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Attention deficit/hyperactivity disorder (ADHD) in children: more focus on care and support, less on diagnosis. BMJ 2024; 384:e073448. [PMID: 38325889 DOI: 10.1136/bmj-2022-073448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
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Quality of mind: Dr Ian McWhinney Lecture, 2023. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:821-826. [PMID: 38092454 PMCID: PMC10949264 DOI: 10.46747/cfp.6912821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
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A book to help us choose hope. BMJ 2023; 383:2727. [PMID: 37977575 DOI: 10.1136/bmj.p2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
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The Patient Earth is sick, but the medical doctors are mainly absent. Br J Gen Pract 2023; 73:455-457. [PMID: 37770214 PMCID: PMC10544514 DOI: 10.3399/bjgp23x735081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
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Responding to the crisis of care. BMJ 2023; 380:464. [PMID: 36828555 DOI: 10.1136/bmj.p464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Don't turn away-a book not just to be read, but to be acted on. BMJ 2022; 379:o2803. [PMID: 36400452 DOI: 10.1136/bmj.o2803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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The importance of empathy. Lancet 2022; 400:271-272. [PMID: 35871809 DOI: 10.1016/s0140-6736(22)01053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
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Diagnostic excellence is a dangerous oxymoron. BMJ 2022; 376:o788. [PMID: 35338044 DOI: 10.1136/bmj.o788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The Role of Anger in Motivating Leadership. Front Med (Lausanne) 2021; 8:613977. [PMID: 34249958 PMCID: PMC8268942 DOI: 10.3389/fmed.2021.613977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/07/2021] [Indexed: 11/13/2022] Open
Abstract
As doctors, we see every working day the pervasive effects of different forms of structural violence and discrimination that undermine the hopes and aspirations of those on the losing side. This leads to powerlessness, fear and anger. Anger is not only forward facing but also directed toward, systems, institutions, governments—rather than individuals. At its best it is a protest against the status quo. We point out that leadership is one of the core values of our professionalism. In the light of what we see and hear, we have a responsibility to use the anger that this engenders within us to speak truth to power: this speaking is leadership. Our message is: feel the fear and the anger, use it to change the world, and enfold leadership in hope and the pursuit of justice.
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Joining the Fight against Poverty: Open Invitation from the International Poverty and Health Network to All Health Professionals. Mcgill J Med 2020. [DOI: 10.26443/mjm.v5i2.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lisa M Schwartz: devoted her career to improving transparency and understanding of medical evidence. Assoc Med J 2018. [DOI: 10.1136/bmj.k5323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Back to the future: aspects of the NHS that should never change—an essay by Iona Heath. BRITISH MEDICAL JOURNAL 2018. [DOI: 10.1136/bmj.k3187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Peter Pritchard: general practitioner with “legendary” improvisation skills. Assoc Med J 2018. [DOI: 10.1136/bmj.k676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The missing person: The outcome of the rule-based totalitarianism of too much contemporary healthcare. PATIENT EDUCATION AND COUNSELING 2017; 100:1969-1974. [PMID: 28408135 DOI: 10.1016/j.pec.2017.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Medicine has an obsession with scientific progress and a misplaced belief in the perfectibility of the human body and mind and, as a result, there seems never to be time for the necessary backward glance. If we in healthcare are to learn any of the lessons of history, it seems important that we pay attention to those who have suffered at the sharp end of historical events. METHODS AND RESULTS This paper invokes thinkers and writers who lived lives scarred by totalitarian politics. Their testimony emphasises the importance of paying attention to the particularity of individual experience and demonstrates the importance of story, listening, seeing, imagination, and attention. CONCLUSION If we are to resist the secular totalitarianism of contemporary healthcare and reinstate the missing person at the centre of what we do, we as healthcare professionals must find the courage to disregard the rules. PRACTICE IMPLICATIONS In every consultation it is important to be aware of the wider historical, political and social context that may direct and constrain the choices available to both patients and professionals.
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Addressing overuse and underuse around the world. Lancet 2017; 390:105-107. [PMID: 28077230 DOI: 10.1016/s0140-6736(16)32573-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
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Abstract
Overuse, which is defined as the provision of medical services that are more likely to cause harm than good, is a pervasive problem. Direct measurement of overuse through documentation of delivery of inappropriate services is challenging given the difficulty of defining appropriate care for patients with individual preferences and needs; overuse can also be measured indirectly through examination of unwarranted geographical variations in prevalence of procedures and care intensity. Despite the challenges, the high prevalence of overuse is well documented in high-income countries across a wide range of services and is increasingly recognised in low-income countries. Overuse of unneeded services can harm patients physically and psychologically, and can harm health systems by wasting resources and deflecting investments in both public health and social spending, which is known to contribute to health. Although harms from overuse have not been well quantified and trends have not been well described, overuse is likely to be increasing worldwide.
