I heard this on the radio recently: Mom takes her new baby to the emergency department on a weekend because she thinks her daughter might have a urinary tract infection. She's right, but regulations say the baby has to stay in the hospital for two days to ensure the infection clears. Afterwards, the mom is surprised by and concerned about a $7,000 hospital bill for the baby's care. The reporter says ...

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There's a pesky cognitive bias that creates a honking big barrier to patients and families making the most of the health advice and services available to us. It's the tendency of experts to overestimate the knowledge of others. One consequence of expertise -- or even just easy familiarity with a topic or institution or practice -- is the inability to remember not knowing what you now know. Think back to your ...

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It looks like an airport lounge without the rolling suitcases. There are about 20 of us cancer survivor-types fiddling with our phones or reading the newspaper. A few of us are sipping delicious contrast fluid in preparation for a scan, but most of us are waiting to meet with our oncologists for follow-up or monitoring visits. All of us are between the ages of 20 and 70 and all of ...

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Do I value the privacy of my health information? What do you mean? That if I email my doctor about an embarrassing symptom, only my doctor will read it? That only my doctor, my nurse and I have access to the information in my electronic medical record, including notes on our confidential conversations, prescriptions and test results? That my local drug store doesn't sell information about me to pharmaceutical companies? That if I ...

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Twitter -- its functions, benefits, risks and limitations -- has figured prominently in the heated discussion about Emma and Bill Keller's respective editorials in The Guardian (since deleted, though the archived version is still available) and the New York Times about the Twitter feed of Lisa Bonchek Adams. I have followed Lisa for a long time and greatly admire her thoughtful, highly personal tweets about the ups and downs ...

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Overheard in the gym: "Yeah, but I heard that ____ can be dangerous." "Oh, they wouldn't let us buy it if it was." Lately, the public's faith in the safety of prescription and over-the-counter drugs has been making me uneasy. Advances in drug development mean that many of us truly can live better lives through their wise use. But are we adequately guided and protected by a) regulators, b) our clinicians, c) a ...

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What can we learn from an experiment conducted on a single person? That is, when the subject population (N) is a single person, aka N=1? How and how much do such findings contribute to knowledge about the experimental intervention? How relevant are results to other patients or populations or diseases? In assessing what is known about a phenomenon, how are these findings treated in comparison to studies with 30 or ...

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You may have noticed an uptick in messages from your health plan or clinician notifying you that "You are the captain of your health care team." I have seen them here and here and here and here, for example. My response to this message? Bad metaphor: I am not the captain of my health care team. I may -- on some days -- consider myself a member of that team, should I actually ...

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Current efforts of clinicians, hospitals and researchers to make health care more "patient-centered" include inviting some of us to advise on research priorities, care organization and delivery under the assumption that, as patients, we understand what patient-centered outcomes and care are. These invitations and our acceptance of them often result in confusion and disappointment for everyone, regardless of good intentions. What do patients know about the inner workings of ...

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Incorporating patient preferences into evidence based medicine Remember the figure-ground drawing from psychology 101 that demonstrates (ahem) "how edge assignment designates perceptual groupings?" I always just thought it was cool how you could look at the picture of a vase and blink and -- whoa, Nellie -- now you saw two people face-to-face. I'm concerned that the frantic drive toward evidence-based medicine as a strategy for quality improvement and ...

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