33 Burst results for "American family physician"

The coronavirus has sparked a boom in digital health

Clark Howard Show

04:35 min | Last week

The coronavirus has sparked a boom in digital health

"I wanNA talk about something that in the midst. Of the misery and the death count's with corona virus in every bad situation. There's always good that emerges at the same time. In an example of that is how the? Health Insurance, industry, and the medical industries have both been. Extremely, hostile through the years to using modern technology such as electric visits telehealth, whatever you WANNA, call it virtual visits. And Corona virus changed all that a raw economics that were affecting the medical industry forced in industry that is always reluctant to change I mean think about. I got a question for you where else in your life name anywhere else in your life ever. That you walk in and you fill out pieces of paper. Seriously like it's nineteen, sixty five. We've got all these electronics today and you fill out paper. At hospitals and doctors offices, you must be kidding me that's how antiquated and backwards medicine is practiced. Okay. Enough about them. But Anyway Corona. Virus. Devastated the revenue models. Of the medical. Industry. People's visits to doctors collapsed. Huge number of people. To great detriment of their own health and potentially life we're not going for things even like their heart care. Or cancer care or chronic illnesses like diabetes not going for their visits they were worried they're going to walk into a doctor's office and they were gonNA come out. With Corona virus and not survive. So medicine finally was like, Hey, maybe that electronic stuff that would work maybe we could try that. Give you an example Humana. According to the Kinsey Business Journal. Nationally has already had a million telehealth visits. Averaging, thirty three thousand visits a day. Just Corona virus. Bay were having virtually zero. Gone from virtually the road a thirty three thousand day. Because doctors wanted their money. But the crazy thing is. It actually dramatically improves. Patients health apparently. because. Big percent of people. Just don't get around going to the doctor even if they have one. And with Corona virus, people just weren't going at all. So, in terms of WHO has a doctor? Anyway a primary care doctor. Only somewhere around sixty percent or so a people even have one. and. Then of those that do. If they try to schedule an appointment, usually, it's really really hard to get one. We'll telemedicine the appointments tend to be shorter they tend to be more focused. And they can eliminate problems that would happen otherwise. But what's even more important? Is. It does improve health outcomes apparently according to the American Academy of Family Physicians Research Save. Done. But. The bigger thing is by having those virtual visits. It creates a relationship. Between doctor patient that right now, even if somebody has a doctor of record, they don't have. something. Goes undetected. So they can get really sick. Who wouldn't have gotten sick somebody could die who wouldn't have died Or. Could have a chronic condition get much worse. So. This is. One of those times where? Something that disrupted all. Pretty much all our lives. is going to have a long-term positive benefit. And it was all about the money.

Corona American Academy Of Family Phy Kinsey Business Journal Humana BAY
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

08:40 min | Last month

"american family physician" Discussed on AFP: American Family Physician Podcast

"Thousand pregnant patients. There is a six to eight percent risk of recurrence in these patients, but antibiotic suppression has insufficient evidence at this time. What's the evidence for treatment in men? There's not much evidence in one randomized controlled trial with a male subgroup. A seven day course of ciprofloxacin had worse curates compared to a fourteen day course but there were no differences in long term outcomes and there's your rapid evidence review of pilot Fridays. Now, we have a medicine by the numbers, a collaboration of the N. T. Dot. COM and American family physician, and this one comes to us from Dr C. Husson and mark. Swayed and it's entitled Fetal Fiber next and testing in threatened preterm, labor? A Cochran review of six RC tease with five hundred, forty, six patients looked at the use of fetal fiber next and testing of singleton pregnancies and threatened preterm Labor between twenty three and thirty five weeks gestation. Why were they looking at fetal fiber testing? Well, clinicians in the D and Emergency Labor and delivery unit US fuel next and testing during threatened preterm labor. So what were their endpoints and results great question their major endpoints or reduction in preterm deliveries at less than thirty seven weeks less than thirty four weeks and less than thirty two weeks. Three of the five studies found that clinician knowledge of results from of fiber next and test was associated with reduced risk of preterm birth before thirty seven weeks. However, a Meta analysis showed that the reduced risk before thirty seven weeks was not significant. What about before thirty, four and thirty, two weeks the meta-analysis determined that clinician knowledge of fetal fiber next and test did not reduce preterm births before thirty four and thirty two weeks. Were there any adverse events? Yes or no hospitalization? However, no difference was found after pulling the results of the RC tease way to second here. Amy Do I see that Edessa? The producer of the fiber next and test funded these studies precisely possible source of bias in the studies in addition to small sample sizes of the studies themselves. So what's the bottom line? The N. T.? Dot Com gives us a red rating meaning no benefit. I know you guys are so excited to talk next about intra-party him fetal monitoring. This article comes to us from Doctors Arnold and Gerry's Oh boy the joys of continuous electronic fetal monitoring. I know right? Continuous monitoring is based on the premise that fetal heart rate variability is a surrogate marker for fetal acidosis. But because of a low prevalence of bad outcomes that might be prevented by monitoring it has a false positive rate of ninety nine percent and low predict value and leads to an increased risk of c-section with a number needed to harm fifty six comparing continuous monitoring to structured intermittent oscillation, we should consider a structured intermittent OSCO tation for low risk labor because it decreases the c-section and operative vaginal delivery rates without an increase an unfavourable. comes. That's an evidence be rating on the strength of recommendation table. Intermittent OSCO. TATION is not the standard in the United States because of nursing staff requirements and physician oversight concerns. Yeah. With continuous monitoring, you can monitor remotely and record continuously. Yeah. We've all spent lots of nights staring at those continuous tracings Yup. Let's talk about classifying the tracing the standard way. The current terminology uses the National Institute of Child Health and human development categories. Category One which is normal category to which is indeterminate and category three, which is pathologic to describe a tracing. You should page Dr C., Bravado Paging Dr C. Bravado to Labor, and delivery. Great Pneumonic Doctor Determined Risk see contractions bra baseline rate the variability a accelerations. D- D celebrations O overall assessment. Yeah and category one is normal fetal heart rate one, hundred, ten to one hundred and sixty moderate variability no late or variable deceleration 's and you can have, but you don't need accelerations or early celebrations. Another key recommendation for practice here. This isn't evidence see rating the presence of moderate variability and or accelerations is predictive of a lack of fetal acidosis. On the other hand, a category three tracing has a sign you saw two pattern or absent variability with recurrent late deceleration replacement, variable deceleration, or futile Brita. Cardia. At this point, you should initiate intrauterine resuscitation maneuvers and if unsuccessful expedite delivery recurrent deep decelerating a finding on a category to strip that requires immediate intervention. And category to management think about intrauterine resuscitation maneuvers, which include ten things outlined in figure one which comes along with a helpful algorithm. A few examples of some maneuvers changed maternal position stop oxytocin and initiate amnio infusion for repetitive variable deceleration 's. This is another key recommendation for practice perform amion fusion for recurrent variable D celebrations to reduce the risk of Se- section. That's be evidence rating from Cochran Review of low quality evidence. Let's end with a recommendation from the choosing wisely campaign. Thanks to the American Academy, of Nursing. Nurses do not automatically initiate continuous electronic fetal heart monitoring during Labour for woman without risk factors consider intermittent ostentation first, and then if needed page Dr Bravado. Let's talk about a letter to the editor from Doctors West Be Ohka and Ricco from Minneapolis. Minnesota in response to the. March. Fifteenth American family physician article about managing hypertension the letter to the editor is entitled. Race based TREATMENT DECISIONS PERPETUATE STRUCTURAL RACISM Dr Welby and her colleagues point out that the authors of the review advocated for the use of race in guiding the selection of anti hypertensive medications without acknowledging that race is socially constructed. They continue by writing that politics and power guided the formation of race as a concept, not scientific certainty and that using race as a biological category to determine medical treatment is bad science. This came up in the original March article because those authors described the NC. Eight guidelines which differentiate treatment by race. Dr? Welby notes that the primary literature for these recommendations do not support this practice? Race based medicine is not benign. It perpetuates structural racism and leads to inequalities in treatments and outcomes. The letter says that American family physician nist and. To raise awareness about the quote insidious way in which outdated assumptions about the biological basis of race permeate current medical practice American Family Physicians Editors Doctors Lynn and Sexton responded by agreeing that race is a sociopolitical construct rather than a true biological category. Our Editors Lament that the literature contains many examples of black race being used uncritically, and this includes decision making in Jay eight hypertension treatment guidelines. The editor's note that they can't rewrite guidelines but strongly encourage guideline authors to justify differential treatment of patients by race using a standard which they outlined in this response to the letter to the editor. Doctors Linen sexton will also will ask AFP editors and future authors to critically assess the quality of evidence and unwritten assumptions when suggesting the use of race in decision making. Yes. This is really important. I'm glad Dr West be and her colleagues brought this to everybody's attention. Next neck pain initial evaluation, and management from.

