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Digital designs for the age of evidence

Whether strolling the streets of Union, New Jersey, as a boy, admiring the painted ladies of San Francisco in college, or traveling back in time via the red brick homes of Boston’s Beacon Hill as a pediatric resident, Howard Bauchner, MD, has always adored exploring the built milieu surrounding him.

“I loved Frank Lloyd Wright and the Prairie School and I loved skyscrapers, and just walking around cities and seeing how these buildings fit into their environments,” Dr. Bauchner recalls of his early avocation. “But it never made it into my college coursework.”

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Instead, Dr. Bauchner’s true and unrelenting passion for medicine took over.

“I never remember wanting to do anything but become a doctor,” says Dr. Bauchner, editor-in-chief of JAMA and senior vice president of AMA scientific publications and multimedia applications.

Yet Dr. Bauchner’s early and continuing appreciation of architecture offers a fitting framework to understand how he has moved medicine forward in the eventful eight years of his tenure at the AMA’s crown jewel.

After all, form follows function. That rightly famed maxim from Chicago architect Louis Sullivan—Wright’s mentor—states that a building’s design should be dictated by its intended use. Wright took the notion further, crafting structures that mirrored and often melded into their surroundings. A building cannot stand alone, Wright argued. Rather, it should fit with, or even enhance, its setting.

So it goes in the world of medical journals. Original research—to have any lasting impact on physicians—must be vigorously interrogated and carefully situated within the broader environment of the evidence, clinical practice, payment, law and more.

“It’s hard to be a really good physician who sees patients every day and can keep up with the literature and understand how that should influence his or her interactions with patients and the clinical decisions they make,” Dr. Bauchner says.

He notes an often-heard “worry that the statistics have become so sophisticated that physicians take for granted what they’re being told.”

“Even randomized clinical trials are more complicated than ever before,” he says. “As data get bigger, that adds its own complications. And there’s always the issue of statistical significance and clinical significance.”

Dr. Bauchner admires “the physician who can keep up with and use that information to influence the decisions they make with patients. It’s the journal editor’s responsibility—and it’s now more important than ever before—to make sure the research published is put in the right light, with the right context and with the right caveats.”

That is why two in three original investigations published in JAMA Network™ journals “has an editorial to help shed light on the findings,” Dr. Bauchner says. “We work really hard to make sure that the discussions about the original investigations are enlightening, but we also bring up the challenges of the research. So, the editors play a proactive role in the discussion sections of papers.”

Dr. Bauchner’s careful thought regarding the proper construction of the medical journal in contemporary practice grows out of decades of devotion to the form.

As a medical student, he says, “I was happy reading medical journals all weekend long. I just loved understanding the evolving evidence for treatments, the lack of evidence, the supportive evidence.”

For Dr. Bauchner, his experience in the Robert Wood Johnson Academic Pediatric Development Program at Yale Medical School marked a turning point.

Read this story in its entirety as featured in our inaugural issue of AMA Moving Medicine.