“Efforts to improve postdischarge outcomes for patients with heart failure have focused on care coordination through provision of telephone contacts and clinic visits, with mixed results. Prior literature indicates that postdischarge phone calls alone do not reduce emergency department revisits or hospital readmissions. There is mixed evidence that more intensive interventions, such as structured home and clinic follow-up visits, are effective, with more recent trials showing lower efficacy, possibly due to better in-hospital care. The Mighty-Heart trial adds to this literature by demonstrating that a high-intensity intervention offering home visits by paramedics and telehealth visits with an emergency medicine physician did not improve patient … Read More
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“Prediabetes is the most prominent risk factor of T2D [type 2 diabetes] with a yearly progression rate of 5–10% and a lifetime progression risk of 74%, and an independent risk factor for vascular diseases, cancer and neurodegenerative diseases. [..] Weight-loss-induced prediabetes remission (>5% of initial body weight) was explained by improved insulin sensitivity and reduced visceral adipose tissue (VAT) volume. At long-term follow-up, participants reaching weight-loss-induced prediabetes remission had a 73% reduced risk of developing T2D compared to those who only met the weight loss goal (but not prediabetes remission) and also had reduced signs of kidney and small vessel … Read More
“Although physicians excel at mapping disease spatially (eg, locating tumors, charting lesions, pursuing biomarkers), patients organize their lives around temporal uncertainty. This pattern extends across episodic conditions. Patients often find that uncertainty between episodes causes more distress than the acute symptoms. They organize their lives around the possibility of recurrence, not the reality of crisis. Chronic episodic disorders do not fit easily into static disease models. Yet clinical coding captures diagnoses, not trajectories. Quality metrics reward event suppression, not functional recovery. A routine office visit might document recent symptoms but overlook emerging vulnerability. In many such conditions, success has been … Read More
“In this Viewpoint, we question traditional approaches to teaching clinical reasoning that focus primarily on illness scripts and pattern recognition. We argue that, while pattern recognition comes naturally to humans, it is susceptible to cognitive biases that lead to diagnostic errors. Instead of emphasizing illness scripts, educators should aim to enhance diagnostic acumen by teaching learners to engage in critical thinking—in other words, reasoning from foundational principles of human pathophysiology. The importance of moving beyond pattern recognition will become increasingly urgent as generative artificial intelligence (AI) becomes central to the practice of medicine. Illness Scripts: Fast, but Risky As the … Read More
Large language models are transforming medicine—but the technology comes with side effects. “Surveys have suggested that many people are more confident in A.I. diagnoses than in those rendered by professionals. Meanwhile, in the United States alone, misdiagnosis disables hundreds of thousands of people each year; autopsy studies suggest that it contributes to perhaps one in every ten deaths. [..] One recent study found that OpenAI’s GPT-4 answered open-ended medical questions incorrectly about two-thirds of the time. In another, GPT-3.5 misdiagnosed more than eighty per cent of complex pediatric cases. Meanwhile, leading large language models have become much less likely to … Read More
[Farr] One of the big questions I have as someone who also wears an investing hat is how big can cash-pay healthcare get? What’s your answer to that as you look at publicly traded businesses like Hims & Hers? [Blitz] Cash-pay is not going away and will continue to grow a ton. Every year our insurance premiums go up, health insurance companies pay for less of your care, they make it harder for us to get basic care paid for, so patients are just tired of all this. They are looking for affordable solutions that are just easy and don’t … Read More
By gatekeeping health data, the AI Action Plan risks hardwiring bias into the future of American medicine. “the Trump administration has purged data from government websites, slashed funding for research on marginalized communities, and pressured government researchers to restrict or retract work that contradicts political ideology. These actions aren’t just symbolic—they shape what gets measured, who gets studied, and which findings get published. Now, those same constraints are moving into the development of AI itself. Under the administration’s policies, developers have a clear incentive to make design choices or pick data sets that won’t provoke political scrutiny. These signals are shaping … Read More
Artificial intelligence is ready to collaborate. Why fixate on automation? “We should insist on AI that can collaborate with, say, doctors—as well as teachers, lawyers, building contractors, and many others—instead of AI that aims to automate them out of a job. Radiology provides an illustrative example of automation overreach. In a widely discussed study published in April 2024, researchers at MIT found that when radiologists used an AI diagnostic tool called CheXpert, the accuracy of their diagnoses declined. “Even though the AI tool in our experiment performs better than two-thirds of radiologists,” the researchers wrote, “we find that giving radiologists access to AI … Read More
Excerpt – The global total fertility rate has more than halved since 1950, with those of most countries already below replacement level. The population pyramid is increasingly inverted, not just in the wealthiest Western nations but also in most places outside Africa. [..] If birthrates do not recover — and at present, they show no real signs of doing so — eventually we will be forced to revert to the system that prevailed for all of human history up until recently: Older people will be cared for privately, typically by their children and grandchildren, and those without families will have to rely … Read More
“less than one third of physicians graduating from primary care residency programs plan on practicing primary care. Often-cited culprits of this workforce shortage include burnout, administrative burdens, income disparities between PCPs [primary care physicians] and specialists, and loss of autonomy amid a shift toward increased ownership of physician practices by health care systems and corporations. Increasingly, however, the shortage of PCPs is being exacerbated by another phenomenon: the evolution of primary care — long championed as a common good — into a private, free-market commodity. [..] most DPC practices operate entirely outside the insurance system, with patients paying a monthly … Read More