Securing Health-Effective Medicine in Practice

The movement for public participation in medical practice and its governance (‘participative medicine’) lacks an understanding of the historical and theoretical contexts within which it has emerged. This paper discusses the problems with physician-centred medicine (previously called ‘the medical model’), administrator-centred medicine (‘managed health-care’), patient-centred medicine, and participative medicine. The concept of health-effectiveness of medical services is emphasised as fundamental in an applied, critical theory of medical practice that equates health-effectiveness with pro-social medical services. The critical theory provides a framework for understanding the movement’s purpose, its misuse by consumerist methods, and the problems when medicine is delivered by pro-market or provider-centred systems, as shown most notably in the Bristol Royal Infirmary Inquiry by the British government. The paper outlines the Tuke Institute model of health-effective services, secured by participative medical practice and its governance and integrated with translational science. Together, the Tuke Institute model and the critical theory provide a scientific framework by which to determine the health-effectiveness of different models of practice through properly scientific research, indicating the necessity of studying models of practice as complex interventions.

From Compliance to Concordance and Beyond

This commentary begins with a brief overview of recent developments in healthcare policy and practice in the UK. Particular attention is paid to the demise of the concept (and practice) of compliance along with and rise of the concept (and practice) of concordance. Analysis suggests that despite considerable changes in the organisation and delivery of healthcare there remains a clear gap between rhetoric and reality. Drawing on insights from qualitative health research issues of identity, embodiment and self-care are explored and synthesised in a single descriptive framework. Neither compliance nor concordance alone adequately captures the reality of patient experiences in everyday life. The framework of understanding proposed here contextualises compliance and concordance and their corollaries within distinct horizons of expectation. For a truly user-driven healthcare it is not a question of either/or but both and more and asking, in reality, what can a body do?

Health Professional ‘Web Based Conversational Learning’ on Unusual Forms of Lupus

This article illustrates a web-based conversational learning system termed, “Virtual Grand Rounds in Dermatology” (VGRD), that was developed by two dermatologist colleagues from the United States and Malaysia, respectively, over the past decade. Two blog posts discussing the diagnostic uncertainty around possible dermatological manifestations of lupus are highlighted along with a few conversational comments from other health professionals. The posts, as they appear on VGRD are presented verbatim and illustrate a health professional narrated website that relies heavily on images and pattern recognition. We show that health professional learning may thrive on feedback from colleagues, even if minimal.

The RTBP – Collective Intelligence Driving Health for the User

The Real Time Biosurveillance Program (RTBP) Pilot, is an active collaboration between multipartners that is utilizing collective intelligence to improve rural health outcomes, in Sri Lanka and Tamil Nadu, India. This paper presents how the RTBP is detecting, preventing, and therefore, improving the health systems of these two nations through the use of ICT to strengthen health reporting systems. It puts forth the challenges that the RTBP pilot has faced initially, and how they have been addressed. The RTBP is also differentiated from other mHealth initiatives by acknowledging how it is not disease specific and how it engages all stakeholders, from the receipients, the health workers, and the government.

DSS for Health Emergency Response

This paper presents the design approach and architecture of a Decision Support System (DSS) for the Hellenic Centre for Emergency Health Care (????, http://www.ekab.gr). The DSS supports the cooperation and decision-making processes at the EKAB call centre concerning the effective activation and allocation of appropriate resources mainly: ambulances, healthcare personnel and other public emergency resources like fire fighting and police. The DSS is a geographic web-based mash-up that builds on top of existing information systems and databases, and collects, aggregates, records, and presents various types of dynamic information about medical incidents in real time, promoting evidence-based medicine. The system provides a number of user interfaces (web-based and mobile) for call centre operators, radio centre operators, ambulance personnel, and administration. A contextual approach was necessary for the design of the system based on various related methods. Field observation of the current ways of work at EKAB sites, design, and development of data resources and user interfaces were conducted.

The Voice of Isotretinoin

This paper is a joint patient and health professional narrative that emphasizes possible utilities of a persistent clinical encounter between patients and health professionals toward improving health outcomes. It illustrates one of the important objectives of “User Driven Healthcare” that notes an increasing influence of asynchronous email as well as electronic social networking between patients and health professionals as transformative toward the future of healthcare. The patient reports an important side effect of a drug hitherto under-reported in the literature as discovered by her physician after further web based searching. This experience led him to further reflect on possible causes of prior reported side effects of the drug such as suicidal ideation.

Creating Secondary Learning Resources from Web Based Conversational Learning Around ‘Rational Usage of Medicines’ in Diabetes

This paper is an exploratory approach to creating stimulating medical education resources in the form of interactive conversational learning between health professionals who present topics related to their practice either in the form of a case uncertainty or a general uncertainty around treatment decisions. Through these conversations, health professionals discover newer insights into the topic being discussed and learn actively along with an online group of health professionals who guide each other contextually through the discussion. doc2doc, BMJ Group’s global clinical online community, presents a unique platform for the above described activity. In this illustrative example, the authors look at the topic of ‘rational usage of medicines’ in diabetes.

Creating Secondary Learning Resources from BMJ Case Reports through Medical Student Conversational Learning in a Web Based Forum

This paper discusses an exploratory approach in creating stimulating medical education resources in the form of interactive conversational learning between medical students and facilitators who dissected a case previously published in BMJ to which the students do not have access, thus bringing out the learning points in an exploratory manner. Through these conversations, students discover the subject and learn actively along with a facilitator who gradually guides them through the case based problem. BMJ Case reports present a unique platform for this case based PBL (problem based learning) activity. In this illustrative example, students and facilitators perform problem based learning in a nearly asynchronous manner on a web based forum.