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OtherOn TRACK

Tip of the Iceberg

Kurt C. Stange
The Annals of Family Medicine May 2010, 8 (3) 268; DOI: https://doi.org/10.1370/afm.1124
Kurt C. Stange
MD, PhD
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The online discussion since the last issue reveals: “[I]n health care, less is often more…about 20% to 30% of all health care spending in the United States goes for over treatment—much of it dangerous.”1

The high-touch aspects of the patient-centered medical home may be more important than the high-tech aspects, but properly done, high-tech can enable valued and valuable high-touch relationships.2

“Secrets” for lowering hospital rates and the cost of health care.3

Growing support for retail clinics collaborating with primary care to increase access and convenience.4

Questions about the use of C-reactive protein testing to guide antibiotic prescribing for respiratory tract infections.5

Opportunities to improve recognition and early intervention for child maltreatment with nuanced evaluation and follow-up of children’s gastrointestinal symptoms.6

Prospects for informed decision making around colorectal cancer screening.7

The challenges of being patient-centered and enhancing useful patient questions.8

The captivating complexity of cooperative behavior and learning communities.9 Valuing knowledge that consists both of readily transferable facts and knowledge that is situated, hard to codify, and often intuitive.10

A journal club that suggests caution in using steroids for treatment of acute pharyngitis,11 and an interesting discussion12 of the nearly simultaneous publication of systematic reviews on this topic in the Annals13 and the BMJ.14

The specialty nature of the disciplines of family medicine and general practice.15

These brief quotations and synopses are just the tip of the iceberg for rich discussions. Follow the hotlinks in the references to dive below the surface. Please consider joining the discussion at http://www.AnnFamMed.org.

  • © 2010 Annals of Family Medicine, Inc.

REFERENCES

  1. ↵
    Grundy PH. Moral authority includes protecting our patients from over treatment [eletter]. http://annfammed.org/cgi/eletters/8/2/100#11727, 14 Mar 2010.
  2. ↵
    TRACK discussion in response to: Ferrante JM, Balasubramanian BA, Hudson SV, Crabtree BF. Principles of the patient-centered medical home and preventive services delivery. Ann Fam Med. 2010;8(2):108–116. http://www.annfammed.org/cgi/eletters/8/2/108. Accessed Apr 15, 2010.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    Grundy PH. Yes it is the right kind of care [eletter]. http://www.annfammed.org/cgi/eletters/8/2/108#11749, 22 Mar 2010.
  4. ↵
    TRACK discussion in response to: Ahmed A, Fincham JE. Physician office vs retail clinic: patient preferences in care seeking for minor illnesses. Ann Fam Med. 2010;8(2):117–123. http://www.annfammed.org/cgi/eletters/8/2/117. Accessed Apr 15, 2010.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    TRACK discussion in response to: Cals JW, Schot MJ, de Jong SA, Dinant G, Hopstaken RM. Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial. Ann Fam Med. 2010;8(2):124–133. http://www.annfammed.org/cgi/eletters/8/2/124. Accessed Apr 15, 2010.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    TRACK discussion in response to: van Tilburg MA, Runyan DK, Zolotor AJ, et al. Unexplained gastrointestinal symptoms after abuse in a prospective study of children at risk for abuse or neglect. Ann Fam Med. 2010;8(2):134–140. http://www.annfammed.org/cgi/eletters/8/2/134. Accessed Apr 15, 2010.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    TRACK discussion in response to: Shokar NK, Carlson CA, Weller SC. Informed decision making changes test preferences for colorectal cancer screening in a diverse population. Ann Fam Med. 2010;8(2):141–150. http://www.annfammed.org/cgi/eletters/8/2/141. Accessed Apr 15, 2010.
    OpenUrlAbstract/FREE Full Text
  8. ↵
    TRACK discussion in response to: Galliher JM, Post DM, Weiss BD, et al. Patients’ question-asking behavior during primary care visits: a report from the AAFP National Research Network. Ann Fam Med. 2010;8(2):151–159. http://annfammed.org/cgi/eletters/8/2/151. Accessed Apr 15, 2010.
    OpenUrlAbstract/FREE Full Text
  9. ↵
    TRACK discussion in response to: Soubhi H, Bayliss EA, Fortin M, et al. Learning and caring in communities of practice: using relationships and collective learning to improve primary care for patients with multimorbidity. Ann Fam Med. 2010;8(2):170–177. http://www.annfammed.org/cgi/eletters/8/2/170. Accessed Apr 15, 2010.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    Greenhalgh T. Communitites and knowledge [eletter]. http://www.annfammed.org/cgi/eletters/8/2/170#11694, 10 Mar 2010.
  11. ↵
    Hilde DP Luijks, et al. RADICAL approach to systematic review on steroids as adjuvant therapy for acute pharyngitis [eletter] http://www.annfammed.org/cgi/eletters/8/1/58#11745, 22 Mar 2010.
  12. ↵
    TRACK discussion in response to: Korb K, Scherer M, Chenot J. Steroids as adjuvant therapy for acute pharyngitis in ambulatory patients: a systematic review. Ann Fam Med. 2010;8(1):58–63. http://www.annfammed.org/cgi/eletters/8/1/58. Accessed Apr 15, 2010.
    OpenUrlAbstract/FREE Full Text
  13. ↵
    Korb K, Scherer M, Chenot JF. Steroids as adjuvant therapy for acute pharyngitis in ambulatory patients: a systematic review. Ann Fam Med. 2010 Jan;8(1):58–63.
    OpenUrlAbstract/FREE Full Text
  14. ↵
    Hayward G, Thompson M, Heneghan C, Perera R, Del Mar C, Glasziou P. Corticosteroids for pain relief in sore throat: systematic review and meta-analysis. BMJ. 2009; 339:b2976.
    OpenUrlAbstract/FREE Full Text
  15. ↵
    TRACK discussion in response to: Hoekzema G. How special is family medicine? Ann Fam Med. 2010;8(3):178–178. http://www.annfammed.org/cgi/eletters/8/2/178. Accessed Apr 15, 2010.
    OpenUrlFREE Full Text
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The Annals of Family Medicine: 8 (3)
The Annals of Family Medicine: 8 (3)
Vol. 8, Issue 3
1 May 2010
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Tip of the Iceberg
Kurt C. Stange
The Annals of Family Medicine May 2010, 8 (3) 268; DOI: 10.1370/afm.1124

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Tip of the Iceberg
Kurt C. Stange
The Annals of Family Medicine May 2010, 8 (3) 268; DOI: 10.1370/afm.1124
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  • Modifying the Measurement Paradigm or Questioning its Very Assumptions
  • On-the-Ground Wisdom About Care Integration
  • The Conversation Continues, as It Should
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