VIDEO: It's just life (not a disease). Así es la vida [subtítulos inglés] - YouTube

"Thisislifix 1 g There is no pill that can solve the reality of not being sick."

"Thisislifix 1 g
There is no pill that can solve the reality of not being sick."

The idea that any normal, bad thing that happens to our bodies is a disease state is called "medicalization." When we label normal aspects of life in this way, it seems to degrade coping mechanisms and increase dependency on the health care system.

Perhaps a bit silly, but certainly on-point, this video reminds people that some things are just a part of life. There is no pill to fix getting a cold, feeling sad after a breakup, or getting older; these are things we have to accept and work through.

Source: https://www.youtube.com/watch?v=mqxuxN5Fw3...

A New Kind of Rounds: Type 2 Diabetes in the Elderly CME

Thanks to my local Division of Family Practice and the Practice Support Program (PSP), we were able to put together "A New Kind of Rounds" event all about helping patients find the right amount of medicine. 

Our first event, focussed on Type 2 Diabetes in the Elderly, and specifically the harms of treating this too aggressively. Inspired by the Lown Institute's RightCare Rounds and the DoNoHarm Project, we started with patient cases in which the patient's perspective highlighted the burden of treatment and the potential harms of too much medicine.

After small-group case learning, I presented a didactic session reviewing the unique factors that change our approach to management in the elderly, the best available evidence on diagnosis and treatment targets, the current guidelines, and some resources that clinicians and patients can refer to in order to make shared decisions about the "right amount" of care.

The event was well-attended and it was heartwarming to see the level of engagement on this topic from clinicians in our community; we are reviewing the evaluations to consider some changes to the format. Participants also generated an amazing of possible topics for future events, from hypertension to cancer-screening, and anti-psychotic use in the elderly to the annual physical. 

The slides are available here.

Your feedback is most welcome. You can comment below or e-mail. 

My other lectures can be viewed here.

Source: http://prezi.com/ln78vzbqpu4-/?utm_campaig...

Must Watch VIDEO: Intro to Too Much Medicine (ABC Catalyst)

28 minutes. That's all it will take to experience a fantastic overview of "too much medicine." 

Australian Broadcasting Commission (ABC)'s Catalyst has been able to clearly describe the problem, share common examples, offer opposing perspectives, and focus on some avenues for change. With guests like Dr Iona Heath (a retired GP and former President of Royal College of General Practitioners at the forefront of the movement to prevent overdiagnosis) and Dr Ranjana Srivastava (an oncologist, who wrote about the right amount of medicine in the context of her mother), it's persuasive, and it is for everyone:

  • newbies: patients and health care providers who are new to the concepts of "overdiagnosis," "overtreatment," and the idea that in medicine, sometimes more is not better will find this a decent introduction
  • keeners: this is an EXCELLENT video to use in your teaching and in spreading the message
  • skeptics: while this video may not persuade you to say "no" to having mammograms or stop ordering them for your patients, for example, it might help reframe the problem: 
    • the main idea is not "never do this test or treatment" but rather: we must combine the best available evidence about risks and benefits of having vs. or not having a test or treatment with the patient's goals, and currently we are doing a pretty bad job of fully informing our patients to empower them to make the choice that is appropriate for them


Go ahead!

 

Could our relentless pursuit of good health be making us sick? Advances in medicine have propelled health care to new heights and a vast array of diagnostic tests and drug therapies is now available. But are we getting too much of a good thing? An increasing number of doctors now say that sometimes, "less is more" when it comes to medical interventions. Some doctors are concerned that resources are being wasted on the "worried well" and that the ever-expanding definition of how we define "disease" has been influenced by vested interests. Could excessive medical interventions be causing more harm than good? Dr Maryanne Demasi examines how our relentless pursuit for good health might be making us sick

*NB if the youtube link doesn't let you view the video from your country, try ABC's website: http://www.abc.net.au/catalyst/stories/4339690.htm*

Want more? Australian media is just knocking it out of the park! ABC's Four Corners did a similar video, Wasted that is also worth a look.

Source: http://www.abc.net.au/catalyst/stories/433...

VIDEO: Wasted: Waste and Harm and Unnecessary Tests (Four Corners)

In just 45 minutes, the problem of overdiagnosis, overtesting, and overtreatment is clearly summarized using examples from the Australian system. The costs and harms to patients are incredible, and an analogy – taking the wrong train and winding up where you never intended – is an effective illustration of the issues.

Some key messages:

Billions of dollars are spent on procedures that are not needed, simply because patients expect them and because doctors continue to lobby to be paid to do their 'favourite' procedures.

What is your estimate of how many of those knee arthroscopies are unnecessary? - Dr Normal Swann, Interviewer
Uh, I would say, at least half. - Dr. Ian Harris, orthopedic surgeon

This is no surprise. Dr James Rickert has been advocating for more appropriate care in orthopaedics, for example with an alternative Choosing Wisely list  (despite what the article says, not just 'one guy's opinion' but rather a summary based on the best available evidence, presented most recently at Preventing Overdiagnosis), for years. But conflict of interest, particularly in industry lobbying and influence in the creation of guidelines, continues to be a problem. So does fee-for-service payment systems which encourage higher throughput rather than best care. 

There are other pressures too:

Often the best medicine is no medicine at all, or the best intervention is no intervention at all. But those conversations with patients that take that time to explain that the evidence simply doesn't support doing a test or prescribing a drug  - are long conversations and it's much easier in clinical practice to do things quickly and prescribe or order a test. - Dr Rachelle Buchbinder, rheumatologist

 

Patients and physicians are both uncomfortable with uncertainty, so tests 'just to see,' continue to be ordered, despite the evidence that they are needless and carry risks. We need to realign expectations, save the waste, and re-direct it into areas of health care that will really help people instead of harming them.

