The Curbsiders Internal Medicine Podcast

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


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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.

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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
    • ...more
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