Recent Articles on Aging

Muriel R. Gillick, "In Technology We Trust," Health Affairs 2010; 2343-2346. [ Full text of this article]

Muriel R. Gillick, "Medicine as ecoculture," Annals of Internal Medicine 2009; 577-580. [ Full text of this article]

The use of diagnostic tests, especially imaging studies, varies markedly across the United States-with higher costs but no better patient outcomes associated with the highest-use regions. A proposed new model of the health care system draws on an analogy with the ecosystem to explain the geographic variations in physician test ordering. This framework emphasizes the adaptability and interdependence of the components of the system. Patients and physicians are influenced by the health care organizations in their community, including the practice site in which the physician works, local hospitals, malpractice lawyers, and imaging centers. These are in turn influenced by institutions in society at large, including the media, health care plans, and the government. Further adaptations to the explanatory model account for the psychologic and sociologic aspects of physician behavior. Understanding the medical ecoculture is essential for effective health care reform because widely touted changes, such as the introduction of an electronic medical record or comparative effectiveness studies, do not address the adaptability and interdependence that characterize the medical ecoculture.

Angelo E. Volandes, Michael K. Paasche-Orlow, Michael J. Barry, Muriel R. Gillick, Kenneth L. Minaker, Yuchiao Chang, E. Francis Cook, Elmer D. Abbo, Areej El-Jawahri, Susan L. Mitchell, "Video decision support tool for advance care planning in dementia: randomised controlled trial," BMJ 2009. [ Full text of this article]

Older people who view a video depiction of a patient with advanced dementia after hearing a verbal description of the condition are more likely to opt for comfort as their goal of care compared with those who solely listen to a verbal description. They also have more stable preferences over time.