Another regional conference, receiving forgiveness from a patient, and anecdotes are insufficient: RightCare Weekly
October 30, 2014
In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.
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In collaboration with the Family Medicine Education Consortium, the Lown Institute successfully held its 2nd regional conference in Arlington, VA, on Thursday, October 23. More than 30 attendees engaged in a day-long dialogue around the issues of RightCare. From the day, numerous leaders emerged, with whom we will work to continue transforming the culture of medicine, both in the DC area and nationwide. Special thanks to regional leader Larry Bauer for all of his hard work to make the conference a huge success.
In her New York Timesblog, Danielle Ofri, MD, tells the story of a disgruntled patient who offered criticism when she returned for a second visit. Said the patient, “I was ready to choose another doctor, but I decided to give you a second chance.” The patient complained that her previous doctor had always performed physical exams at her visits, but Ofri hadn’t done so at her last visit. While the comments stung, Ofri, in reviewing her notes, realized she had indeed neglected that part of the exam—one of the most important. Was it because of rising time pressures or documentation requirements? She apologized, and continued with the visit, recognizing how fortunate she was in being given a second chance by the patient. While they parted cordially, Ofri wondered how many other patients she may have inadvertently disappointed over the years. Without feedback like this, she would never know.
Bill Gardner at The Incidental Economist responds to the story we shared last week, “Why Doctors Need Stories.” He makes some good points: Most importantly, decisions made based on anecdotes or case reports can subject patients to harm. That remains the case even in the many situations in which there is no high-quality evidence to guide practice. Stories can offer options, but they are never sufficient for establishing causality and certainty of a treatment’s benefits.
The importance of high-quality evidence for clinical decision-making was reinforced again this week by the Milwakee Journal-Sentinel, which wrote about the widespread practice of approving drugs based on surrogate endpoints. Surrogate endpoints, which have been used to improve chemotherapy agents, drugs for heart disease, and many other treatments, are biological markers like cholesterol levels or tumor growth. But often, those studies are never followed up to show the drug actually extends patient lives or reduces symptoms. The GAO criticized the FDA’s handling of surrogate endpoint approvals several years ago, but the system doesn’t appear to have changed much since then.
Road to RightCare: Early bird registration has been extended through November. Register soon to save $150 on a remarkable conference! The conference will take place in San Diego, March 8 – 11, 2015. Also, don’t forget about our scholarships for students, clinical trainees, nurses, community leaders, and patient advocates! Applications are due December 7.