fetal acidosis editor American family physician Dr C. Bravado Dr Welby Cochran Review United States Dr C. Husson American family physician nist N. T. Dot ciprofloxacin Emergency Labor Dr West Doctors Arnold Brita Dr C. producer Amy
Navigating Innovation for Family Medicine with Paul Dow

Outcomes Rocket

05:25 min | 2 months ago

Navigating Innovation for Family Medicine with Paul Dow

"Welcome back to the outcomes. Rocket saw Marquez is here and today have the privilege of hosting Paul Dow? He is the current e-health innovation strategist for the American Academy of Family. Physicians based in Lee would, Kansas with the advent of covid nineteen. The goal is focusing on practice tools that will be robust in the rapid transition that telehealth and virtual patient engagement during the emergency, and beyond policy and innovative thinker and a strategist than the space and I'm excited to be diving into what they're up to at the. American Academy of Family Physicians and for him to share his message around practice viability, and then and his him, and his organizations search for long-term solutions to help with cove in nineteen, and beyond a Paul, such a privilege to have you here if you can give us a little more insight into you and your bio, and and then we could dive into into the the interview. Sure. It's great to be here, Saul, thank you for having me. I. Am a helping petition and have worked for the Academy for about a year prior to that I was at the. Leading Cardiac Society Washington DC for about six years, and then prior to that. Were for medical device vendor for about ten in their clinical education space. Clinical Background is in radiology. Sea Tac X. Ray tech from back in the day but moved were into health it that really kind of seemed like the future and turns out he was so I'll have a variety of other predictions by the end of the podcast, and maybe a few lottery numbers. I love it. I got my plenty handy. Yeah insightful Paul. I definitely was the future, and it is the president now. Health it. The use of technologies like a I digital health. They're here with us and have been accelerated What what is it? That inspires your work in healthcare? I mean you've been in it for for a long time. What keeps you working within the bounds of healthcare? All to me that it's endlessly I guess endless curiosity. He's be interested There's there's so much to learn and file and. It. It feels like there's always a new development into new insights that come out of research or technology. Advancements and trying to apply those into a clinical space you know. How can we make this this thing? This taking care of people more efficient and more effective, not not in the sense of trying to make positions more efficient hamsters. But more, how do you? Leave them off. The monotonous tasks that their their skills are not suited for. Physicians you know floor five stenographers by one then to use their clinical expertise and their deep insight into the diagnostic process as well as also their deep empathy. They got into healthcare because they care about people and if we can have tools. Free up their time then they can focus on hearing for people and You know that that to me is really a huge motivator. A finding solutions that actually work aren't just cool. I'm doing air quotes now But, actually actually are productive and help them on a day to day basis. Love it yeah, it's it's a great great calling, and as as we dive further into into your organ, the organization Europe part of It'd be. It'd be great to to know how you guys see yourselves position to add value to family physicians but also to educate us on on what your community looks like in the breakdown of of physicians that you guys are are helping. Share, so we have about seventy five thousand members of ASAP. if you include residents and medical students that swells to about one hundred, but as far as practicing clinicians in the field, it's about seventy five thousand We have fifty thousand who are employed at a variety of locations, every qualified health centers Medical Centers and the other twenty five thousand are independent practices so basically these are small businesses that are run by clinicians. And we're trying to find solutions to help. Help all of them. You know certainly There is no one perfect technology that's going to fix everyone's issues, but if we are you know patch, some of these technologies together and then provide some insights on workflow your best practices. We share within within the House of Family Medicine. you know then we can start to build some trends and build some some improvements that can be sure to one day.

Paul Dow American Academy Of Family Phy American Academy Of Family Saul Marquez Medical Centers Washington Dc LEE Kansas House Of Family Medicine. President Trump
Trump administration begins process of withdrawing from World Health Organization

Democracy Now! Audio

00:36 sec | 2 months ago

Trump administration begins process of withdrawing from World Health Organization

"The trump administration's begun the process officially withdrawing from the World Health Organization and a move condemned by public health officials across the world, the move cave on the same day, the WHO warned the global peak of the pandemic has still not been reached the American Medical Association American Academy of Pediatrics American. Academy of Family Physicians American College of Physicians Condemn, President Trump's decision. Saying quote puts the health of our country at grave risk. Former vice president. Joe, Biden has vowed to reverse trump's decision on his first day in office if he wins the November election.

American Medical Association A Academy Of Family Physicians A Donald Trump World Health Organization Vice President President Trump Biden JOE
How the Pandemic Has Changed the Way We Sleep

Coronavirus Daily Briefing

03:43 min | 4 months ago

How the Pandemic Has Changed the Way We Sleep

"According to preliminary results of a study of sixteen hundred people from sixty countries, forty six percents of people reported poor sleep during the pandemic. That's up from just twenty five percent before the pandemic insomnia and vivid weird dreams, both caused by the increased stress of the time we're living through has been evident anecdotally and as indicated by a fourteen percent uptick in sleep. Medication Prescriptions Melatonin sales in over the counter supplement for the natural hormone that induces sleepiness are up forty four percents. Philip Musket a professor of Psychiatry at Columbia University Medical Center said he's avoiding prescribing medications to patients preferring to offer sleep hygiene tips. He's seen that actually staying asleep is the biggest problem for most people and says some of the primary factors causing that is that people are lacking in structure and exercise. Stain active can help you sleep more soundly and boost your immune system Dr Musk's also advises sticking to a regular sleep schedule and avoiding naps during the day. The good news according to Kathy Goldstein physician at the University of Michigan and an associate professor of neurology at the Schools Sleep Disorders Center is that what most people are experiencing is acute insomnia or quitting the Wall Street Journal having difficulty for or staying asleep a few times a week for three months or less and quotes, the third of people will experience acute insomnia at some point in their lives usually caused by some stressor. stressor in their life like say a pandemic the key doctor. Goldstein says though is not letting the issue. Become a chronic one quote. It's important to avoid associating your bed or bedroom with a place where you were awake. Experts recommend that if you can't fall asleep or wake up in the middle of the night and are unable to go back to sleep after twenty minutes get out of bed and do something, relaxing and quotes. Natasha Bouillon a Phoenix based family physician at one medical, says most people's sleep problems right now either stem from a lack of normal schedule or general anxiety about the pandemic. Some tips she recommends mindfulness through meditation, exercise or cognitive behavioral therapy. To maintain a consistent sleep schedule, turn devices off an hour before going to sleep and make your sleeping space a device free zone, consider even ditching your smartphones alarm and getting an actual alarm clock, as for anyone, experiencing vivid dreams or nightmares Melinda Jackson, a senior lecturer at the Turner Institute for Brain and Mental Health at Monash University in Melbourne, says quote. During Times of stress, there's a release of narrow chemicals that can trigger these vivid dreams and nightmares in some people end quotes. And, Dearly Barrett a dream researcher at Harvard Medical School notes that waking up frequently throughout the night can also cause people to remember their dreams better. Contribute to the sense that your dreams are more vivid than usual. guardless of how? Your sleep has been disrupted. Or why here are a few more sleep? Hygiene tips to leave with quoting the Wall Street Journal eat at regular times than snacking day. Avoid, napping or compensating for poor night of sleep by going to bed, unusually early limit caffeine and avoid alcohol avoid electronic devices one to two hours before going to sleep, but if you do use a blue light filter and try to look at content that is not stressful. Get Bright Light in the morning. Try to find a workspace that isn't in your bedroom and stop working at a specific our and make time for relaxing activities end quote.

Schools Sleep Disorders Center Philip Musket Wall Street Journal Natasha Bouillon Kathy Goldstein Melatonin Columbia University Medical Ce Associate Professor Of Neurolo Professor Of Psychiatry Harvard Medical School Dr Musk University Of Michigan Dearly Barrett Caffeine Phoenix Melinda Jackson Family Physician
Calling Trump: When connections help steer virus supplies

