Sensible Medicine

JUNE 28, 2024

What there was -- courtesy of colleagues from across the country – were cases illustrating needless excess, careless follow-up, poor commitment to clinical care, and the devaluation of primary care that undermines our entire system. They also repeated all the tests that the community hospital had done.

Follow-Up 265

Follow-Up Tests Hospital Discharges 265

Sensible Medicine

SEPTEMBER 8, 2024

We so desperately need RCT data for our screening tests. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial I’ve come out pretty strongly against GDMT. It also shows us how hard it is to up-titrate GDMT.

Follow-Up 286

Follow-Up Discharges Hospital Medication 286

Sensible Medicine

MAY 28, 2024

The USPSTF claims "screening interventions" decrease the prevalence of depression at six-month follow-up by an odds ratio of 0.60. This number is surprising when we consider the following: A meta-analysis of six RCTs found the benefit of SSRIs, compared to placebo, to be small and statistically insignificant at six months.

Follow-Up 360

Follow-Up Discharges Appointments Tests 360

Sensible Medicine

JUNE 15, 2024

The medical college admission test contains many irrelevant questions that have nothing to do with being a doctor. There was a follow-up component to the biochemistry question, and it too was a logic puzzle, however, unfortunately it was incorrect. Next up… residency. I recently did some sample MCAT questions.

Medication 360

Medication Tests Follow-Up Admissions 360

Sensible Medicine

AUGUST 4, 2024

I even have a talk, “keeping up on the literature.” All had urea breath tests for Helicobacter pylori , the bacteria that causes most peptic ulcer disease and is closely associated with gastric cancer. People that tested negative were followed. Those who tested positive received either curative H.

Follow-Up 266

Follow-Up Tests Medication 266

Pulmonology Advisor - Practice Management

SEPTEMBER 6, 2024

Ordering diagnostic tests is a standard procedure for physicians; yet if the test results aren’t reviewed and acted upon, what was the point of ordering the test? However, Dr P, who had an extremely high caseload at the medical center, failed to follow up on this finding. Some follow up on results.

Follow-Up 52

Follow-Up Tests Medication Appointments 52

Sensible Medicine

SEPTEMBER 9, 2024

Trials select their patients, test the drugs in run-in periods and use research coordinators to help patients navigate complex health systems. Actual cardiologists performed these visits, which included up-titration of meds, but, also, as Adam correctly notes, patients had MD-level assessments. But trials are best case scenarios.

Discharges 305

Discharges Follow-Up Admissions Hospital 305

Sensible Medicine

MARCH 1, 2024

He acknowledges that we have little to no data that our currently accepted cancer screening tests reduce all cause mortality. ” Going further, Dr. Attia argues that our studies of screening tests do a poor job of finding the benefit of screening. There is a very small chance this test will save your life.

Tests 284

Tests Follow-Up Medication 284

Sensible Medicine

JULY 28, 2024

In a follow up post , Adam Cifu, my friend and colleague, took me to task. ” Photo via instagram (you can follow me there). Those are the loose, plastic ones that end up in the ocean, strangling turtles and other sea creatures, after being used for armed robberies or college protests. A reduction of 3%.

Follow-Up 350

Follow-Up Tests 350

Scrubs

APRIL 6, 2023

“It just doesn’t follow the science. ” Now that the state mask mandate is null and void, it’s up to each facility to implement its own mask requirements. Chin-Hong said he expects many hospitals will still require masks for all patients and staff but that requiring every facility to mask up no longer makes sense.

Hospital 352

Hospital Long Term Care Follow-Up Tests 352

Sensible Medicine

FEBRUARY 6, 2024

They spend money on test prep courses and needle their teachers into inflating grades. They were dedicated, followed directions, worked hard, were skilled at the “customer service” side of medicine, and were mature enough to know that medicine was for them.

Admissions 324

Admissions Follow-Up Customer Service Tests 324

Sensible Medicine

MARCH 20, 2025

Sure, sometimes we ask you to do a fit test. The providers who make my job harder and make me feel useless insinuate that we administrators follow rules blindly, as if someone like me were part of a herd of sheep and not an adult with a master’s degree. We know more about hospital governance than most doctors do.

Hospital 166

Hospital Patient Care Huddles/Rounds Follow-Up 166

Scrubs

JUNE 12, 2023

The biotech firm known as Grail made headlines earlier this year thanks to its signature Galleri blood tests, which can detect up to 50 different kinds of cancer early on to improve patient outcomes. The tests were hailed as the “first of its kind” when it hit the market in 2023. It’s that they simply didn’t exist.

