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 be cared ...

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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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Outsourcing work to cheaper workers is a common strategy of corporations. It has largely escaped the public's notice, however, that much of this new labor force isn't located in Southeast Asia, but is rather found here in the U.S. and is virtually free. It is we, using our laptops and smartphones to perform tasks once carried out by knowledgeable salespeople and service representatives. This was particularly salient to me this week: ...

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Recently, both my husband and I came away from a conversation with my doctor positive that we understood my new weight gain plan. Funny thing: Each of us recalled a different plan. I am always struck by how our memories of the words spoken by my doctor can be so dissimilar. No, not all of them, but enough of them to be wary of going to any appointment without a ...

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One of my doctors always asks if he can examine me before he starts. He identifies each body part he is going to touch as a question. I feel like I can always say, "No ear exam today, thank you." Or alternately, "I've been having a little pain in my left ear. Can you check it?" Tiny point. Subtle. But by merely asking me, my doctor signals that I am not ...

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"Health care costs are sky-rocketing!" "The percentage of the U.S. GDP devoted to heath care costs is the highest in the world." "The cost of Medicare is unsustainable." For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn't what brings us the most anxiety. It's when we're patients or helping a loved one find care that so many of us are deeply ...

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Have you noticed that most sick characters on TV shows look pretty good and are coherent -- often feisty -- even when they are in the hospital? Have you caught the number of ads for drugs and health plans showing happy, vigorous people that dominate the major consumer health websites and are common on TV? Have you noted that websites of disease voluntary organizations (lungcancerCrohn's diseasearthritis) tend to show healthy people participating in ...

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