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BackPage Online, February 2019

doi: 10.1097/01.BACK.0000553245.45442.ad
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A Profusion of Diagnoses: Validated and Unvalidated

Modern medicine is seeing a profusion of new diagnoses—as well as treatments for these putative medical conditions. But as a New York Times column by Dhruv Khullar, MD, asked, “With millions of Americans taking risky medications for questionable diagnoses, have we medicalized everyday life?”

Questionable diagnoses, and their accompanying treatments, unfortunately, can be hugely expensive. Khullar pointed out that 12 newly established diagnoses—some of which overlap with back problems—have accounted for $80 billion in annual spending.

And the world of spinal medicine, of course, abounds with poorly validated diagnoses—and insufficiently validated treatments for them: e.g., degenerative disc disease, Modic changes, sacroiliac instability, myofascial pain syndrome, etc.

Interestingly, Khullar opened his article by describing his own patient, whom he eventually “diagnosed” with fibromyalgia. Fibromyalgia, however, is not a diagnosis. It is a broad classification that applies to a whole spectrum of symptoms. So Khullar appears to be engaging in some of the diagnostic behavior he is criticizing in the article. Other than that, this is an excellent reminder of the hazards of leaping to conclusions in medicine without adequate research.

Here is a link to the New York Times article:

https://www.nytimes.com/2018/11/06/well/live/a-profusion-of-diagnoses-thats-good-and-bad.html.

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Pioneer in Medical Communication and Health Literacy Passes Away at 55

Lisa Schwartz, MD, one of the world's leading researchers on the ways medicine might improve communication with the general public, patients, and healthcare providers, has died at the age of 55. She and her husband collaborator Steven Woloshin, MD, headed the Dartmouth Center for Medicine and the Media, where they worked tirelessly to improve the communication of medical information to clinicians, journalists, policy makers, and the general public.

Here is a link to a tribute at the Dartmouth Institute: https://tdi.dartmouth.edu/news-events/dartmouth-institute-honors-legacy-professor-lisa-schwartz

And here is article about the focus of the work of Schwartz and Woloshin: https://dartmed.dartmouth.edu/spring12/html/truth_in_numbers/

https://www.nature.com/articles/d41586-018-07532-5?utm_source=STAT+Newsletters&utm_campaign=a49fd7d4af-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-a49fd7d4af-149680581

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Egotistical Surgeons: A Few Bad Apples Giving the Whole Barrel a Bad Reputation?

A few bad apples appear to be giving surgeons an unwarranted reputation for rude egotistical behavior. “Healthy self-confidence has an important role in surgery, but we must take care that it doesn't develop into disruptive ego,” say Christopher G. Myers and colleagues in a review in BMJ. “Recent years have seen a palpable change in the surgical community, with major efforts made to shift towards a more positive, humanistic surgical culture. This reflects a broad recognition that ego-driven behaviors and disruptive attitudes pose a risk to surgical culture and to patients,” according to the researchers. Although reports of excessive egotism are on the decline, patients still complain about surgeons being arrogant, intimidating, and/or rude. Surgical culture, they suggest, is in the midst of a transformation towards a more positive and humanistic culture, in part as a response to both extreme and subtle ego-driven disruptive behavior among surgeons.

Here is a link to the article at BMJ: https://www.bmj.com/content/363/bmj.k4537.full

Here is a link to “rapid responses” from other healthcare professionals at BMJ: https://www.bmj.com/content/363/bmj.k4537/rapid-responses

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