On The Media

06:54 min | 6 months ago

Calling Trump: When connections help steer virus supplies

"President trump who's told states to fend for themselves has had female blocking orders for vital equipment secured by governors some of them anyway so the government can buy them instead this week FEMA see is that in order for five hundred ventilators from a private company obtained by democratic Colorado governor Jared Paul is only to have trump give back a hundred of them at what he called the request of the state's endangered Republican senator Cory Gardner Thursday's Denver post editorial declared trump is playing a disgusting political game with our lives but the trump administration says it's got a plan and that it's working White House adviser Peter Navarro April second these guys up here doing a heck of a job organizing the supply chain well I think that's news to a lot of medical providers no I'm levy is a national health care reporter for the LA times trying to follow the cultic nineteen supply chain I can't say I've talked to many hospitals or doctors offices or clinics around the country who feel that the supply chain is being managed in anything close to a rational way that's for sure and we can't seem to get answers from FEMA or the White House about what system if any is being used to balance the needs a couple weeks ago I was speaking with the head of the Texas academy of family physicians who working with the golfing buddy of his managed to in about a half million masks over the border from Mexico and then spent about seventy two hours getting them to rural hospitals and doctors offices around Texas because the state of Texas didn't have anything to distribute so you've got the system in which everybody's running around trying to get masks and ventilators and everything else and then on top of that is a totally opaque system of what appears to be haphazard intervention by the federal government on some supplies but not all of them everyone is completely perplexed we hear that trump is having no problem directing to Florida whatever Florida seems to need so zero which is the agency that is allegedly responsible for distributing supplies from the strategic national stockpile has claimed that they have some formula for distributing medical supplies that reflects states in large metro areas relative populations and the relative severity of corona virus outbreaks they are actually shipping things across the country however it's impossible to find out what that formula is whether or not allowances are being made in one way or another four criteria that have not been identified president trump hasn't been shy about claiming that he's willing to reward its friends and punish his enemies the conspiracy minded person might think well is there some nefarious methods to how these supplies are getting distributed or not we just don't know what difference does it really make if we know or we don't know what the formula is for distributing this stuff this is taxpayer money that we're talking about private actors in the market of course don't have an obligation to be transparent about what they're doing because there's no expectation under normal circumstances that they're acting in the public interest we hope that the government is acting in the public interest but without transparency who knows who's accountable for this who's in charge is it rear admiral John Paul love check who's at the head of FEMA's coronavirus supply chain task force is it FEMA director Peter Gaynor is it Peter Navarro who is reportedly coordinating private and public sector communication maybe it's the Jared Kushner or the invisible hand isn't really fundamentally the president and no one else you know without clear lines of authority things are not getting done as far as we know in a particularly efficient way nor do we know that however they're being done is being done in a lawful way frankly if for example the president's son in law is dialing up private companies and asking them to give support in one way or another to the supply chain challenges what assurances are being made to those companies about what they can expect I'm talking about promises that are made the company acts that if they help out that they'll be made whole in the end with they'll be reimbursed at a certain level without a process all of that is open to question is there a way to have an informed data driven approach to this as Jared Kushner said the federal government was engaged in if in fact the federal government isn't engaged in an informed data driven approach can big business small business health officials state officials do this on their own so the facts on the ground suggests that this can't happen on its own no that's not to say that there aren't a lot of efforts by individual actors some of them quite influential to play a constructive role I mean we've seen a number of large companies including apple for example say we are going to use our connections to the supply chain to procurer masks and we're going to distribute them the owner of the New England Patriots flew the patriots plane to China to go pick up a shipment of masks and flew back to Boston the problem is when you have this sort of thousand points of light approach to procuring and distributing needed supplies what ends up happening is that well connected medical centers that have relationships with large companies either because they do business with them or because they're located in their backyards are often times at the top of the list so for example sales force made a donation to the university California San Francisco Medical Center because they have a long standing relationship both being based in San Francisco does UCSF knew that equipment more than a hospital in New York City or New Jersey that's a lot to ask of sales force to try to make that determination they don't have any expertise in

Fema President Trump
Calling Trump: When connections help steer virus supplies

On the Media

06:54 min | 6 months ago

Calling Trump: When connections help steer virus supplies

"President trump who's told states to fend for themselves has had female blocking orders for vital equipment secured by governors some of them anyway so the government can buy them instead this week FEMA see is that in order for five hundred ventilators from a private company obtained by democratic Colorado governor Jared Paul is only to have trump give back a hundred of them at what he called the request of the state's endangered Republican senator Cory Gardner Thursday's Denver post editorial declared trump is playing a disgusting political game with our lives but the trump administration says it's got a plan and that it's working White House adviser Peter Navarro April second these guys up here doing a heck of a job organizing the supply chain well I think that's news to a lot of medical providers no I'm levy is a national health care reporter for the LA times trying to follow the cold pick nineteen supply chain I can't say I've talked to many hospitals or doctors offices or clinics around the country who feel that the supply chain is being managed in anything close to a rational way that's for sure and we can't seem to get answers from FEMA or the White House about what system if any is being used to balance the needs a couple weeks ago I was speaking with the head of the Texas academy of family physicians who working with the golfing buddy of his managed to in about a half million masks over the border from Mexico and then spent about seventy two hours getting them to rural hospitals and doctors offices around Texas because the state of Texas didn't have anything to distribute so you've got the system in which everybody's running around trying to get masks and ventilators and everything else and then on top of that is a totally opaque system of what appears to be haphazard intervention by the federal government on some supplies but not all of them everyone is completely perplexed we hear that trump is having no problem directing to Florida whatever Florida seems to need so zero which is the agency that is allegedly responsible for distributing supplies from the strategic national stockpile has claimed that they have some formula for distributing medical supplies that reflects states in large metro areas relative populations and the relative severity of corona virus outbreaks they are actually shipping things across the country however it's impossible to find out what that formula is whether or not allowances are being made in one way or another four criteria that have not been identified president trump hasn't been shy about claiming that he's willing to reward its friends and punish his enemies the conspiracy minded person might think well is there some nefarious method to how these supplies are getting distributed or not we just don't know what difference does it really make if we know or we don't know what the formula is for distributing this stuff this is taxpayer money that we're talking about private actors in the market of course don't have an obligation to be transparent about what they're doing because there's no expectation under normal circumstances that they're acting in the public interest we hope that the government is acting in the public interest but without transparency who knows who's accountable for this who's in charge is it rear admiral John Paul love check who's at the head of FEMA's coronavirus supply chain task force is it FEMA director Peter Gaynor is it Peter Navarro who is reportedly coordinating private and public sector communication maybe it's the Jared Kushner or the invisible hand is it really fundamentally the president and no one else you know without clear lines of authority things are not getting done as far as we know in a particularly efficient way nor do we know that however they're being done is being done in a lawful way frankly if for example the president's son in law is dialing up private companies and asking them to give support in one way or another to the supply chain challenges what assurances are being made to those companies about what they can expect I'm talking about promises that are made the company acts that if they help out that they'll be made whole in the end with they'll be reimbursed at a certain level without a process all of that is open to question is there a way to have an informed data driven approach to this as Jared Kushner said the federal government was engaged in if in fact the federal government isn't engaged in an informed data driven approach can big business small business health officials state officials do this on their own so the facts on the ground suggests that this can't happen on its own no that's not to say that there aren't a lot of efforts by individual actors some of them quite influential to play a constructive role I mean we've seen a number of large companies including apple for example say we are going to use our connections to the supply chain to procurer masks and we're going to distribute them the owner of the New England Patriots flew the patriots plane to China to go pick up a shipment of masks and flew back to Boston the problem is when you have this sort of thousand points of light approach to procuring and distributing needed supplies what ends up happening is that well connected medical centers that have relationships with large companies either because they do business with them or because they're located in their backyards are often times at the top of the list so for example sales force made a donation to the university California San Francisco Medical Center because they have a long standing relationship both being based in San Francisco does UCSF knew that equipment more than a hospital in New York City or New Jersey that's a lot to ask of sales force to try to make that determination they don't have any expertise in

