Journal of evaluation in clinical practice
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The most important advance of precision medicine (PM) has been a specific way to define and understand disease. However, PM may fail to be therapeutically effective if diseases are natural kinds. ⋯ Need for improved design of future interventions that better acknowledge problematic epistemology of PM.
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This article returns to Goffman's early formulations of 'stigma' in outlining a critique of contemporary social scientific uses and abuses of the concept. We argue that whilst Goffman's discussion of stigma is not without its troubles, it has mostly been approached in a manner that treats the concept outside of an appreciation of stigma as a phenomenon of interaction order. ⋯ We analyse both social scientific and lay uses of the stigma concept in relation to care-experienced young children and self-harm to demonstrate the shared categorisational practices and logics that are often obscured through theoretical treatments of stigma. The recommendation is, then, that an attention to 'stigma' in care settings must begin with the conditions in and from which stigma might come to feature as a sense-making device for all parties.
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Screening is a useful tool for identifying potential health issues; however, it can also lead to overtreatment. Consequently, patients are sometimes harmed by unnecessary treatments and there are cost implications. Overtreatment can also occur in other areas of medicine besides screening and sometimes medical interventions are used to improve performance rather than to treat disease. ⋯ The problem with overtreatment results from the different interests involved: autonomy is the guiding idea for patients and outcome is the guiding measure for societies. A general solution will not be possible because of these inherent conflicting interests. However, medical research may improve the identification and predictions surrounding any anomalies detected during scans and reduce the problem in practice for specific conditions.
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Evidence-Based Medicine proposes a prescriptive model of physician decision-making in which 'best evidence' is used to guide best practice. And yet, proponents of EBM acknowledge that EBM fails to offer a systematic theory of physician decision-making. ⋯ Physicians are required to interpret and apply any knowledge-even what EBM would term 'best evidence'-in light of their own knowledge, background and experience. This is consequential for EBM as understanding what physicians do and why they do it would appear to be essential to achieving optimal practice in accordance with best evidence.
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Substance use disorder (SUD) is often understood as a chronic illness. ⋯ The paper concludes that the delivery of treatment services is inequitable as SUD is not treated as a chronic illness.