Articolo di Arjun Panesar su The Guardian

Social media has changed most aspects of life – including how people gather information about their health. While online forums for those with particular conditions, such as diabetes, are rapidly growing in popularity, the NHS is continuing to ignore them, even though they have the potential to save large sums of money. It is a frustrating blind spot.

My own experience of co-founding and running Diabetes.co.uk – the largest online community for people living with the condition – suggests these kind of forums have almost no contact with the NHS, despite our estimation that we could be saving it more than £7m a year by educating people about their condition and helping them manage it so they can avoid costly ambulance call-outs and hospital admissions.

Diabetes now affects more than 4 million people in the UK, a 65% rise in the past decade. The condition is a major user of NHS resources, with treatment costs for type 2 now taking £10bn a year, nearly 10% of the total budget. Complications, including heart disease and amputations, are by far the most expensive part of treating the condition. Inpatient care of complications costs between £1,800 and £2,500 for each patient.

If the health service made more use of self-supporting communities to educate people with diabetes, it would reduce the need for costly inpatient care.

There is clearly a rising demand for what online forums offer, perhaps reflecting the steady migration of the search for information from offline to online. Diabetes.co.uk, which launched in 2010, gets more than 2 million visitors each month and now has 415,000 members in the UK.

The democratisation of knowledge should be seen as an addition to healthcare not – as it is hard to escape concluding – a challenge to it. We think the health service should learn from consumer technology giants such as Apple, which uses forums to augment their customer service.

By not engaging with forums like ours, the health service is not just losing opportunities to reduce care costs but also to gather information on patient experience and attitudes. One survey we conducted generated 20,000 responses in six weeks, for example. continua a leggere

Articolo di Noam Scheiber sul New York Times

Early in the morning on Aug. 12, 2015, a 68-year-old man named Barry turned up at PeaceHealth Sacred Heart Medical Center in Springfield, Ore., confused and feverish.

The case was not a candidate for even a minor subplot on “House.” The admitting doctor stopped one of the patient’s medications and inserted an IV to deliver fluids, and by late the next morning, he had largely recovered.

Still, Dr. Rajeev Alexander, the hospitalist who took over his care, was determined to make an accurate diagnosis.

For nearly half an hour, Dr. Alexander, a perpetually rumpled man, chatted with Barry and Linda, his sister, about the events that had landed him in the hospital, the food processing plant where he once worked, the stroke that had impaired his mind. “It was a very scary night last night,” Linda, his caretaker, said. “He was just sitting on the floor, like you would sit a 6-month-old when they haven’t got their balance.”

Dr. Alexander considers it proper technique to review each mundane detail with a patient. He is full of scorn for the eureka style of medical diagnosis depicted on television, and by his own admission, he reads a CT scan with the sophistication of a barber.

Eventually, Dr. Alexander would discard the more exotic theories that had crossed his mind — meningitis, or possibly a condition known as serotonin syndrome — and settle on a far simpler malady: dehydration, which aggravated a chronic kidney problem.

He was nonetheless unapologetic about the time he had invested.

“Real life is all about the narrative,” he said. “It’s sitting down and talking about bowel movements with a 79-year-old woman for 45 minutes. It’s not that interesting, but that’s where it happens.”

Dr. Alexander’s method is at the center of an emotional debate in medicine, in which the imperative to increase efficiency in a high-cost health care system is often at odds with the deference traditionally accorded to doctors. continua a leggere