My LDL is 62 and I've finally gotten my HDL over 40. It took 20 damn years to achieve that HDL.
American Healthcare continues to go backward
- Thread starter steross
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I'd really like to see the actual words. Taken without context it sounds horrific. But, if meant only as a hyperbolic statement regarding antibiotic overuse which is a HUGE problem, then so what?
People say all the time, "I'd have to be on my deathbed before I would blah, blah, blah" which isn't meant to be literal.
I did a study with my students in Ohio looking at visits for respiratory infections at a primary care clinic. 80% of them resulted in antibiotics even though the symptoms were most likely viral in the vast majority of cases.
UHC is the worst.
I'm debating if I should back off my meds. My last LDL was 35 and since that was taken we have incorporated more fish and plant based proteins in our diet and cut back on meat some so it is likely lower. I realize RCTs have yet to find a "too low" but for primary prevention not sure if I really should be pushing it to there.
You can always increase again if you need to.
There are a couple of things that I commonly find in the EHR:
1. A condition will be documented that the patient never had, and gets perpetuated by cut and paste and no one ever corrects. Sometimes it’s like a patient had chest pain so coronary artery disease is documented, but the work up is negative and CAD is never taken off the chart. Sometimes it is just wrong.
2. Medications just disappear from the chart. For instance, just a few minutes ago I was looking at a patient’s history of cholesterol medications. In 2013 he was on simvastatin. In 2014 he was no longer on simvastatin. There is no documentation of it being discontinued, it simply disappeared.
AI is probably going to exacerbate this problem.
I use AI for my notes at the clinic. Saves me a lot of typing and time. But, they are brief notes, I tell it what in the convo to put in the note, and review each one and cut a bit more.
Meanwhile, I'm hearing from friends running residency programs that the ER resident notes will now be multiple pages and have a differential diagnosis 13 items long. That is AI garbage. An internist can think that way, an ER doc does not. We should be thinking "What is gonna kill them" not "I wonder if this abdominal pain is the first episode of acute intermittent porphyria."
The notes become so long they are ignored. What is the point of that?
But even internists should be thinking horses and not zebras when they hear the hoof beats.
What on earth am I supposed to do with a medication that just disappears from the chart? Maybe they just forgot to renew it and it dropped off inadvertently, OR maybe the patient had a reaction to it and it was discontinued for a good reason but never documented. And the patient doesn’t recall ever having been on it. I’m not going to roll the dice and hope it wasn’t the latter.
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