Another great highlight from the @SamirUnni @DRsLoungePod episode.
I asked Samir why the Federal Govt. hasn't gone after the obvious fraud in the system (Providers banned from federal payment who are still getting paid).
Answer:Look at where regulators end up getting jobs 🫣
How Much Does a Calcium Score Actually Help?
https://anishkokamd.substack.com/p/but-how-much-does-a-calcium-score?utm_source=post-email-title&publication_id=978319&post_id=188686660&utm_campaign=email-post-title&isFreemail=true&r=tduh3&triedRedirect=true&utm_medium=email via @anish_koka @DavidLBrownMD
I was born in India but received my entire undergraduate, graduate and post graduate medical education in the US.
I have worked with countless FMGs in a variety of capacities - some have been incredible mentors and teachers.
I have legitimate concerns about the 2nd/3rd order effects of this type of legislation referenced by @MaryBowdenMD
Thread:
R to @anish_koka: open.substack.com/pub/anishk…
An examination of the ubiquitous calcium score. (Link in reply)
The real question is if it’s a data point that meaningfully adds value beyond clinical risk factors.
I don’t think it’s a meaningless data point objectively, and as value is subjective a lot of patients love the information so it’s a test I do use a reasonable amount.
But when you dive in it’s actually pretty poor on the prognosis front beyond what we already can ascertain based on your history/blood work.
If not for the advent of PCSK9i’s that open up the possibility of very low LDL in the entire population (law of diminishing returns applies in LDL lowering!) the test would have even less value.
When you add in the inappropriate risk classification that may result , as well as side effects of medical therapeutics (not speculation , see DANCAVAS trials discussed in post) it begins to feel like we’re trying to squeeze water from a stone.
We clearly need to spend some serious dollars on getting way better tests/
Science to sort out who among the low risk population is going to have a bad event.
We are clearly at the limits of what cardiac imaging can do for us with regards to prediction. (And No. AI derived Plaque volume isn’t it either )
In 1977, an Indian man cycled from India to Sweden to reunite with his Swedish love.
This incredible voyage took him through 8 different countries and spanned a total of 4 months.
48 years later, they are still happily married.
This is a great summary. I similarly had my views changed about MAiD.
Opposition to legalized euthanasia is a Chesterton fence worth preserving.
There are people in this country who rooted against their own country and own team in this game.
The team who wanted to share their victory with the children of their teammate who was killed by a drunk driver.
Perspective.
Fantastic episode - so well explained! Please do yourselves a favor #MedX and listen 👇🏽
“Modern society, through multiple modes (Pharma, private equity, etc.) psychopathically destroyed the appropriately scaffolded, rational relationship people have with medicine.”
The Professor is always on target.
And they only enter through NC but after a few years can move to another state. Not safe. You have no idea the training,skill level of the “doctor” treating you. There has been this general trend to lower standards and make things easier and in many areas,that’s dangerous. It’s always about the money.
If you’re wondering, Medicare Advantage essentially exploits the marked information asymmetry to sell a heavily subsidized (so cheaper to the consumer) , but inferior (with regard to medical coverage) product to the consumer.
I’ve always found it a bit amusing that it has become dogma information asymmetry is why markets can’t exist between doctors and patients, but information asymmetry in the insurance marketplace has no one seriously arguing an insurance marketplace can’t exist.
I don’t follow hockey, but this had me tearing up. They brought their teammate’s (who was killed by a drunk driver) kids out onto the ice with their dad’s jersey to celebrate the moment. 🥹
The single best explainer for how we got to the medical mess we find ourselves in is most definitely a graphic novel produced by @DrDiGiorgio that everyone, physicians, and citizens should be subscribing to. (link in reply)
Below: LBJ gives us the CMS monster.
R to @anish_koka: offlabelideas.com/p/claim-de…
You need id to shovel snow in New York ?
Professor at Villanova - a Catholic University : “.. we need to go in a socialist direction..”
UPDATE: To register to shovel snow in Mamdani’s NYC you must present two forms of ID, plus a social security card 😱
The median wait time to get an MRI is under 4 months and the median time to see a specialist is under a year in Alabama.
Canada can’t say the same.
Great explanation of the IDR process. @councilsns
Thank you @anish_koka @DrDiGiorgio @EdGainesIII for a great pod. Deserves more views especially for independent physicians fighting for independence @CMAdocs @ASALifeline
Ed Gaines: How Independent Physicians Finally Got Leverage Against Insur... https://youtu.be/QITUqT322Iw?si=K9iEdUoG19h3FKwd via @YouTube
I’m in Texas. It’s a great place to practice, but this is very scary. You should do a @DRsLoungePod on this
My daughter wanted to have lunch with me today.
On weekdays, that is almost never possible.
But today was the first of January, and I promised her I would come. Sharp at 2.00 pm.
At 1.30, just as I was about to leave, a 30 year old man, Mr. Mahesh (name changed), was rushed in with severe chest pain. He was having a massive heart attack.
There was no choice.
An emergency angioplasty followed. Over the next ninety minutes, he was given a new lease of life. His angio pics are posted below.
My daughter missed her lunch with her dad on the first day of the new year.
But Anya (name changed), the kindergarten going daughter of Mr. Mahesh, will now have her father with her on her birthdays, school days, and all the important moments of her life.
Not all doctors are saints.
But the wives and children of doctors who work in emergencies, they are the true angels.
Happy new year 🎉🎉🎉