Fema President Trump
Indpendent vs. Employed Physicians

2 Docs Talk

08:18 min | 7 months ago

Indpendent vs. Employed Physicians

"Here's the thing. Physicians are still not free from bureaucratic tasks just because they're employed. They still have all kinds of paperwork to do on a daily basis prior authorizations data entry for Amar's insurance claim denials charting. I could go on and on the bottom line. Is we still have to face an increasingly burdensome regulatory environment regardless if we're employed or independent practitioners so we have this decades long trend away from the independent practitioner towards the employed physician? Who is happier was hard to stay. There was a study at a New York that looked at small physician. Run Group practices and Solo Practices. They evaluated the rate of burn out amongst these physicians using the Mas Block burnout inventory. Which is the industry. Standard and the rates of burnout were remarkably low at thirteen point. Five percent that's compared to around fifty percent nationally. That's a huge difference. Yeah but we should stress. It was a very small regionally specific steady only around two hundred thirty five providers in New York state so in contrast mets Cape's large annual physician burnout report for two thousand. Eighteen doesn't show a big difference in burnout. Rates between employed and self-employed Ducks. So we're not so sure. Physicians or any happier less burned out when they become employed. How about when it comes to money? Are they making more as an employed physician or as an as an independent well? When I asked myself this question I thought the answer would be yes. I mean large health systems and hospitals have the advantage of the economy of scale when negotiating insurance and pharmaceutical contracts as well as buying medical devices and all the other Supplies supplies needed to practice medicine. Yeah they they can be more efficient with staff and facilities to multiple physicians can share nurses as well as administrative personnel and clinic space right but it turns out employed physicians make less money not more than independent ones in Texas. They make about sixty six thousand dollars less annually and I mean really I mean. Those economies of scale are meant to benefit the employees. They're meant to benefit the shareholders. So and the gap in California is even larger employed physicians make about eighty thousand dollars less annually than independent physicians. So the cost savings that corporate medicine potentially realizes are not being passed on to the physicians. And no they are not and here's some food for thought according to the group Physicians for a National Health Program. The number of physicians in the country has grown about one hundred and fifty percent from nineteen. Seventy five to two thousand ten. That's apparently in keeping with population growth on the other hand. The number of health care administrators has grown three thousand two hundred percent in the same time period. That's okay first of all. It just doesn't seem like doctors should have more paperwork if you've got three thousand two hundred percent more administrators. Yeah so they're creating table. Still doctors have to work. And that's a lot of people other than the doctor and the patient making living off of the doctor patient relationship. Exactly so why are we doing this? Why are physicians making this switch? If it's not going to make us happier and will most likely make us poorer so I have been both in employed physician as well as a partner in a moderately sized physician group practice. Okay did you make more when you're independent? I definitely did. Were you happier or less burned out. As an employed physician know better I was employed or independent. Had almost no effect on my level of happiness whatsoever you were equally equally miserable or happy as it may be as either an employer of independent physician. Exactly and here's why if I'm employed or self employed regardless the compensation model and the regulatory environment are the same. I have to bill. Insurance Companies and Medicare Medicaid to be paid for each visit procedure surgery medication medical device or service provided to that patient uh-huh this requires appropriate documentation based on Medicare regulations and appropriate billing based on that documentation. So and the only person who can document and bill is the physician. It can't be done by anyone else in. This is the case that the physician is independent or employed so as Medicare and insurance regulations for documenting and billing become more complex. The physician is the one dealing with the complexity and the reason for the ever. More complex regulatory environment is because of the ever increasing costs of medicine in this country. Right and all this time spent documenting and billing is time we should be spending with our patients. So that's why physicians are unhappy. Of course it is. I mean that's one of the reasons. We have no time to develop meaningful relationships with patients. No time to nurture or maintain those relationships. Because it's all about doing what reimburses not restores so not a newsflash. Everybody in the country knows. Our healthcare system is broken. We've known for some time at the solution to the problem is much harder to come out. There are a lot of people working on the problem but physicians are actually in a position to do something today and for some physicians. This means opting out of corporate medicine and traditional reimbursement models altogether exactly so a lot of folks might have noticed that independent physician and physician owned practices with doll. Payer models are popping up all over the country yeah like concierge. Medicine or primary care for example which. I think we've done a podcast on before. Did we think so which one both of them? Yeah well. Let's let's talk about direct primary care again because that's the model. I've been seeing most often with direct primary care. Physicians charge a membership fee monthly or quarterly or even annually. And for that feed. The patient gets pretty much all their primary care. Needs taken care. Have they usually get as many clinic? Visits as they want they'll get access to their dock via email or phone all the necessary. Labs X ray screening tests even many minor procedures are covered. It's important to know DP doesn't cover sub specialty care or hospitalizations so usually people will also have a large deductible major medical policy to cover that kind of stuff or like like major imaging. Besides extras like cat scans are emory's are usually sourced outside. Yeah so also. These practices. Don't take Medicare or Medicaid. Usually but there are some that. Do there've been some experiments with it? Yeah so as like a part C PLAN. There are a couple of of dramatic. I think there's one in Arizona that had got special permission for Medicare to well. That's cool do a trial. I don't know where where it stands. I'll have to Google that and see where they're at and Report back on that on an update episode. Maybe well so currently. Dpc is is designed to try and meet the needs of the under sixty five age group But the main thing is that the physician doesn't Bill Insurance Companies. There aren't hidden costs to patients. No COPAYS deductibles. Yeah Yeah and a lot of these practices. They don't they have basically a nurse and like not a lot of other office staff because since they don't have all that administers they don't need all. They're very small intimate little practices. And so yeah and you just pay monthly feel to have that so you have pricing transparency as well. Yeah so now. With deep sea physicians are free of the burdensome regulatory environment no more billing or jumping through documenting hopes and no more oversight from non medical administrators. And if you ask these physicians with the benefits of primary care are the very first thing they will tell. You is more time with their patients which is a win win for the doctor and the patient. Well if you look at the size of their practice that alone should clue most are at least half sometimes a quarter of the size of a traditional fee for service practice. And and how does it the cost to the patient workout? Did you see constipation? Cost to patients? Of course well. I'm glad you asked twelve years. Old Data show that most patients will pay about what they would with traditional insurance sometimes even less so they're getting improved access to care more time with her dog for the same price or less than they would with a traditional fee for service policy right and the American Academy of Family Physicians. Very supportive of this model. They promote and provide seminars and toolkits to the physicians who are interested and more more graduate. Medicine programs are starting to train the residents in DPC which is well for the future thing. I agree it's GonNa be fun seeing how it all plays

American Academy Of Family Phy Medicare New York Self Employed Mas Block Solo Practices Bill Insurance Companies Amar Run Group National Health Program Google Texas California Partner Medicaid Cape
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

01:42 min | 1 year ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Welcome to the American family physician podcasts for the October Fifteenth Twenty Nineteen Issue I'm jake us steps on a logistics and we'll finish up with Where I listened segment the opinions expressed in the podcast Dr do not represent the opinions of the American Academy of Family Physicians surrounding led screens and asymmetric kids five years younger and pregnant women and concluded did was that there's insufficient evidence to assess the balance of benefit in harm's neither population wa Wa wa I statements but with the Nebula snus hi statements I think it's important here to consider what we do know about harms and benefits definitely herbert especially since it's still a recommendation of bright futures and required part of Medicaid early periodic screening diagnostic and treatment visits those EPS DT.

American family physician American Academy of Family Phy Wa herbert Medicaid five years
How Your Health Is Connected to Soil Health

The Doctor's Farmacy with Mark Hyman, M.D.

05:46 min | 1 year ago

How Your Health Is Connected to Soil Health

"A functional medicine doctor Dr Hyman this is on treating the body as a system rather than treating the individual symptoms in this mini episode Dr Hyman Explores how this application of systems biology ends beyond our bodies inner workings to its interaction with the natural environment. Here's Dr Hyman in conversation with family physician and founder of the health from the soil up initially Dr Daphne Miller you're describing this sort of broad range of things where you're seeing the harm that our current agricultural production system does to the workers right because of toxic chemicals because of poor working conditions because of being almost indentured servants and human rights really is a huge issue there and the same time that your were hurting the soil that we grow our food in so our soil is depleted aren't food is depleted and then we are growing is commodity products that are turned into processed food corn wheat and soy that ended up causing all this chronic disease on the other end of the spectrum and it's this huge problem in everything's can elected and that is some of the beauty of your work where you actually are connecting the dots between all these things that don't seem connected like what is the the crow biology the soil has to do with us and you talk a lot about this and you're working I I'm fascinated sort of dig into this because again a get a little bit deeper right away about how the microbiome which is his brand new topic in medicine didn't even exist and we were in medical school connects to the microbiome of the soil and why that's important I mean for example you don't wash your organic vegetables right eat the dirt right so talk about how you came to understand that and what the science is behind that and and and what we need to do to change. What's happening I I want to say that I really appreciate what you said before for in terms of getting the big picture there because there's actually a lot of people in medicine who still don't that this really is a story on the on on helpful side of exploitation of workers exploitation of soil and then exploitation of our own bodies we who are the recipients of that food in that system and I think that's a very important notion to grab onto so we can't heal communities unless we actually take care the farm workers and take care of soil but the microbiome is this wonderful way of tracking that connection it's kind of a nerdy side intifida way of telling that story that you just told because in fact that what's so so unbelievable doing this work is that it tracks through many levels from the microbial to the cultural so micro to macro from legislated to cellular and the the story of how our internal microbiome all these you know billions of Tyrian Fungi Nemo toads how they are linked to soil is still trying to be understood in told it's not the sciences in its infancy and we know of course at our microbiome is a unique microbiome you know each one of us has an unique microbiome fingerprint it's anger print it's not the same microbiome a- soil but we know that there is a lot of cross talk we evolved as these single L. creatures out of soil we all grew up in the dirt right time gathering and and over Millennia what's happened is that aren't microbes have found their distinct niches but that they in fact do communicate and this research is slowly slowly coming out and food is probably one of the really important shuttles that you know goes back and forth in terms of informing the two microbiomes and influence facing him in different ways but it's not to say that our microbiome is the same as soil microbiome there's cross talk which is there absolutely genetic crosstalk conventional medicine encourages the diagnosis of disease followed by standardized treatment however naming disease becomes increasingly me wingless as we understand our inner workings and biological systems within the context of our entire organism Dr Hyman further explored this topic with his mentor and other a functional medicine Doctor Jeffrey Bland using the lens of functional medicine the things that you helped us know and understand really just getting people I said do those simple things that make profound differences changing the information and that you know food is information everything is information you exercise information sleep is information botts our information yeah these are all communicating with every cell and every system in your body every second and when you understand that enormously empowering because then you can do something about precisely we have now understood starting to understand I don't want to say complete understanding but we're starting to understand that this outside world the things that we eat had come from the soils and the environment from which nature nurtures have an inborn communication connection to our bodies receptor systems that signal through every DNA Aliquo all that creates our function now that is a paradigm shifting concept that were connected into the soil into the air into the water into the sun in ways that are directly it kind to these biological processes we call intracellular signal transaction for which we are involved matrices not can disconnected from the world but in in regretted part of the network of the world into our