Watch the video for more cutting commentary and alarming statistics.

 

FULL VIDEO: FOUR CORNERS: WASTED

TEASER: 


Source: http://www.abc.net.au/4corners/stories/201...

Doctors' grade: C- on #ChoosingWisely Test Your Knowledge Questions in CMAJ

Fascinating results emerge from a small online poll of Canadian Medical Association Journal (CMAJ) readers. Web polls on the CMAJ site were done over the span of 7 months and the following 12 True or False questions were asked.

Although not scientific, the results tell us that (at least mildly-) engaged physicians (those going to the CMAJ website) like to provide a lot of unnecessary and harmful care, particularly in the area of diagnostic imaging.

Not only do we need more research on why physicians think this way, we also need research on what methods are effective at changing behaviours. We don't know yet if Choosing Wisely-type outreach to patients and providers can improve practice. We think and hope so . . .

See the Choosing Wisely Canada update for more.

EDIT:

*NB: Dr S.P. Landry has a keen eye and noticed an error; for the item pertaining to "All children with head trauma require imaging to rule our fracture and brain injuries" the answer should be FALSE. So, the correct response rate would be 70% on that question, making the overall score of respondents a little less terrible, but still remarkably bad ;)


Source: http://www.choosingwiselycanada.org/news/2...

VIDEO: What causes antibiotic resistance? Kevin Wu | TED-Ed

It is goofy (there are butt-faces, silly monsters, Salmonella shooting lasers, and even a fart scene at 2:22) and informative. It is bound to be a classic!!!

Watch this fun video explaining What Causes Antibiotic Resistance thanks the Kevin Wu and Ted Ed.

View full lesson: http://ed.ted.com/lessons/how-antibiotics-become-resistant-over-time-kevin-wu Right now, you are inhabited by trillions of microorganisms. Many of these bacteria are harmless (or even helpful!), but there are a few strains of 'super bacteria' that are pretty nasty -- and they're growing resistant to our antibiotics. Why is this happening?

Source: http://ed.ted.com/lessons/how-antibiotics-...

A summary: How to prevent #overdiagnosis @SwissMedWkly

For anyone who is even remotely interested in the movement to prevent overdiagnosis, I suggest you check out this article, How to Prevent Overdiagnosis, in its entirety.

Dr Arnaud Chiolero et al. have provided a thorough overview of the causes of overdiagnosis, methods to estimate the frequency of overdiagnosis, and interventions to prevent overdiagnosis.

As a teaser, I present to you the summary tables from the article:

We all might argue about the exact contributors to overdiagnosis, but this list (based on a review of the literature) is pretty thorough. Fortunately there is hope to combat the problem, and some specific examples are given:

See the article or follow Dr Chiolero (@swissepi) on Twitter for more.

Source: http://www.smw.ch/content/smw-2015-14060/

When is Medical Treatment Overtreatment? Maine Doctors Take New Look

I found a great 5 minute radio clip about Overtreatment, focussing on how healthcare providers and patients are finding the "right treatment" in Maine.

For those who'd rather listen than read, this is a great interview Patty Wright did with a Nurse Practitioner, Senior Vice President of the Lown Institute (Shannon Brownlee), the Director of a Maine Hospital Emergency Department, and a patient.

We have a lot of clinical guidelines we're supposed to follow. We sort of follow them like a cookbook. I was following them blindly, as I suppose many people do. They have no idea of the data behind it.

It's a really easy to understand and balanced summary of the problems of overtreatment.

Listen HERE!

Source: http://news.mpbn.net/post/when-medical-tre...

Myths and MSUs

Urinary tract infections (UTIs) are common in the elderly. They are also commonly overtreated. This can result in adverse reactions to medication including side effects like upset stomach or diarrhea, interactions with other drugs like coumadin (a blood thinner), or allergic reactions. There is also the potential loss of normal flora (good bacteria in our body) leading to overgrowth of C. difficile (bad gut bacteria) or Candida spp. (yeast) and development of antibiotic resistant organisms (AROs). Assuming someone has a UTI when they don't might also mean missing the real diagnosis.

This issue is unsurprisingly #1 on the Canadian Geriatric Society's Choosing Wisely hitlist: "Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present."

The Association for Elderly Medicine Education (AEME) has released a handful of excellent Mini-GEMs (Geriatrics E-learning Modules) on their youtube channel. This one, on "Myths and MSUs", where MSU = mid-stream urine test, was recently brought to my attention. It's aimed at physicians, but the take away for patients would be to ask "I feel fine and don't have any symptoms - do I really need an antibiotic for my bladder?"

I think it's a really clear walk-through of how to manage bladder infections, with a view to understand colonization (bacteria hanging out in the bladder that isn't causing harm) and interpreting the dip-stick test so as to avoid overtreatment. It's also a good reminder that, although common, a UTI is not always the cause of delirium, a temporary state of confusion secondary to underlying illness usually in the elderly.

Here's the video:

This MiniGEM explains how and when to diagnose UTI in older patients, and common pitfalls to avoid!
Source: https://www.youtube.com/watch?v=JPzz6fcmxo...

Believing in Treatments That Don't Work

Dr David Newman considers the example of Beta-Blocker medication use in patients with heart attacks. Studies show that using these medications might make patients with heart attacks go into heart failure, rather than protecting the vulnerable heart. He cites numerous other examples of treatments that make sense by deductive reasoning, but aren't in fact beneficial.

Ideology trumps evidence . . .

Treatment based on ideology is alluring. Surgeries to repair the knee should work. A syrup to reduce cough should help. Calming the straining heart should save lives. But the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.

Read more on the Well Blog of the NY Times.

Source: http://well.blogs.nytimes.com/2009/04/02/t...