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The New England Journal of Medicine is one of the most important general medical journals in the world. Doctors rely on the conclusions it publishes, and most do not have the time to look beyond abstracts to examine methodology or question assumptions. Many of its pronouncements are conveyed by the media to a mass audience, which is likely to take them as authoritative. But is this trust entirely warranted? Theodore Dalrymple, a doctor retired from practice, turned a critical eye upon a full year of the Journal, alert to dubious premises and to what is left unsaid. In False Positive, he demonstrates that many of the papers it publishes reach conclusions that are not only flawed, but obviously flawed. He exposes errors of reasoning and conspicuous omissions apparently undetected by the editors. In some cases, there is reason to suspect actual corruption. When the Journal takes on social questions, its perspective is solidly politically correct. Practically no debate on social issues appears in the printed version, and highly debatable points of view go unchallenged. The Journal reads as if there were only one possible point of view, though the American medical profession (to say nothing of the extensive foreign readership) cannot possibly be in total agreement with the stances taken in its pages. It is thus more megaphone than sounding board. There is indeed much in the New England Journal of Medicine that deserves praise and admiration. But this book should encourage the general reader to take a constructively critical view of medical news and to be wary of the latest medical doctrines.
Expert clinical problem-solving methods and guidance—from the editors and contributors of the New England Journal of Medicine This invaluable resource from the New England Journal of Medicine expertly addresses methods and challenges in clinical diagnosis. Including the peer-reviewed content of the NEJM’s renowned “Clinical Problem Solving” feature, this powerful resource is packed with case discussions from both ambulatory and hospital practice. Each Case Presentation reveals thought-provoking clinical and laboratory clues as the diagnostic considerations begin to emerge. Subsequent clinical detail and discussion and expert analysis add to the diagnostic picture until a final clinical diagnosis is reached. New England Journal of Medicine: Clinical Problem-Solving features: Published cases drawn from the New England Journal of Medicine reflecting actual patient-management situations that physicians experience in their everyday clinical practice Two brand new, never-before-published chapters on medical decision-making skills and methods Wide-ranging coverage of the major considerations in each case, from underlying pathophysiology to signs from the physical examination to lab testing strategies More than 100 full-color illustrations, tables, and algorithms Meticulously selected references that open up avenues for further study And much more! From cover to cover, New England Journal of Medicine: Clinical Problem-Solving presents the best case analysis, diagnostic thought processes, and problem-solving-- direct from master clinicians.
This unique and engaging open access title provides a compelling and ground-breaking account of the patient safety movement in the United States, told from the perspective of one of its most prominent leaders, and arguably the movement’s founder, Lucian L. Leape, MD. Covering the growth of the field from the late 1980s to 2015, Dr. Leape details the developments, actors, organizations, research, and policy-making activities that marked the evolution and major advances of patient safety in this time span. In addition, and perhaps most importantly, this book not only comprehensively details how and why human and systems errors too often occur in the process of providing health care, it also promotes an in-depth understanding of the principles and practices of patient safety, including how they were influenced by today’s modern safety sciences and systems theory and design. Indeed, the book emphasizes how the growing awareness of systems-design thinking and the self-education and commitment to improving patient safety, by not only Dr. Leape but a wide range of other clinicians and health executives from both the private and public sectors, all converged to drive forward the patient safety movement in the US. Making Healthcare Safe is divided into four parts: I. In the Beginning describes the research and theory that defined patient safety and the early initiatives to enhance it. II. Institutional Responses tells the stories of the efforts of the major organizations that began to apply the new concepts and make patient safety a reality. Most of these stories have not been previously told, so this account becomes their histories as well. III. Getting to Work provides in-depth analyses of four key issues that cut across disciplinary lines impacting patient safety which required special attention. IV. Creating a Culture of Safety looks to the future, marshalling the best thinking about what it will take to achieve the safe care we all deserve. Captivatingly written with an “insider’s” tone and a major contribution to the clinical literature, this title will be of immense value to health care professionals, to students in a range of academic disciplines, to medical trainees, to health administrators, to policymakers and even to lay readers with an interest in patient safety and in the critical quest to create safe care.
Motivated by the explosion of molecular data on humans-particularly data associated with individual patients-and the sense that there are large, as-yet-untapped opportunities to use this data to improve health outcomes, Toward Precision Medicine explores the feasibility and need for "a new taxonomy of human disease based on molecular biology" and develops a potential framework for creating one. The book says that a new data network that integrates emerging research on the molecular makeup of diseases with clinical data on individual patients could drive the development of a more accurate classification of diseases and ultimately enhance diagnosis and treatment. The "new taxonomy" that emerges would define diseases by their underlying molecular causes and other factors in addition to their traditional physical signs and symptoms. The book adds that the new data network could also improve biomedical research by enabling scientists to access patients' information during treatment while still protecting their rights. This would allow the marriage of molecular research and clinical data at the point of care, as opposed to research information continuing to reside primarily in academia. Toward Precision Medicine notes that moving toward individualized medicine requires that researchers and health care providers have access to very large sets of health- and disease-related data linked to individual patients. These data are also critical for developing the information commons, the knowledge network of disease, and ultimately the new taxonomy.
Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
"With an increase in visits to remote and dangerous locations around the world, the number of serious and fatal injuries and illnesses associated with these expeditions has markedly increased. Thus, so has the need for medical personnel trained specifically to handle the health risks that are faced when far removed from professional care resources." "Expedition and Wilderness Medicine covers everything a prospective field physician or medical consultant needs to prepare for when beginning an expedition. Divided into three parts "Expedition Planning," "Expeditions in Unique Environments," and "Illness and Injuries on Expeditions," - this unique book covers everything that the expedition physician needs to know."--BOOK JACKET.
A remarkable cat. A special gift. A life-changing journey. They thought he was just a cat. When Oscar arrived at the Steere House Nursing and Rehabilitation Center in Rhode Island he was a cute little guy with attitude. He loved to stretch out in a puddle of sunlight and chase his tail until he was dizzy. Occasionally he consented to a scratch behind the ears, but only when it suited him. In other words, he was a typical cat. Or so it seemed. It wasn't long before Oscar had created something of a stir. Apparently, this ordinary cat possesses an extraordinary gift: he knows instinctively when the end of life is near. Oscar is a welcome distraction for the residents of Steere House, many of whom are living with Alzheimer's. But he never spends much time with them -- until they are in their last hours. Then, as if this were his job, Oscar strides purposely into a patient's room, curls up on the bed, and begins his vigil. Oscar provides comfort and companionship when people need him most. And his presence lets caregivers and loved ones know that it's time to say good-bye. Oscar's gift is a tender mercy. He teaches by example: embracing moments of life that so many of us shy away from. Making Rounds with Oscar is the story of an unusual cat, the patients he serves, their caregivers, and of one doctor who learned how to listen. Heartfelt, inspiring, and full of humor and pathos, this book allows readers to take a walk into a world rarely seen from the outside, a world we often misunderstand.