Dr Hyman Dr Daphne Miller Family Physician Founder
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

03:24 min | 1 year ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"The AFP podcast is brought to you by the American Academy of Family Physicians and by Baylor Scott and white health providing care in Thirty six hospitals and over eight hundred patient care centers across Texas currently recruiting for Primary Care Physicians for our central Texas locations welcome to the American and family physician podcast for the October first twenty nine thousand nine issue I'm Steve I'm Herbert I'm Hillary we are residents and faculty mostly residents from the University of Arizona College of Medicine Phoenix Family Medicine residency. This time on the podcasts we're going to talk about hand foot and mouth disease opioid use disorder you're thickening feeds hypertension in pregnancy antibiotics for Rhino Sinusitis anti coagulation and stay tuned for a new song at the end the opinions expressed in the podcast our own do not represent the opinions of the American Academy of Family Physicians the Editor of American family physician or Banner Health to not use this podcast the medical advice instead see our own family doctor medical care I up we have a rapid evidence review but I I think we should welcome Hillary to the podcast one of our six co host this year I'm happy to be here welcome Hillary thank you this rapid evidence review is from Doctors Gil Kane lowder's and Makoto Hey Herbert what's the most explanatory phrase in medicine I'm going to with hand foot and mouth disease correct hand foot mouth disease is a common virus presenting in children younger than ten years old which was caused by enteroviruses and Coxsackie virus transmission is fecal oral aural by respiratory droplet patients are most infectious during the first week the illness but active virus could be presidents tool for forty eight weeks diagnosis clinical and is based on the classic presentation of Macula Popular or popular particular rash on the hands and feet and also in the mouth hence the name hand foot and mouth that's easy to remember agreed simplicity check other illnesses to keeping your differential here are Banja her pedic ginger voice titus app this all sorts pegase vulgarity management supportive pain and fever can be treated with weight based Acetaminophen Ibuprofen or application of light again is not recommended because of lack of benefit and the potential for harm antivirals like a cycle there have a dearth of research concerning their efficacy indications for hospitalization include failure to maintain adequate hydration or the development of neurologic or cardiopulmonary. Gatien's guess what else the best prevention is handwashing shocker specifically counsel patients to wash their hands after using the restroom after diaper changes and before eating GimMe the takeaway here diagnosis clinical treatment is supportive prevention has handwashing.

American Academy of Family Phy Hillary University of Arizona College Editor of American family phys Texas Primary Care Physicians family physician Herbert Doctors Gil Kane lowder AFP Baylor Scott Macula Popular Ibuprofen Banja Banner Health Gatien Steve I Makoto forty eight weeks
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:43 min | 1 year ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"The AFP podcast is brought to you by the American Academy family physicians and by Quest Diagnostics because latent tuberculosis. It can be common during the back to school season. Quest Diagnostics offers a comprehensive manual blood tests that can help medical professionals detect latent. TB before it activates visit TB blood testing dot com during more hey and welcome to the American family physician podcasts for the September Fifteenth Twenty nineteen issue. I'm Jake and Victoria. I'm Herbert and we are residents and faculty mostly residents of the University of Arizona College of Medicine Phoenix Family Medicine Residency Today on the podcast. We're GONNA talk about. It's like Oh pyro neom wipes urinary incontinence will have a poem on Augmentation therapy for treatment resistant depression talk about pelvic inflammatory disease. He's over practice guideline about dual anti platelet therapy and we'll finish up with another poem about how you can rule out community choir pneumonia the opinions expressed in the podcast our our own. Internet represent the opinions of the American Academy of Family Physicians the Editor of American family physician or Banner Health to not use this podcast for medical advice instead sear doctor for medical care the best okay first up we have steps GLICO PYRO NEOM or Q. Brexit a topical wipes for hyper hydrolysis GLICO parochial or Q. Brexit. Wipes are used to treat hyper hydrolysis in patients nine years or older. Let's go through the steps of reviewing this new drug starting with S for safety. It's most important to know that these wipes contain a topically dosed any cholinergic adverse side effects include those you would see with systemic absorption and include blurred vision and dehydration the pneumonic for the Anti cholinergic toxic. Joe Is one of my favorites Madison Hatter Altered Mental Status Blind as a bat for madressas Isis. Read is a beat for flushed skin. Hot is a hair dry as a bone for an hydrolysis and full as a flask for urinary retention exactly exactly that is an awesome pneumonic and while we are going for the whole driza bone thing here. It's important to remember that code ministration of these like. Oh pyro NEOM wipes with other anti CHOLINERGIC meds might get into trouble so you should avoid it in order to minimize the risk for these side effects for tolerability into clinical trials more than one third of patients experienced minor adverse effects.

Quest Diagnostics American family physician American Academy of Family Phy Herbert University of Arizona College Editor of American family phys urinary retention urinary incontinence American Academy AFP Jake Madison Hatter inflammatory disease Banner Health Brexit Joe depression nine years
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

01:32 min | 1 year ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"The a._f._p. Podcast is sponsored by the american academy of family physicians and buy a new offering from the a._f._p. Presenting counting select articles from the august issues of american family physician in audio format for listening anywhere learn more at a._f._p. Dot org slash journal audio and welcome to the american family physician podcast for the september first. I twenty one thousand nine issue. I'm steve. I'm melissa. I'm victoria. We are residents and faculty mostly residents from the university of arizona college of medicine in phoenix family medicine residency today on the podcasts. We're going to talk about the common cold tonsilectomy threatened miscarriage venus ulcers servers ridiculously low back pain and prostate cancer decision making the opinions expressed in the podcast dr do not represent the opinions of the american academy of family physicians. The editor of american family physician or banner health do not use this podcast for medical advice instead. See your family doctor for medical care it sir all right..

american family physician american academy of family phoenix family medicine american academy of university of arizona college prostate cancer editor
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

03:14 min | 1 year ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"The a._f._p. Podcast is sponsored by the american academy of family physicians and buy a new offering from a._f._p. Presenting counting select articles from the august issues of american family physician in audio format for listening anywhere learn more at a._f._p. Dot org slash journal audio you welcome to the american family physician podcast for the august fifteenth twenty one thousand nine hundred ninety issue. I'm steve. I'm caroline. I'm michelle and victoria. We are residents and faculty mostly residents from the university of arizona college of medicine and phoenix family medicine residency this time on the podcast. We're going to talk about health maintenance in school age children the primary care workforce actinic actinic keratoses electronic cigarettes and postpartum depression the opinions expressed in the podcast. Our own did not represent the opinions of the american academy of family physicians. The editor of american family physician or banner health do not use this podcast for medical advice instead sear family doctor for medical care the first up we have two articles on health maintenance in school age children parts one and two covering history physical exam screening immunizations and counseling recommendations. These two articles are by groups from the university of michigan and the university of utah and somehow victorian machel combined these articles into a rhyming poem share dead ready for this victoria. I'm ready preventative. Medicine is what we do best but where do we start on our health maintenance quest history physical and all the vaccines to make sure kids get the appropriate screens. It's taking the history can seem like a daunting task but questions about screen time and sleep are important to ask seat belts and helmets and secondhand smoke diet and exercise and making sure they don't drink coke. Don't forget to ask about regular dental care and if things get too long hand them a questionnaire while formal development screening is not recommended. You should still ask about school and whether or not they attended chronic. Absenteeism shouldn't be missed more than fifteen days. Per year has been linked to health risks for some kids. School can be a real struggle consider a learning disability a._d._h._d. Or bullying if they're having trouble for the physical exam the guidelines aren't clear but look for signs of abuse one point. Two five million kids are discovered each year the u._s. p._s. T.f and a he gives screening recommendations but don't always agree. There are some different screens that you should explore like screening for depression at age twelve not before one screening tool is the adolescent patient health questionnaire.

american family physician american academy of family american academy of university of arizona college michelle university of michigan editor university of utah fifteen days
Black woman says flight crew made her cover up outfit with a blanket

