#109: Things We Do For No Reason: A High Value Episode

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 20 August 2018

⏱️ 67 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Things We Do For No Reason #TWDFNR highlights some widespread practices that are difficult to justify based on lack of proven health benefits, but significant cost (both financial and non-financial harms). Avoid these low value practices and inflated medical bills with tips from expert, Dr Lenny Feldman, MD, FACP, Associate Professor of Medicine Johns Hopkins. Topics include: renal ultrasound and urine electrolytes in acute kidney injury (AKI), folate deficiency and anemia work-up, prealbumin and malnutrition, blood transfusions, shellfish and contrast allergies, monitoring after switch from IV or oral antibiotics, and “against medical advice” discharges.

Don't forget to check out Clinicwiki.org a free, online resource for teaching ambulatory medicine.

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Credits:

Written and produced by: Justin Berk MD, MPH, MBA
Editor: Matthew Watto, MD
Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD, FACP
Guest: Lenny Feldman MD, FACP

Time Stamps

00:00 Announcements
00:38 Disclaimer, intro, and guest bio
03:53 Guest one liner, some recommendations, and advice
08:35 Defining high value care and things we do for no reason (TWDFNR)
12:40 Why do clinicians order useless testing?
14:58 Urine electrolytes for acute kidney injury
20:30 Renal ultrasound for acute kidney injury
25:54 Stop ordering folate for anemia workup
31:47 How many units should I transfuse?
34:40 Prealbumin and albumin for malnourishment.
43:24 Iodine, shellfish and contrast allergy
50:28 Patient leaving against medical advice
56:45 Switching from IV to oral antibiotics
63:27 Dr Feldman’s plugs
65:36 Outro

Transcript

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0:00.0	Before we get to the night show, I wanted to tell you about a great new resource called
0:05.4	clinicwiki.org.
0:06.9	This is a free, open access primary care teaching wiki.
0:10.9	If you want, you can create an account for free and start to contribute.
0:14.8	This is founded by residents for residents cultivating great teaching resources for primary
0:20.5	care topics like high blood pressure, chronic kidney disease, pharyngeitis, asthma, knee
0:24.7	pain, etc.
0:26.0	They have faculty advisors from around the country.
0:29.1	Please check it out at clinicwiki.org.
0:59.1	Welcome back to the curb, Siders.
1:08.9	Is anybody here?
1:11.9	Hi, Matt.
1:12.9	How are you?
1:13.9	I'm doing well.
1:15.7	I'm really off without steward here.
1:18.9	I don't even know if steward is unpredictable.
1:21.0	I feel like he's predictably unpredictable or something like that.
1:25.4	I don't know.
1:26.4	I mean, I actually, I kind of winced at the part where he normally interrupts.
1:29.8	So I feel like he's here with us in spirit.
1:33.6	That's true.
1:34.6	That's true.
	...

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