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beware of the bio plausible

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  • Avatar Tangler 
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    Yikes, i hate being wrong. Sometimes it is hard being a biased overconfident pattern seeking primate.
    One reason to become FI is to potentially feel more empowered to say no. A position where you can tell folks : “Sorry, that won’t help” or “sorry that is more likely to harm than help”. Do no harm. Easier said than done. Especially if you are an indentured servant.
    The investment correlation is in the second link. investing Podcast looking at same idea (flawed science/evidence) and the investor.

    http://getpocket.com/explore/item/when-evidence-says-no-but-doctors-say-yes

    https://podcasts.apple.com/us/podcast/invest-like-the-best/id1154105909?i=1000439925357

    #219033 Reply
    Avatar Tangler 
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    Forgot to mention: investing podcast is an interview of the author!

    #219062 Reply
    Zaphod Zaphod 
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    Youd probably keep over in shame if you ever realized how many things are unnecessary or not only no preponderance of evidence of benefit but clear evidence it either doesnt work or causes more hard than good.

    It’s actually difficult to keep up with all the non helpful things. Some have very different tradeoffs than say a heart cath, so dont come with such a dire downside and are easier to justify.

    #219067 Reply
    Liked by Tangler
    CordMcNally CordMcNally 
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    If everyone practiced perfect evidence-based medicine, the American public would hate their healthcare even more and feel like nobody was doing anything.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    Avatar HikingDO 
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    Exactly. An evidenced based physical on a healthy adult would take me all of about 30 seconds. Instead I do the song and dance of listening to the heart and lungs, palpating the abdomen, etc, because without it I’d be ripped to pieces on my patient evaluation scores.

    #219106 Reply
    Liked by Lordosis, Kamban
    Avatar Tangler 
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    Youd probably keep over in shame if you ever realized how many things are unnecessary or not only no preponderance of evidence of benefit but clear evidence it either doesnt work or causes more hard than good.

    It’s actually difficult to keep up with all the non helpful things. Some have very different tradeoffs than say a heart cath, so dont come with such a dire downside and are easier to justify.

    Click to expand…

    Maybe we (I) should keel over in shame? Perhaps we (I) should change what I do? I think we need to do what we would want for our family.

    I heard a talk the WCI gave about cost and NNT and NNH.  It was a while ago so forgive me if this is not perfect, but I believe he discusses what he tells patients.  info like: 1. this is the number needed to treat (NNT) 2. This is the cost. 3. Number needed to harm. Tries to help them make an informed decision.

    I will personally try to do better at providing info. Not easy to rage against the machine……..and there is always the doubt (what if I am wrong?). Also, easier to go with the flow in many jobs that facilitate.

    Ex. Doing anesthesia for back surgery on an obese person with musculoskeletal back pain. The anesthesiologist knows (or thinks she knows) the back surgery is not super likely to fix the pain but the surgeon wants to do surgery, the patient wants the surgery, the hospital wants the money, the room booked, patient NPO and patient’s wife took of work………….

    Not like that anesthesiologist is going to look great if they tell the patient, “hey this is a long shot for fixing your pain, you need to diet, exercise and loose 60 pounds”.

    However, what if the patient has severe pulmonary hypertension?

    With significant risk of procedure, does the surgery/post op care and the risk make the anesthesiologist obligated to speak up…..you bet. A position of FI makes that discussion a little less stressful……albeit not by a ton.

    #219107 Reply
    Avatar Tangler 
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    If everyone practiced perfect evidence-based medicine, the American public would hate their healthcare even more and feel like nobody was doing anything.

    Click to expand…

    Really? It will never be perfect. Nothing will ever be perfect, but this sounds like a license to not try.  Really? What kind of healthcare do you personally want for you? your family? You are better than this. I have seen your other posts, you are a smart doc. We (docs, nurses, etc.) need to take back medicine and we need to eliminate costly baloney. I know, I know things like liability, reimbursement, keeping your job when you have a pile of loans……I know. I need to be better.

     

    #219108 Reply
    Avatar Tangler 
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    Exactly. An evidenced based physical on a healthy adult would take me all of about 30 seconds. Instead I do the song and dance of listening to the heart and lungs, palpating the abdomen, etc, because without it I’d be ripped to pieces on my patient evaluation scores.

    Click to expand…

    Again, really? Perhaps talk to the patient and explain to them what you are looking for and why? Example, ortho doc only looking at the concerned joint might say: “I am going to focus on your knee today, if that is ok with you, if there is something else we need to focus on, let me know” or the Anesthesiologist listening to the heart and lungs and doing a detailed airway examination prior to surgery.

    Like investing, perhaps have a reason for doing what you do? Why do I do this?

    If you are doing a “song and dance”, I don’t want you for my doc. Ok, that is a little harsh and I am guilty too, but we should be thinking about these things, I think. The article is long, but worth a read.

    #219109 Reply
    Avatar Panscan 
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    Like every 30 yr old ct head for headache. Or following up a 4 mm solid pulm nodule, or an intrapulm lymph node where the report says its a lymph node. Adrenal nodules, etc etc.

    So many ct for PE in peolle with giant effusions and bad edema

    #219114 Reply
    Avatar Panscan 
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    Spine stuff that has horrible outcomes. FAI which we don’t even know if it’s actually a thing.