News and Perspective with Tom Hutyler

02:18 min | 1 year ago

Black woman says flight crew made her cover up outfit with a blanket

"Twelve a Texas woman says our outfit nearly got kicked off American Airlines flights she says her romper was deemed too risque for the airline I was so humiliated I walked down the aisle with my head down I didn't want to see another passengers face doctor teacher roses late last month she and her eight year old son had just boarded a flight headed from Jamaica to Miami that's when she was approached by a flight attendant who she says was African American flight attendants stopped me in the aisle and said we need to talk to you up for the family physician it says that she was then removed from the plane and asked repeatedly if she had a jacket lies okay what is going on you have pulled me off the plane to ask three times do I have a jacket in a tropical climate B. herself in a blanket provided by the crew she walked back to her seat later posting to Twitter writing here is what I was wearing when at American air asked me to deep plane for a talk at which point I was asked to cover up Dr Robi leaves there was racial and body discrimination at play writing on Facebook we're police for being black our bodies are over sexualized as women and we must adjust to make everyone around us comfortable there were definitely other passengers on the flight wearing topical a tire short shorts one was also a mother also traveling with a child and she said you know no way and she looked at my shorts she looked at her shorts and she said well your shorts are longer than mine and no one said anything to me on Tuesday the airline issued an apology and a refund but rose says she wants an explanation I will be empowered to dress the way that I feel comfortable dress the way that I feel appropriate if you were going to have a dress code it should be applied equally to every person every shape to every race all we could find regarding American Airlines dress code is a very vague reference in their conditions of carriage to dress appropriately not wearing anything offensive American does plan on hiring a chief inclusion and diversity

Jamaica Miami Family Physician Dr Robi Facebook American Airlines Texas Twitter Rose Eight Year
American Airlines, Houston And Miami discussed on America's Truckin' Network

America's Truckin' Network

00:36 sec | 1 year ago

American Airlines, Houston And Miami discussed on America's Truckin' Network

"American Airlines offering an apology to a Houston based doctor the woman claimed she was ordered to use a blanket to cover up her summer outfit on a recent flight now she's speaking out saying she was targeted due to or curvy figure and because she is black war for maybe sees Victor kendo in Miami it felt like this walk of fame doctor teacher wrote a Houston family physician and eight year old son returning from vacation flying from Jamaica to Miami they just boarded when Doctorow says the pilot who was white authorized to removal from the plane you have pulled me off the plane

American Airlines Houston Miami Family Physician Jamaica Doctorow Victor Eight Year
Benefits of taking Vitamin D supplements

Rush Limbaugh

04:52 min | 1 year ago

Benefits of taking Vitamin D supplements

"Seventy Dr canal for those just tuning in what are some of the main benefits the people might expect to see once they go from being vitamin D. deficient as you say after becoming vitamin D. sufficient how can they be feeling or which they see differently well the first thing that you'll notice is the feeling in your well being and your just think clear but as time goes on you you'll notice differences in your gums and teeth and if you ask anybody who's taking this product and has taken a for several months just ask them about their fingernail ask them what the change with the different than your fingernail now these are things you can experience big now what is it what does it do to your fingernails grow quicker they become harder they become less rebel really shine your it's really a remarkable change in your fingernail but it takes more than a month is it takes about six months the fingernails grow but these are things we can see and feel vitamin D. effects thirty six organ can't feel what it's doing in your pancreas the whole what it's doing for your blood pressure yeah you know or your prostate but we don't have time to talk about the thirty th the organ but what we're talking about is the immune system the pancreas the heart blood pressure muscle strength brain activity prostate health breast health Colin L. bone marrow T. thing gum kidney lung retina skin stomach uterus I mean I could go on but again because activated vitamin D. is a steroid hormone it can affect all these organs because there's two thousand gene that it is the key to those teams and it depends upon which organ it is it which gene is involved so there's two thousand mechanisms of action that's very important to understand because you know we've been jaded with vitamin claimed vitamin C. environment either gonna deal but are you going to do this you're gonna etcetera and so people find it hard to believe I mean if item in the only did one thing they find it easier to believe but they just have to remember the mechanism of action which is unique to any vitamins you mentioned colon health here my family physician as a precautionary move but we are pretty healthy dose of vitamin D. what's the connection yeah what is the reason you're Gastroenterol just did that is because there's just a wealth of buddies now they're coming out showing that colon health and vitamin D. levels are connected but they're the same studies about breast hello the same studies about prostate health this is like an insurance policy you're you're nuts not to take this and then the other thing I want to say is do you listen here in five years I don't want you to say I didn't know about that but I was never told that in five years from now I don't want you to turn around and say I didn't know about I wish you wouldn't know because you've been pulled out right now you're being told you know you can't say you never you never knew about it because I'm telling you right now it's involved for example in a number of places in the country if you walk into emergency room with anything that might be your heart you know what they do but a hundred thousand units right off the bat first thing a hundred thousand years the vitamin D. and then they keep giving now yes of course speaking of the cardiovascular system I know you can play talk for about thirty minutes on this but some of the information you sent me here just fascinating what vitamin D. does talk about its role in maintaining a healthy cardiovascular system yeah they include we know that heart health is better the closer you live to the equator we know heart health is better in the summer then the winner but just recently there been a slew of study out of the best universities in the world all connecting your vitamin D. level to your heart health there's a study for example out a Harvard by a friend of mine professor Edward given each he and his conclusion was pretty star here in this quote low levels of vitamin D. are associated with higher risk integrated man even after controlling for known risk factors that is even after they control for smoking high blood pressure high triglycerides diabetes all the things known to contribute even after they control for that there was a strong effect of vitamin D. so the way these doctors are thinking is look what the risk versus what the benefit it looks like from the studies there's a tremendous risk associated with vitamin D. deficient we don't have all the studies we need and we're doing those studies now but it would be unethical to let people remain vitamin D. deficient while we're conducting all the studies we need to about heart health their bone health their breasts teller prostate health your immune system it would be unethical to let them wait vitamin D. deficiency the problem is that many doctors used antiquated reference ranges and so if your level thirty five they'll tell you that the okay it's not okay the level needs to be fifty or higher and get that adults need five thousand

Dr Canal Five Years Hundred Thousand Years Thirty Minutes Six Months
Tiger, girlfriend named in wrongful death lawsuit

Steve Cochran

01:22 min | 1 year ago

Tiger, girlfriend named in wrongful death lawsuit

"And Tiger Woods has been named in. A wrongful death lawsuit filed by the family of an employee of woods, Jupiter Florida restaurant. The man twenty four year old nNcholas MS burger died in one car crash into Semper after drinking at the restaurant where he tended bar suit. Also names, the restaurant's manager who is woods girlfriend. Erika Hermann the suit contends woods and Herman were aware that MS burger had a drinking problem. Well, then what the family's physician have fired him. I I don't get the liability. I mean, I know there's some laws that say if you're allowed to be over served, and you die or kill someone in the process that the bar, the liquor supplier could be relied reliable. Yeah. But but they're they're holding a news conference this morning. So I guess we'll find out a little bit more about what they're thinking. But apparently, they had one of the the suit contends that they not only were where he had a problem, but they actually participated in drinking with him. Just a few nights before he was killed. So he should not have had alcohol available to them at the restaurant. Even though he tended bar. So yeah, I listen. I'm not sure how you with all respect in agree for the loss. Ship. I I

Tiger Woods Erika Hermann Florida Herman Twenty Four Year
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:13 min | 1 year ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Recurring segments in American family physician is the curbside consultation, and this curbside consultation is entitled effective advocacy for patients and communities. The commentary here is from Dr hack and styles from Madison Wisconsin, we as family doctors understand that advocacy is a core component of medical professionalism. We haven't evidence-based background and our training teaches us about a deep understanding that the health of an individual is tied to the health of families and communities. So this curbside consultation offers a framework based on advocacy at four levels of healthcare interpersonal, organizational, health, system and policy advocacy on an interpersonal level starts with listening carefully to hear patients concerns to work for patients, health and social needs family physicians can recognize. Implicit bias teach others and demonstrate understanding of people from all backgrounds. Organizational advocacy involves serving as a leader to help places of employment education professional membership or worship embrace emission of community service to invest in and strengthen local communities S, family physicians. We know many, social and economic factors influence the health of our patients by advocating beyond individual organizational affiliations, we can help create conditions for collective action. This is the health system level of advocacy. We can promote systems that address social determinants of health, affordable and high-quality childcare, healthy foods public education housing and safe recreation, the fourth level of advocacy is on a policy level, we family physicians can express our support for health promoting policies through communications with political leaders in the public. We are credible champions for policies that support robust healthcare systems financing mechanisms and public health infrastructure. We can train the next generation of advocates an influence public opinion through commute. Outreach writing public speaking an editorial 's if you'd like to build your advocacy skills. Check out the American Academy of family physicians and society of teachers of family medicine resources to gain advocacy, experience on a national level..

