning each desk.  The technology and organization were just about the opposite of what I saw in Argentina.

But it wasn’t the technology that was most impressive.  It was the deep passion the doctors clearly feel about the art of pathology, and the prominence it must have in any realistic conversation about quality in health care.  “Pathology has always been in the basement,” Dr. Asa told me, and she means it more than just literally.  Most hospitals have their pathology departments in basements, where the space needed for big lab equipment is at less of a premium.  But it also reflects the importance some place on pathology, almost treating it as an afterthought.

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How to Get Diagnosed Like a Hollywood Star

Thursday, April 30th, 2009

By Evan Falchuk

My younger brother is an executive producer of the show “Nip/Tuck” and an executive producer of soon-to-air Fox show “Glee.“  Last year, he almost died.

It started when he woke up one day with numbness on one side of his body.

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Misdiagnosing Misdiagnosis

Friday, April 10th, 2009

By Evan Falchuk

The Journal of the American Medical Association just published an important Commentary (abstract here, full text is subscription-only) on the striking lack of attention being paid to diagnostic error:

Despite their major public health implications, diagnostic errors have received relateively little public or scientific attention, including from the patient safety community. . . In the Institute of Medicine’s Too Err is Human Report, diagnostic errors were mentioned only twice, compared with 70 mentions for medication errors. . . None of the 20 evidence-based Patient Safety Indicators established by the Agency for Healthcare Research and Quality (AHRQ) or the 30 safe practices recommended by the National Quality Forum specifically mention failure to diagnose. . . . A 2003 report of 93 AHRQ-funded patient-safety projects found only 1 focued on misdiagnosis.

There’s a reason for this.  Health care quality is conventionally thought of as bringing concepts of high-quality manufacturing processes to medicine.  Just as there is a right way and a wrong way to attach a door to a car, there also is a right way and a wrong way to treat a patient.  If we standardize the process of treating patients, we can eliminate defects in medical care.    The drive for patient safety over the last decade has focused on finding and working on those areas of medical care that fit this model.   Treating patients — the process of care — most closely fits.

But the framework breaks down when you apply it to the really hard and important part of medicine:  deciding on the the patient’s diagnosis.

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  • "Medicine is learned by the bedside and not in the class room. Let not your conception of manifestations of disease come from work heard in the lecture room or read from the book: see and then research, compare and control. But see first."
    - Sir William Osler, MD
    The Father of Modern Medicine
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