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Information without wisdom. BMJ 2017; 358:j3203. [PMID: 28679507 DOI: 10.1136/bmj.j3203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The importance of values in evidence-based medicine. BMC Med Ethics 2015; 16:69. [PMID: 26459219 PMCID: PMC4603687 DOI: 10.1186/s12910-015-0063-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based medicine (EBM) has always required integration of patient values with 'best' clinical evidence. It is widely recognized that scientific practices and discoveries, including those of EBM, are value-laden. But to date, the science of EBM has focused primarily on methods for reducing bias in the evidence, while the role of values in the different aspects of the EBM process has been almost completely ignored. DISCUSSION In this paper, we address this gap by demonstrating how a consideration of values can enhance every aspect of EBM, including: prioritizing which tests and treatments to investigate, selecting research designs and methods, assessing effectiveness and efficiency, supporting patient choice and taking account of the limited time and resources available to busy clinicians. Since values are integral to the practice of EBM, it follows that the highest standards of EBM require values to be made explicit, systematically explored, and integrated into decision making. Through 'values based' approaches, EBM's connection to the humanitarian principles upon which it was founded will be strengthened.
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Abstract
Multimorbidity has become the norm for the majority of patients attending primary care, and while the proportion of those with multimorbidity is higher in older age, the absolute number of people with multimorbidity is greater in those under 65. The specialist-based single-disease model of treatment assumes that each index disease is the dominant illness within the complex system and that the other comorbid illnesses are held constant while management is focussed on the single condition. Thus, applying single disease guidelines to a person with five chronic comorbidities, no matter what they are, results in potentially harmful polypharmacy. This approach has led to the current ‘epidemic’ in morbidity and mortality from adverse drug reactions that now outstrip the target diseases as a cause of death. In this article, we highlight four characteristics of quaternary prevention framework that policymakers should take into account when considering the quality of health care.
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Primary care priorities in addressing health equity: summary of the WONCA 2013 health equity workshop. Int J Equity Health 2014; 13:104. [PMID: 25376383 PMCID: PMC4226901 DOI: 10.1186/s12939-014-0104-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research consistently shows that gaps in health and health care persist, and are even widening. While the strength of a country's primary health care system and its primary care attributes significantly improves populations' health and reduces inequity (differences in health and health care that are unfair and unjust), many areas, such as inequity reduction through the provision of health promotion and preventive services, are not explicitly addressed by general practice. Substantiating the role of primary care in reducing inequity as well as establishing educational training programs geared towards health inequity reduction and improvement of the health and health care of underserved populations are needed. METHODS This paper summarizes the work performed at the World WONCA (World Organization of National Colleges and Academies of Family Medicine) 2013 Meetings' Health Equity Workshop which aimed to explore how a better understanding of health inequities could enable primary care providers (PCPs)/general practitioners (GPs) to adopt strategies that could improve health outcomes through the delivery of primary health care. It explored the development of a health equity curriculum and opened a discussion on the future and potential impact of health equity training among GPs. RESULTS A survey completed by workshop participants on the current and expected levels of primary care participation in various inequity reduction activities showed that promoting access (availability and coverage) to primary care services was the most important priority. Assessment of the gaps between current and preferred priorities showed that to bridge expectations and actual performance, the following should be the focus of governments and health care systems: forming cross-national collaborations; incorporating health equity and cultural competency training in medical education; and, engaging in initiation of advocacy programs that involve major stakeholders in equity promotion policy making as well as promoting research on health equity. CONCLUSIONS This workshop formed the basis for the establishment of WONCA's Health Equity Special Interest Group, set up in early 2014, aiming to bring the essential experience, skills and perspective of interested GPs around the world to address differences in health that are unfair, unjust, unnecessary but avoidable.
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Breast cancer screening causes more harm than good: Yes. J Prim Health Care 2014; 6:79-80. [PMID: 24624416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Iona Heath: not keen on posh boys. BMJ 2014; 348:g1286. [PMID: 24495956 DOI: 10.1136/bmj.g1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Back to Back: Breast cancer screening causes more harm than good: Yes. J Prim Health Care 2014. [DOI: 10.1071/hc14079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Not safe in their hands. BMJ 2013; 346:f1004. [PMID: 23427123 DOI: 10.1136/bmj.f1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Every day in every way we are getting better and better: the optimism of health policy. BMJ 2012; 345:e5608. [PMID: 22915731 DOI: 10.1136/bmj.e5608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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