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Tests are routine but not always necessary

Respondents

Eric Last

Dana Deighton

Carly Flumer

Photo by National Cancer Institute on Unsplash

Making an appointment is the start

Respondents

Carly Flumer

Eric Last

Kimberly Richardson

Daniel G Garza

Photo by Martha Dominguez de Gouveia on Unsplash

Your doctor should know why you are overweight first

Respondents

Carly Flumer

Eric Last

Photo by Diana Polekhina on Unsplash

Doctors advised to send birthday cards

Responses by

Eric Last

Carly Flumer

Soojin Jun

Daniel G Garza

Photo by lucas law on Unsplash

Consider what you wear when you are a doctor

Respondents

Daniel G Garza

BJ Miller

Eric Last

Carly Flumer

Dana Deighton

Photo by Lumin on Unsplash

Scans and X-ray requests convey something to the patient

Respondents

Carly Flumer

BJ Miller

Eric Last

Mike Rabow

Photo by Jonathan Borba on Unsplash

The questions you ask in a doctor’s room matter

Respondents

Carly Flumer

David Rakel

Eric Last

Kimberly Richardson

Dana Deighton

Special mention Michael Bungay Stanier

Photo by Eunice Lituañas on Unsplash

The biggest challenge is sustainability

My interview with Marie DeLuca is here.

Also Andrew Goldstein was interviewed here.

Health advocacy is being formalized as a professional activity for physicians across North America, but the accommodation of this activity into conceptions of daily practice has been controversial and confusing. There appears to be a lack of clarity around what a physician should do as a health advocate and how this should manifest in daily practice. In this article, the authors explore how the medical community has characterized the health advocate role and the roots of the debates regarding its place within training and practice, using the example of the CanMEDS Health Advocate Role. They argue that the confusion might be a result of subsuming two distinct activities, agency and activism, under the rubric of health advocacy. They propose that these activities and their associated skills are sufficiently distinct as to merit separate discussions. Agency involves advancing the health of individual patients (“working the system”), and activism involves advancing the health of communities and populations (“changing the system”). The authors suggest that distinguishing between agency and activism within health advocacy provides opportunities to explore their distinct goals and skill sets in a manner that will advance the debate about health advocacy, a conversation that remains critically important to the medical profession.

Dobson et al

Photo by Markus Spiske on Unsplash

It’s not the symptoms, it’s the context.

More on the Art of Doctoring in my conversation with the one and only Baktash Ahadi

Objective. People with RA have episodes of worsening disease activity (flares) that prompt them to seek clinical review or medication change. This study explored patients’ perspectives of flare that prompts them to seek medication review.

Methods. Fourteen focus groups across five countries comprised 67 RA patients. Transcripts were analysed by several researchers and a patient, using inductive thematic analysis.

Results. Patients use flare for five different scenarios, including flare that prompts medical help-seeking, where six themes were identified. In ‘Symptoms and early warnings’, pain is intense (wanting to die), constant and persistent and considered a key feature. Systemic features predominate, including fatigue, feeling generally ill (flu-like), physical and cognitive shut-down and social withdrawal. Warning signs (prodrome) comprise fatigue and flu-like symptoms. ‘Self-management of intensifying symptoms’ includes pacing, heat/cold, rest and increasing medication, often without medical advice. Patients ‘Define this as uncontrollable flare’ when clusters of unprovoked, persistent symptoms halt their ability to run daily life, until prompted into ‘Seeking help when symptoms can’t be contained’. Underpinning themes are ‘Individual context’ (e.g. different symptom clusters) and ‘Uncertainty’ (e.g. when to seek help). Patients report that the current patient global visual analogue scale (VAS) does not capture flare.

Conclusion. Patients use flare for multiple events and seek help for complex clusterings of intense, unprovoked symptoms that defy self-management, not necessarily captured in joint counts or global VAS. Flare terminology and definition have implications for clinical practice and trials, therefore further research should establish a professional/patient consensus.

Hewlett et al

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Playing Tennis With Snow Boots On

Medical students and doctors use narrative skills on a daily basis. Taking a history from a patient, summarising a case for senior colleagues, and recording or reading a patient’s notes all require the construction of a meaningful chronological sequence, with important events included and less important ones omitted. Similarly, when doctors compare and contrast clinical presentations and cases from their own experiences, write up case reports, or document patients’ own accounts, they rely on narrative to structure their thoughts and conclusions

Hurwitz et al. BMJ 2012

My interview with Barbara Hirsch on Narrative Medicine.

Photo by William Carlson on Unsplash