American family physician American Academy of family Madison Wisconsin
Gun Shops Work With Doctors To Prevent Suicide By Firearm

Mark Levin

02:48 min | 2 years ago

Gun Shops Work With Doctors To Prevent Suicide By Firearm

"In their lane in Colorado. A group has come together to bridge the divide as NPR's Melissa block reports they found common ground on one thing preventing firearm suicide the group is the Colorado firearm safety coalition, it's motto fighting suicide together, it includes doctors and public health. Researchers also gun shop owners and a firearms instructor who is a competitive shooter, Michael Victor off this is my competition gun. This all day are fifteen Victor off is a gun enthusiast and a retired family physician. And when he thinks about suicide prevention one patient in particular comes to mind, a young woman who shot and killed herself decades ago when he first started practicing, and I never saw that coming. I didn't. Have the slightest clue? I didn't know she owned a gun. Now this week if I were talking to her I would say, do you have a gun house? Do you have access to a gun does this figure into any of your plans, you know, and if so I really like to talk to you about changing Victor off is one of the founders of the coalition along with Dr EMMY bets she's an emergency room physician and public health researcher who focuses on suicide prevention she's been affected by gun suicides in her own family, including one just recently a cousin in his twenties. And that's still pretty raw for many of us. I think and I think for me happening in the midst of the work that I do it made me pause and think about I want to keep doing this work, and how could I have not done more to prevent it. When they started the coalition. Dr bet says they knew they wanted to include both people in healthcare and gun dealers. What really struck me was that they think were astounded by the suicide statistics. And those numbers are stark, Colorado. Has one of the highest suicide rates in the US guns account for half of those suicides. And if you look at all firearm deaths in Colorado, nearly eighty percent of them are suicides. What I say to people is if you want to reduce suicide deaths, you have to talk about firearms, and if you wanna reduce firearm deaths, you have to talk about aside, they are so linked in this country. And when we talk with patients, it should not be about secondment rates. It should not be about politics has no place in the exam room. This should really be about the home safety. That's wants doctors to know. There are no restrictions on asking patients about guns in the home. There's no gag rule despite a common misconception. There was a Florida law that prohibited. Doctors from asking about gun ownership, but it was struck down as unconstitutional, and Dr bet says physicians should know the data about suicide and guns, which are by far the most lethal method of suicide eighty five to ninety percent of people who attempt with a gun will die. Because that's what

Colorado Dr Bet Michael Victor Dr Emmy NPR Melissa Block Family Physician United States Instructor Florida Researcher Eighty Percent Ninety Percent
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:23 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Most inmates are discharged from correctional facilities without a supply of medications or for also primary care mental health services or substance abuse treatment in summary of care for incarcerated patients, this article recommends a model that includes intake services that screen for physical and behavioral health conditions and for common infectious diseases interprofessional health services that include acute and chronic care behavior and substance abuse care, dental, care and social services and reentry services that optimize continuity of care. Patient self management and connecting patients with host services in their community. We have a new editorial series introducing lounge right care reducing overuse and underuse from because Seyni and are fearless leader. Dr Kenny Lynn in this issue of American family physician. We're launching lounge right care reducing overuse and under use a collaboration between the lounge institute and American family physician, the lounge institute's motto is do as much as possible for the patient and as little as possible to the patient the new feature in American family physician will promote a vision for delivering healthcare. That is true to the evidence balanced in its approach and focused on the patient remarkably overuse, and underuse coexist in modern medicine, they're present in geographic regions health systems, hospitals, and sometimes as we all know. Even in the same patient. Appropriateness of care depends greatly on the clinical context. So the goal of this new feature is to simply summarize common clinical practices in which their opportunities to move closer to the goal of right care to avoid overuse by not doing unnecessary things and to improve under-use by incorporating evidence based interventions into routine practice achieving the right care involves matching broad general parameters established by randomized trials and other types of evidence to the unique characteristics values and priorities of the patient physicians. Must recognize that the most important dimension of patient care is the strength of.

American family physician lounge institute Dr Kenny Lynn Seyni
It is time to expand and defend our lane for the publics good.

Second Opinion

03:45 min | 2 years ago

It is time to expand and defend our lane for the publics good.

"This is Dr Michael Wilks with a second opinion. This has been a difficult week what with major fires a major, California bar shooting and almost constant post election bickering. So it's even more remarkable that the NRA had the owed acidy to attack American physicians. The NRA story started when a prestigious medical journal, the annals of internal medicine published a paper advocating for sound policies to eliminate firearm related injuries and death. Their position was not unique to this one journal. It was not unique to just internal medicine doctors or just medical providers. In fact, thousands of medical and nursing and other health science students across the nation's belong to safe in organization that stands for scrubs addressing the firearms epidemic. These students are disgusted that our elected officials are. Unwilling to stop gun violence. The medical profession has a unique responsibility to focus on issues related to preventing death and disease. We need to speak out against gun violence, just as we do for other preventable causes of injury and death. So when the NRA tweeted a response to the annals article that said, quote, someone should tell the self-important anti-gun doctors to stay in their lane, unquote. Most doctors found the tweet highly offensive Dr Mark Abell leading family physician and professor of medicine at the university of Georgia put it this way. Well, this is very much our lane gun violence and preventing gun violence is the job of every physician every primary care physician pediatrician ER physician in always we see the consequences of gun violence in our work preventing. It is like trying to prevent drowning. Trying to prevent bicycle accidents by telling folks to wear helmets telling folks to wear seatbelts, you know, it's no different doctors regularly engage in discussions with people around the dangers of keeping guns in the house particularly in situations where there are children people with mental illness or substance abuse or others who are at high risk of harming themselves or others. We do this whenever there is research on how people can prevent injuries. What is different with guns is that nine thousand nine hundred ninety six the NRA convince congress to bar the federal CDC from doing any research on gun violence. This draconian law was the NRA's backlash to an important study by the CDC done in the early nineteen nineties that study showed quite convincingly that bringing a gun into the house puts everyone at a much higher risk of injury. Well, the. Array lashed out. So now twenty two years later, the CDC can do research and drowning and seat belts and led Texas city, but it cannot do anything related to guns given the change in house leadership. It's long past time to overturn this ridiculous ban. Doctors can help prevent gun injuries and death. This is Dr Michael Wilks. With a second opinion this podcast was made by public radio station. KCRW our status as a nonprofit enables us to make bold and unusual programs. But we need your support to keep it that way donate or become a member at KCRW dot com slash join. And thanks.

NRA Dr Michael Wilks CDC Annals Of Internal Medicine Family Physician Kcrw California Dr Mark Abell Texas City Professor Of Medicine University Of Georgia Congress Twenty Two Years
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:08 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"American family physician. So it'll come rapid fire. Thank you. Dr atherton. Staples. Finally, stay tuned for the world premiere of our new song. Everybody needs a family doctor. Okay. Starting off. With knee pain in adults and Adelaide essence, the initial evaluation from doctors bunt, Jonas and Chang. As you all know knee pain is common like really common about twenty five percent of adults are affected by knee pain. And this is a common complaint seen in the primary care setting right season. Three SU welcome back in gale. So let's talk initial evaluation differential diagnosis and tools to help guide workup. Initial evaluation should include patient, age and pain location, onset, duration and quality other things to consider include pertinent, medical and surgical history. History of swelling, joint, instability, and precipitating trauma or injury if any season three sue let me just say I'm a big fan. Throw that out there. Now moving on. What are some of the more concerning features that may warrant an urgent referral think? Things like severe pain immediate swelling, knee, instability, or inability to bear weight following trauma or for any signs of infection. Your initial evaluation should include a systematic approach. This means inspection palpitation range of motion strength and neuro vascular testing as well as your special tests history and physical exam may provide clues about the diagnosis. Anterior pain may indicate involvement of the patella or patellar, ligaments, medial or lateral pain. May mean a municipal arrangement or maybe due to an injury of the collateral, ligaments diffuse pain, especially in older adults is consistent with osteoarthritis while mechanical symptoms like locking buckling or catching suggest an internal arrangement. Additional evaluation with imaging may be necessary..

knee pain American family physician Dr atherton Adelaide Jonas Chang twenty five percent
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

01:56 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"For my ABS. Sean Honey, ooh, raw and unfiltered. Organic Honey. Hi, yes. Yes again, so maple syrup and Honey are one is low and one is high. Exactly. It's super confusing. Yeah, we've got a lot to learn. Really. God, I don't have to have a map diet. All right, Steve. Notes. Oats are low Fahd map. There you go? Yes, I, I think we did pretty well. That missed one. That's we got like a be totally true. Collectively a b. Thanks for playing the high low game. Thank you. I'm going to put some syrup on oats. But not any, but no Honey on apples. We're going to stay in the gastro, intestinal tract here with a medicine by the numbers from Dr green medicine by the numbers. As you remember is a collaboration of American family physician and the dot com. This medicine by the numbers chewing gum for reducing post caesarean section Ilias chewing gum may sound trivial, but decreasing Eleusis not if you consider all surgery post op Ilias increases discomfort and prolonged hospitalization by five days. In total, this study pulled from seventeen trials with the total population of about three thousand women. The primary endpoint studied include post operative Ilias and time to flayed us, and the result is in chewing. Gum does reduce post op Ilias and NT scoring system gives it a green with a total number needed to treat of fourteen to seventeen. Other results included a reduced time..