Tests 188

Tests Follow-Up Billing Communication 188

Scrubs

AUGUST 4, 2023

Providers are typically paid for each test and procedure they perform, which can lead to a conflict of interest, especially when patients have to foot the bill. New studies reveal just how widespread medically unnecessary care can be, forcing patients to pay for procedures and tests they may not need. The findings were astonishing.

Tests 230

Tests Billing Insurance Medication 230

Scrubs

APRIL 5, 2023

Dereck Paul is the co-founder of Glass Health, a start-up in San Francisco that offers artificial intelligence chatbot services to doctors looking to ease the burden of routine processes, such as patient documentation. “So, what tests they would order and what treatments they would order.”

Documentation 355

Documentation Follow-Up Medication Hospital 355

Sensible Medicine

APRIL 16, 2024

The idea was that interventions could then be tested in the high-risk groups. I admit that I do not follow the Medical AI literature closely. I imagined that the tool was picking up more than just vascular calcifications and heart size. This was long ago enough that I was awed by the potential. 3 Is a CXR datum or data?

Follow-Up 248

Follow-Up Tests Admissions Hospital 248

Sensible Medicine

NOVEMBER 27, 2023

Don’t get hung up on the specific medical problem. The medical question comes up pretty often: What to do with moderate anemia (low red blood cell counts) in a patient recovering from a heart attack (myocardial infarction = MI)? (We The MINT trial tested these two strategies. No drug companies. No devices. with CI to 0.99-1.7

Follow-Up 283

Follow-Up Tests Medication Hospital 283

Sensible Medicine

JULY 31, 2023

And it puts to the test an everyday practice in US cardiology. The second area of uncertainty was the question of going right to the cath lab for angiography after a positive stress test. It was a conservative vs early invasive approach to ischemia test. The Trial Patients had to have a positive stress test.

Tests 241

Tests Medication Follow-Up 241

Sensible Medicine

AUGUST 25, 2023

We read about diseases and their associated diagnostic tests and treatments. Clinical findings and blood tests hint at the diagnosis, but the only truly confirmatory test is a biopsy of the temporal artery – a small procedure but a procedure all the same. Diagnostic tests give you more than just a diagnosis.

Diagnostics 244

Diagnostics Tests Hospital Follow-Up 244

Sensible Medicine

JULY 9, 2023

Yet, like most unexpected clinical changes in my career, I ended up learning unexpected truths. A few years before, on a routine visit, they drew a a large battery of blood tests, and recommended colonoscopy. Because this was a non-invasive test (a CT scan), he went ahead with it. One man taught me about lung cancer screening.

Follow-Up 261

Follow-Up Tests Scheduling Medication 261

Sensible Medicine

AUGUST 7, 2024

For example, Bergman reports a 2002 study in which ventilated premature babies were placed to sleep on either their tummies or backs, and the following states were measured: quiet sleep, active sleep (which is less restorative than quiet sleep), crying time, number of stress responses (startle, tremor, and twitch), and oxygen saturation.

Follow-Up 286

Follow-Up Transfers Tests Documentation 286

Sensible Medicine

DECEMBER 20, 2023

I’ve been following the general conversations and have been particularly interested in AI’s potential to improve diagnostic performance. The test characteristics of most data from the history is poor. I started with a steroid two years ago, but the pain was too severe and I ended up with an injection in my back.

Appointments 267

Appointments Diagnostics Scheduling Follow-Up 267

Scrubs

MAY 7, 2023

When you call a patient to follow up and they don’t pick up. When you’re just trying to do your job, but the universe decides to test your patience with a ripped glove. When you’re just trying to enjoy your sandwich, but your co-worker won’t stop talking.

Follow-Up 246

Follow-Up Scheduling Tests Hospital 246

Sensible Medicine

APRIL 22, 2024

It had long follow-up and enrolled patients who had established heart disease. The clinical equivalent of their approach was similar to stress testing for finding coronary stenoses. It was as if they had found a positive stress test in a patient with low-risk for heart disease.

Tests 261

Tests Follow-Up Medication 261

Sensible Medicine

JULY 30, 2024

Commentary The authors conclude that “protocol-directed active surveillance offers a clear set of expectations for patients and clinicians to follow.” This cohort was primarily made up of insured, educated, and non-Hispanic white patients. ” This is perhaps too strong a conclusion given this study’s design.

