The Curbsiders Internal Medicine Podcast

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

08.20.2018 - By The Curbsiders Internal Medicine PodcastPlay

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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

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