2 Docs Talk: Medicine | Health | Healthcare Policy | Evidence Based Medicine

Over the last several decades a shift from independent physicians to corporate-employed physicians has changed the healthcare landscape.  It would make sense to consolidate and take advantage of economies of scaled to make healthcare for efficient.  Today 2 Docs Talk about whether this supposition plays out. Who is happier - independent or employed physicians? And whose patients fare better. 

With stronger regulations on pesticides (for good reason), bedbug infestations have been on the rise in recent years. These little parasites live in the nooks and crannies of places where humans like to rest and recharge.  Today, 2 Docs Talk about bedbugs, what they are, what they do, and why they are on the rise. 

When Kendall and Amy began medical training, the HIV/AIDS crisis was at its peak. The number of infections were blowing up, and people were dying in frightening numbers.  But looking back at the story of HIV, it's a lesson in how public health systems work and why fear should not guide our decisions.  Today 2 Docs Talk about the history of HIV and the current status of HIV-related disease.

When EMRs or EHRS first started popping up, it was an exciting time to be alive. The promise of no longer having to dig through fat charts to locate a lab report or trying to decipher some all but illegible note from a consultant left many physicians downright hopeful. But, as with most changes in medicine over the past few decades, the real reason for shifting to electronic was financial. This means that many EMRs are not designed to better patient care, but to better the billing process.  Today,  2 Docs Talk about the role of EMRs, where they have failed us, and how we can still make them work for us with a little effort.

A lot has changed over the past 50 years. We've gone from a society that used baby oil and reflective tanning mats in the 70s to one that will spend $50 and up on a rashguard with UV protection. These changes were prompted by the growing number of melanoma diagnoses.  In this episode, 2 Docs Talk about what melanoma is and how it's demographics have shifted over time. We also take a look at prevention, diagnosis, and treatment of melanoma. 

With the continued persistence of the modern anti-vaccination movement, even with the studies that originated it debunked, we have to ask some difficult questions about what we know and how we reach people with accurate medical evidence.  The Dunning-Kruger effect is the wrench in the works when we ask those questions. How does it, and our modern love of celebrity, stand in our way? Today, 2 Docs Talk about those questions and ponder some solutions.

For so long, colorectal cancer screening beginning at age 50 has been gospel in preventative medicine. But recently, trends in the incidence of colorectal cancer suggest we may be doing to much screening in the wrong people, and not enough screening in the right people. This means missed diagnoses and unnecessary interventions.  But recent research offers an alternative that we hope will target screening for the right people, while the rest of us get to avoid the "scope." Does this approach provide what we need to keep the most people the healthiest for the longest time? Resources: USPSTF recommendations for colorectal cancer screening (note -a new draft update is in progress now, so these could potentially change in the near future). BMJ recommendations on colorectal cancer screening QCancer risk calculator for 15 year risk of colorectal cancer

For those who pay attention to the state of healthcare in the U.S., the idea that we face a looming physician shortage is nothing new. Today, 2 Docs Talk about where the idea of a potential shortfall comes from, what is being done to try to remedy the problem, and some numbers that suggest maybe a shortage isn't on the horizon anyway. Resources: AAMC predictions of physician shortage Ezekiel Emanuel's response to AAMC prediction    

There has been a lot of commentary in the news and in medical journals about the problem of maternal mortality - specifically how we are really crappy at tracking it, which makes it really difficult to know if interventions are working or making things worse. In a country with healthcare as advanced as it is in the U.S., this is just stupid. I mean, we could use fancier words, but the bottom line is stupid.  Today, 2 Docs Talk about maternal mortality, the problems with tracking it, and one place that's done a pretty good job of both tracking and improving the numbers.  Resources: That Propublica article we kept referring to. Obstetrics and Gynecology article about trends and tracking Identifying Maternal Deaths in Texas CMQCC Toolkits WHO's Trends in Maternal Mortality

Medicare can be confusing for a lot of folks. Part A, Part B, Part C, Part D – some are automatic, some require enrollment; some have premiums, some don't; some have eligibility requirements besides age, some don't. It can get confusing.  To try to take some of the mystery out of Medicare, today 2 Docs Talk about Medicare Part C, also known as Medicare Advantage Plans. Take a listen and decide for yourself if these plans really offer any advantage.

Have you ever had water in your ear after swimming, gotten a bug in there, or just felt the urge to clean that wax out of there? If so you might have experienced otitis externa, or an infection of the outer ear. In today's episode, 2 Docs Talk about cotton swabs (should you use them to clean out your ears?), ear wax (what is it, how do you get rid of it, and do you really want to get rid of it?), and how the outer ear can become infected (swimmer's ear anyone?).   