    #219116 Reply
    Liked by MaxPower, Tangler
    Zaphod Zaphod 
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    Exactly. An evidenced based physical on a healthy adult would take me all of about 30 seconds. Instead I do the song and dance of listening to the heart and lungs, palpating the abdomen, etc, because without it I’d be ripped to pieces on my patient evaluation scores.

    Click to expand…

    Again, really? Perhaps talk to the patient and explain to them what you are looking for and why? Example, ortho doc only looking at the concerned joint might say: “I am going to focus on your knee today, if that is ok with you, if there is something else we need to focus on, let me know” or the Anesthesiologist listening to the heart and lungs and doing a detailed airway examination prior to surgery.

    Like investing, perhaps have a reason for doing what you do? Why do I do this?

    If you are doing a “song and dance”, I don’t want you for my doc. Ok, that is a little harsh and I am guilty too, but we should be thinking about these things, I think. The article is long, but worth a read.

    Click to expand…

    I think you’re missing the point here, these takes are absolutely correct. This is why traditional medicine and other things take off. Medicine is part a practice geared to helping people with diseases etc…., even primarily so, however it is done through people and they have expectations and ways they want things to go. This influences their perceptions of the care and quality of it they receive.

    This should be flatly obvious, but just remember doctor satisfaction scores and how they work. How does a pt rate a doctor? Likeability, how they got on, if they were told and received what they wanted (affirmation, drugs, etc…). If you simply did what was only necessary like a robot people wouldnt be happy, because that parts just a small part of the overall experience.

    When americans go to the doctor, which they do for all kinds of things and a lot need no treatment, they still expect to be treated, if you dont, theyre upset. Perfectly normal.

    #219130 Reply
    CordMcNally CordMcNally 
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    If everyone practiced perfect evidence-based medicine, the American public would hate their healthcare even more and feel like nobody was doing anything.

    Click to expand…

    Really? It will never be perfect. Nothing will ever be perfect, but this sounds like a license to not try.  Really? What kind of healthcare do you personally want for you? your family? You are better than this. I have seen your other posts, you are a smart doc. We (docs, nurses, etc.) need to take back medicine and we need to eliminate costly baloney. I know, I know things like liability, reimbursement, keeping your job when you have a pile of loans……I know. I need to be better.

     

    Click to expand…

    A license to not try? I think you’re misinterpreting my post. A large majority of things that we do have zero evidence for and only have the potential for harm. Antibiotics for URIs, x-raying a body part that we know isn’t broken and is backed by clinical decision rules, CTs of heads when they don’t need one, etc. We do A LOT of things that are not indicating just for the sake of doing something. The patient comes in because they think SOMETHING needs to be done. Very few patients are ok with just the reassurance that they need. Doing what is indicated (which many times is nothing) would be taking back medicine and eliminating costly unnecessary tests. However, when people show up to a doctor and nothing (even though nothing may be indicated) is done, they dislike their healthcare even more. I think we’re on the same page and saying the same thing but I think you misinterpreted something in my post.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #219140 Reply
    Liked by MaxPower, Tangler
    Zaphod Zaphod 
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    medical school scholarship sponsor

    For example, did you know they dont wear masks in the OR in the UK, or rather its optional? Crazy right. How about booties in the OR? Neither have any evidence of infection risk or deterrence and the booties have no realistic plausibility anyway.

    I would still wear both if only for personal protection though.

    Some of these things arent harmful and some are cheap, but theyre still lacking in evidence or firmly disproven. This is exceedingly common in medicine and life in general. Dont fight it to much you will drive yourself mad.

    #219142 Reply
    Lordosis Lordosis 
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    Status: Physician
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    Joined: 02/11/2019

    Exactly. An evidenced based physical on a healthy adult would take me all of about 30 seconds. Instead I do the song and dance of listening to the heart and lungs, palpating the abdomen, etc, because without it I’d be ripped to pieces on my patient evaluation scores.

    Click to expand…

    I have a few people who hound me on press ganey every time they come in.  Doctor did not do a yearly EKG/check enough reflexes/ listen to carotids/ Carotid US, Doctor did not check my Vit D/ Vit E/ Lyme titers/ swab for MRSA colonization in healthy asymptomatic person.

    These are all real examples of things people wrote or called in to complain about to my administration.  My nonclinical administrator does not understand.

    People what ridiculous things and do not want to be told no.

    What boggles my mind is why they come back to see me again and complain to the same admin again.  Just change doctors and find a shill who will do what you want!

    Sorry for the rant.

    “Never let your sense of morals prevent you from doing what is right.”

    #219188 Reply
    portlandia portlandia 
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    Status: Physician
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    For example, did you know they dont wear masks in the OR in the UK, or rather its optional? Crazy right. How about booties in the OR? Neither have any evidence of infection risk or deterrence and the booties have no realistic plausibility anyway.

    I would still wear both if only for personal protection though.

    Some of these things arent harmful and some are cheap, but theyre still lacking in evidence or firmly disproven. This is exceedingly common in medicine and life in general. Dont fight it to much you will drive yourself mad.

    Click to expand…

    No masks in OR? Interesting.

    I would be happy if we could get rid of the yellow MRSA gowns in the hospital. No way those are doing anything other than causing docs, Rns hassle.

     

    #219195 Reply
    Liked by Tangler, Zaphod

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