The US rural healthcare crisis is a quiet emergency affecting roughly 60 million people — one-fifth of the population — who face higher mortality rates, systemic hospital closures, and severe specialist shortage. Over 700 rural hospitals (roughly 30% of the national total) are currently at risk of closing due to financial shortfalls. Since 2005, more than 190 rural hospitals have closed while another 25% have closed their maternity wards. While 20% of Americans live in rural areas, only 10% of US physicians practice there. Rural residents face higher rates of premature death from heart disease, cancer, and stroke compared to their urban counterparts. Suicide rates are significantly higher in rural areas, particularly among adult men and children. While only one-third of motor vehicle accidents occur in rural areas, they account for two-thirds of all accident-related deaths. This episode explores the rural healthcare crisis.

The facts are staggering. Lung cancer remains the number one cancer killer of both men and women. 230,000 new lung cancer diagnoses are expected in the US this year.  The average annual cost of treating advanced or metastatic lung cancer is astronomical, often exceeding $200,000 per year. Lung cancer screening with low-dose CT scans is severely underused in the U.S. with less than 20% of the millions of eligible high-risk former and current smokers getting tested. Lung cancer screening works.  It’s safe and effective. It saves lives. It saves healthcare dollars as the cost of treating advanced cancer continues to skyrocket.  On this episode, we'll try to understand how to increase use of this inexpensive test that can save more lives and money than any other in healthcare.

One hundred years ago, medical researchers noted that upper-body obesity was associated with high blood sugar (diabetes), high blood pressure (hypertension), and hardening of the arteries (atherosclerosis.)  Fifty years later the term "metabolic syndrome" was coined. In 1988,  a prominent researcher introduced Syndrome X, in which he claimed that the underlying problem with obese, diabetic, hypertensive patients with heart disease was related to the body becoming unresponsive or resistant to the effects of their own insulin. The X was used to highlight insulin resistance was then a medical mystery.  Today, we've come to understand insulin resistance as the underlying mechanism causing type 2 diabetes, obesity being its primary cause.

The American healthcare system is in crisis characterized by high and rising costs, fragmentation, poor access to care, administrative complexity, and workforce shortages. Costs are passed on via ever rising premiums, deductibles, and out-of-pocket expenses for insured individuals. Meanwhile, factors like administrative burden, a fee-for-service model, and limited access to primary care contribute to widespread medical debt and a fear of financial ruin for many who are underinsured or uninsured. Our once admired healthcare system is failing despite the U.S. spending much more per capita on healthcare than other wealthy nations. On this episode, we see how all this is affecting people personally.

Among the many reasons I chose the specialty of medical oncology is that cancer can present anywhere in the body, manifest any symptom, affect anyone, and its clinical course often presents conundrums for our inner Sherlock Holmes or Dr. House. “The Weekly Check-Up” radio show launched the year I retired from my clinical practice. I didn't realize how important a role it would play in my continued sanity as I navigated the next phase of my professional career. Like my cancer practice, “The Weekly Check-Up” callers cover the entirety of human anatomy and physiology, and there is always a puzzle to solve. This  episode features a diverse set of topics that keep the radio show and these podcasts both entertaining and informative. - Dr. Bruce Feinberg, host of “The Weekly Check-Up Podcast.”

Medical historians endlessly debate the greatest medical advancements. Among them are vaccination credited to Jenner in 1796; anesthesia credited to Crawford-Long in 1842; antibiotics with Fleming’s discovery of penicillin in 1928; and X-rays credited to the Curies and Roentgen in 1895. Then you have organ transplantation, public health improvements, insulin, the microscope, germ theory, and the discovery of DNA by Watson and Crick. “The Weekly Check-Up Podcast’s” list concludes with computerized tomography, the fiber optic endoscope, and percutaneous coronary intervention or PCI. Together these discoveries resulted in a quantum leap in disease prevention, diagnosis, and treatment, as we'll hear on this episode.

The use of sound or acoustic energy in medicine has evolved from the ancient diagnostic method used by ⁠Hippocrates by placing his ear to the chest. However, we had to wait 2,000 years for the invention of the ⁠stethoscope⁠. Today, acoustic energy is used in diagnostic imaging called ultrasound that has revolutionized obstetrics and cardiology, while therapeutic applications of sound have resulted in shockwave lithotripsy to break up kidney stones, destroy tumors. This episode explores new uses of sound energy.

Great trauma systems do not prevent trauma; they limit the carnage, disability, and chaos that are its consequence. Preventing trauma is the work of public policy and organizations like the Georgia Trauma Foundation. Seat belt laws, helmet laws, and air bag requirements have saved literally millions of lives.  But technology, policy, education, and awareness have limits. Reckless driving, driving while intoxicated, and the use of cell phones while driving are some of the root causes that speak to a crisis of personal accountability and the inherent irrationality of the human condition.  Worse, they decry hubris, selfishness, and lack of civility that jeopardizes not just the driver’s life, but the passengers and bystanders who are placed at risk. 

If you’ve ever gone with your gut to make a decision or felt butterflies in your stomach when nervous, you’re likely getting signals from an unexpected source: your second brain. Hidden in the walls of the digestive system, this brain in your gut is revolutionizing medicine’s understanding of the links between digestion, mood, behavior, health, and even the way you think. Add increased understanding of the influence gut bacteria has on disease and health, called our microbiome, and we may begin to grasp that our gut or gastrointestinal system has a much more complex role in human health beyond nutrition and energy, as we learn on this episode.

The hormonal chaos women experience month after month from menarche through menopause is due to natural, fluctuating levels of hormones like estrogen and progesterone that can impact mood, energy, and even physical health. These hormonal shifts affect internal chemicals called neurotransmitters that can lead to mood swings, anxiety, brain fog, and fatigue. They may be a normal part of the female life cycle that spans Menarche, Menstruation, Pregnancy, Postpartum, Perimenopause and Menopause, but they are often referred to as the “stages of chaos” as we'll hear more about on this episode.