Kratom doesn't sound like your typical herbal supplement, but it does come with all the issues common to the supplement industry. Namely, it hasn't withstood the test of clinical trials to demonstrate safety and efficacy.  And that causes problems.  Problems like not knowing how much of the ingredient is in the supplement, or how much of other ingredients for that matter. Or wht kind of side effects might be evident if it were subjected to randomized placebo-controlled trials.  But another problem is that it might actually offer a solution to a very big problem—opioid addiction But we don't know if it does because guess what? It hasn't been studied.  This week, 2 Docs Talk about Kratom and why the regulatory requirements (or absence thereof) on the supplement industry might be causing us to miss out on some real benefits.

With our apologies to and appreciation of Frances McDormand. The opioid crisis is showing no signs of tapering off any time soon, so today, 2 Docs Talk about the cornerstone of opioid addiction treatment - medication assisted therapy or MAT. We also (because we can't resist) talk about the irony of the very company who triggered the epidemic with their deceitful marketing practices now profiting from selling the treatment for that very problem. Resources: Previously, we disucssed the opioid epidemic in episode 12 - you can find it right here.

After a hiatus that lasted much longer than planned, we are back with our fall 2018 season of 2 Docs Talk, with look back on previous topic and an update on what's been going on since we first discussed them. We'll talk about the following episodes: Hormone Supplementation and Menopause Right to Try Legislation The Flu, the Flu Shot and the Future Cervical Cancer and the HPV Vaccine Medicaid Expansion The Mumps   Other resources for this episode can be found here: JAMA article on racial differences in vasomotor symptoms  Info on HPV vaccine expanded recommendations Mumps booster information

If you've had many conversations about healthcare reform, it is likely you've heard some variation on this theme:  "Hospitals have to provide care for people who show up. So everyone can get healthcare when they need it. So when people say that can't get healthcare, that isn't true." Is there any merit to that argument? Spoiler: NO. But if you want to hear more about where that idea comes from, take a listen.  Resources: https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/ http://www.kff.org/medicaid/state-indicator/medicaid-income-eligibility-limits-for-parents/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!

If you aren't taking an SSRI yourself, there it's almost certain you know someone who does. Selective Serotoning Reuptake Inhibitors are one of the most commonly prescribed classes of drugs out there. Is their widespread use earned on the basis of good evidence? It's not clear - let's take a look. References: Genetic and clinical predictors of sexual dysfunction in citalopram-treated depressed patients. Perlis RH, Laje G, Smoller JW, Fava M, Rush AJ, McMahon FJ Neuropsychopharmacology. 2009;34(7):1819. Epub 2009 Mar 18.  Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!  

Right to Try laws have come about as a response to cumbersome paperwork required to access the FDA's compassionate use program. However, the FDA has lessened the paperwork required for terminally ill patients to access investigational drugs.  So is Right to Try a meaningful movement, or is it simply one piece of an overaraching ideology. Today, 2 Docs Talk about Right to Try laws and who they help. Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!

For decades, much has been made of the healthvbenefits of drinking alcohol. And those benefits are real. But, what exactly are the benefits, and how do they stack up against the risks associated with alcohol?  Today, 2 Docs Talk about the ways alcohol and help and harm your health, and we offer some of our opinions, too.  Resources: https://www.hsph.harvard.edu/nutritionsource/alcohol-full-story/ https://www.cdc.gov/features/costsofdrinking/index.html https://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!  

If you are of a certain age, you remember a time when pretty much every kid got chicken pox. But those days are behind us as most of our children are vaccinated agains varicella, the virus that causes chicken pox. But for us old folks, shingles is the still around to remind of the old days when we still got chicken pox.  Today 2 docs talk about the effect of the varicella vaccine, the problem with shingles, and what you can do about it.   Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!

Senator McCain has a malignant brain tumor called a Glioblastoma Multiforme, orglioblastoma or GBM for short. He’s not the first person politically connected to get one of these things. I think this is what Senator Ted Kennedy had back in 2008 and also Beau Biden, Joe Biden’s son died of a glioblastoma. Glioblastomas are one of a class of brain tumors called Gliomas. Gliomas can be low grade which are considered pre-malginant or pre-cancerous or they can be high grade malignancies such as GBMs.   Today 2 Docs Talk about Glioblastoma Multiforme, and the difficulties associated with treating - or not treating - the tumor.  Resources: Don't Tell John McCain to Fight His Cancer FDA approval of Optune device for Glioblastoma 2 Docs Talk episode on hospice Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!