Follow-Up 258

Follow-Up Tests Medication Insurance 258

Sensible Medicine

MAY 25, 2023

For calcium deposits in breast arteries to be important, we would need to know that some action based on this finding, whether it be further diagnostic testing, lifestyle modification, or medical therapy, actually benefits a woman. This finding suggests an increased risk of coronary artery disease; clinical follow up recommended.”

Tests 190

Tests Diagnostics Follow-Up Insurance 190

Sensible Medicine

NOVEMBER 17, 2023

I told him I would send a test to verify the diagnosis but that we would start treatment immediately. I told him that when the test came back positive, he would need to tell Grace so that she too could be tested and treated if necessary. Give me the test and the antibiotics. “Yeah, I am a total dog.

Tests 266

Tests Billing Scheduling Follow-Up 266

Sensible Medicine

JUNE 26, 2023

It can be caused by failure of the testes to produce testosterone or by a problem higher up in the “pituitary-hypothalamic axis.” If you understand the normal distribution, and thus how we define what is a normal blood test result, and are, or know, a man over 45, you realize this is an ENORMOUS market.

Tests 246

Tests Follow-Up Medication 246

The Healthcare Blog

APRIL 2, 2024

Then someone discovered that the largest living thing in the world was actually the 106 acre, 47 thousand tree Pando aspen grove in central Utah, which genetic testing revealed to be a single organism. United channeled almost $52 billion of that cash into buying health-related businesses, nearly all of which end up housed inside Optum.

Tests 130

Tests Hospital Insurance Medication 130

Sensible Medicine

DECEMBER 15, 2023

They were healthy and needed to deal with a single issue or felt like it was time for a “check-up.” ” He left without making a follow up appointment and I never saw him again. When I think back on PW and our interactions around his insomnia, I end up shaking my head. “I am truly sorry to hear that.

Tests 284

Tests Diagnostics Follow-Up Scheduling 284

Doximity

MARCH 21, 2025

She estimates that this prompt saves her up to two hours per week , and sometimes even more when demand is high. She estimates that this prompt saves her about an hour daily , adding up to 7 hours weekly and nearly 28 hours monthly. Follow-up in three months with repeat labs. GPT helps me generate them efficiently."

Documentation 52

Documentation Tests Insurance Follow-Up 52

Sensible Medicine

JANUARY 15, 2024

A place where a learner can go to look up the seminal trials that established modern day cardiology practice. This trial tested the use of early IV beta-blocker (atenolol) in patients with MI. Instead of starting oral beta-blocker many days after MI in BHAT, ISIS1 tested immediate use of IV beta-blocker.

Hospital 335

Hospital Tests Admissions Follow-Up 335

Sensible Medicine

NOVEMBER 3, 2023

Even though my practice is made up of about 750, overwhelmingly older people, mostly with chronic medical conditions, I only attend to the death of a patient a few times a month. There have been previous admissions after which the patient did not make it to follow-up appointments. Acceptance followed and waxed and waned.

Hospice 314

Hospice Bookkeeping Follow-Up Appointments 314

Sensible Medicine

JANUARY 8, 2024

NHANES is one of the many registries that measure health parameters in adults and then follow them for years. In this study, among 10,000 adults, nearly 2000 had completed hearing tests and had hearing loss. The effect held up even when the researchers accounted for differences such as age, ethnicity, education, and medical history.

Medical History 291

Medical History Tests Follow-Up Communication 291

Sensible Medicine

JUNE 8, 2024

I asked Anupam Jena if he could run the Medicare analysis on docs with R01s vs those without, but he felt it would be limited by thin data, and also pointed out that what they lost in clinical skills, they might make up for in intelligence. Most have given up the lab, and are largely clinicians or work in other sectors.

Follow-Up 310

Follow-Up Hospital Tests Medication 310

Sensible Medicine

JULY 11, 2023

How large a number needed to screen is too large for a test to be acceptable? If we are to reach agreement on the benefit of cancer screening, thus enabling guideline committees to speak with one voice, we must agree on what constitutes an effective screening test and on how much we, as a nation, are willing to pay for it.

Tests 181

Tests Diagnostics Follow-Up Medication 181

Sensible Medicine

OCTOBER 4, 2023

The device becomes a screening test or provides information to “promote wellness.” Perhaps the most well-known example happened when the nature of primary hyperparathyroidism changed with the advent of automated multi-channel chemistry tests. ” My ears prick up. “Yes, it often peaks up to 140 mg/dL (7.8

Tests 219

Tests Follow-Up Admissions Appointments 219