Sean Honey Ilias American family physician Steve five days
Cincinnati, American Academy Of Family and Great Lakes discussed on Rush Limbaugh

Rush Limbaugh

01:08 min | 2 years ago

Cincinnati, American Academy Of Family and Great Lakes discussed on Rush Limbaugh

"At least four people dead including the gunman after an active shooter situation at the fifth third Bank headquarters downtown in Cincinnati. According to a thorn is the alcohol, tobacco and firearms officials. They are on the steam, and they work to sweep the building today. Here's the Cincinnati police chief talking to reporters this point

Cincinnati American Academy Of Family Great Lakes Family Physician Dr Melinda Marie Osborne Pfizer Henry Ford Wayne State University Detroit Seventy Three Degrees
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:01 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Welcome to the american family physician podcasts for the june i twenty eighteen edition i'm sorry i'm sue i'm michelle i'm joanna we are residents from the university of arizona college of medicine phoenix family medicine residency today on the pod we're going to talk about diets for health generic drugs hyper hydrolysis asthma pulmonary embolism biomarkers for alzheimer an uncle emergencies the opinions expressed in the podcast our own internet represent the opinions of the american academy of family physicians the editor of american family physician or banner health do not use this podcast medical advice instead sear own family doctor for medical care first up we have diets for health goals in guidelines from doctors lock schneider han and zik from utah and michigan i want to tell a story about things i like to eat is the kind of story that may get long but don't leave till we get through the meat i've always had a problem with dietary advice there are so many fads i cannot easily decide so have come up with a rhyme to help you remember all the changes that you can make between now and the end of december first let's start out with your plate the center of each day it should be filled half with fruits and veggies and only a quarter with whole grains the fourth that's left for protein ideally the healthy kind and rounded off with a nice tall glass keeping water front in your mind fruits and veggies are the best and should be consumed whole juicing your produce takes the fiber out which isn't helping your bum hole remember potatoes are not included saddest day of my career instead we lump them in with grains with.

alzheimer editor utah american family physician michelle university of arizona college american academy of family michigan
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:14 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"This is a super depressing choose your own adventure you'll like this one then she has no complications and lives happily ever after option actually wasn't covered in the article we're going to wrap up with osteoarthritis rapid evidence review this is a new feature in american family physician rapid evidence reviews and who better to bring us the first rapid review than friend of the pod one of the founders of the evidence movement and family medicine deputy editor mark abell there is a lot packed into serve you wo is there ever will try to share a few things that we learned patients with osteoarthritis we'll have pain in the fingers shoulders hips knees or ankles and are usually over forty years old or even more commonly over fifty you expect minimal morning stiffness in osteoarthritis make sure the patient doesn't have another cause of polly articulate joint pain like rheumatoid arthritis which we discussed an episode fifty nine yeah and with these patients with this joint pain the pretest probability of osteoarthritis is so high that there really aren't any physical zam findings or symptoms that can help you rule out osteoarthritis the negative likelihood ratios of these findings bony enlargement functional impairment pain during fluctuation and hebridean nodes range from zero point six to zero point nine this means that the absence of these findings is really not helpful at ruling out osteoarthritis yeah and the presence of these findings is not really useful to rule in osceola arthritis either also you don't need an x ray if the patient has the risk factors and typical symptoms to confirm the diagnosis but you probably want an xray if you're going to consider a surgical referral x ray findings don't always correlate well with symptoms though and do not order an mri without good reason because even people over fifty with no pain ninety percent have joint abnormalities yeah so okay let's move onto treatment first line treatments suggested in this article are full dose seat him in offen topical therapies exercise tai chi ni.

american family physician deputy editor mark abell polly ninety percent forty years
YouTube Shooting: Doctor treating victims blasts endless gun violence

News, Traffic and Weather

00:52 sec | 2 years ago

YouTube Shooting: Doctor treating victims blasts endless gun violence

"Which is quite a bit there's evidence that we don't possess we're still conducting searches and we still have some forensic examinations to conduct so we don't know that yet the chief says the suspect parked behind youtube zainal one cherry avenue building and got in through a parking garage but never made it inside the building they're still trying to figure out what kind of security measures she would have had to defeat to get that far at son bruno police headquarters holly kwan kcbs and just to reiterate something that holly mentioned authorities say that the youtube shooter now seem dom visited a gun range in south city before the rampage that jackson arms shooting range is located in south san francisco it's only three miles from youtube headquarters in san bruno two women who were shot at youtube were released last night from san francisco general they are twenty seven and thirty two years old thirty six year old man remains hospitalized his condition was upgraded today from critical to serious and kcbs gentlemen reports the doctor who treat victims of gun violence are increasingly outspoken about ending it sf general trauma surgeon dr andre campbell used his moment in the spotlight talking about victims of the youtube shooting to express his frustration once again we are confronted with the spectre of mass casualty situation he's chief of emergency medicine doctor chris colwell has been frustrated by gun violence for some twenty years since he treated victims of the columbine shooting but now we do seem to be on the cusp of at least the potential to really do something dramatic and look back at las vegas just last six months how many times we've had it from right in our face this is in my opinion the greatest crisis facing our country on the national stage dr michael munger president of the american academy of family physicians predicts more and more doctors.

San Francisco San Bruno Youtube Chris Colwell Las Vegas President Trump Bruno Holly Jackson Dr Andre Campbell Dr Michael Munger American Academy Of Family Phy Thirty Two Years Thirty Six Year Twenty Years Six Months
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:02 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"There is evidence it doesn't work choosing wisely tells us not to perform population base screening and not to retain lee measure vitamin d unless the patient has hyper calcium ee or decrease kidney function let's close out our vitamin d discussion with a guest friend of the pods summarizing his editorial on this subject hi i'm dr killing luna professor fairly medicine at georgetown university in depth deputy editor of american family physician lows editing the article and vitamin d by the father and son team of doctors the fever i was struck by the discordance between the overwhelming number of studies that showed no benefits of screening than supplementation in americans increasing enthusiasm for them in 2014 foreign of ten adults seventy years or older reported taken a daily vitamin d supplement for at least a thousand units which is one hundred times as many as in two thousand over that time period the volume of vitamin d testing and medicare patients increased by similar degree why is this happening i suggested three reasons an epidemic of vitamin these deficiencies seems plausible since we spend most of our time indoors in slather on the sunscreen went outside lots of observational studies have shown the low vitamin d levels are a marker of chronic health conditions in these studies received more publicity than trials that vine no benefits from supplementing people to get their levels into the socalled normal range finally there is a widespread misunderstanding of what a normal vitamin d level is resulting in persons with levels of 20 to 30 being called vitamin d insufficient when are most likely just fine although there is little evidence of harm beside from harm to our patients pocket books from vitamin d supplements and lower doses nearly seven percent of adults over sixty or taking more than 4000 ius daily a level that the national kennedy medicine considers to be potentially toxic i believe that less screen supplementation of vitamin d is the essence of evidencebased medicine and choosing wisely not all family doctors agree with me an online comment into my editorial said that it needed a realitychek but the reality is that the vitamin d praises out.

professor georgetown university deputy editor american family physician seven percent seventy years
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:01 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"No welcome to the american family physician podcast bonus episodes seven as you know our podcast is hosted by residents in faculty at the university of arizona college of medicine phoenix family medicine residency i'm steve and today we have two special guests high of jc work editor of american family physician and vicechair of the department of family medicine at georgetown university medical center nice to be worth your steve hi i'm semi sexton iin this soon to be editor in chief of afp i am also president of my private practice in arlington virginia premier primarycare physicians and i'm excited to be here yeah thank you guys both so much so we did a full interview with jay way back on pilot episode number one you may have noticed that there are three editorials in the january fifteen and february first issue of american family physician with jay saying farewell and also is introduction so before we chat with dr sexton i have a few questions for you jay you've been editor of american family physician for thirty years or close to which i realised as over half the life of our entire specialty has been awhile at the life of a half the life of the journal i'm is oldest so the the journal is yeah and i realized sumie that if you are going to be half the life of our specialty you'd have to be editor for fifty years starting now okay that that really affects my retirement plan i'll think of it that way okay so jay um what were the biggest changes in american family physician over the almost thirty years that you were editor and and what are the things that you're most proud of.

editor american family physician president private practice virginia jay dr sexton university of arizona college steve georgetown university medical editor in chief arlington thirty years fifty years
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:02 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"The hood of recurrence between the two but photo quite relation has less post procedure pain surgical procedures have three main goals remove symptomatic him right oh collins reduce redundant tissues and minimise pain and complications the more definitive the procedure the greater the pain and the longer the recovery hem rate acting means are typically opener closed with close being the more commonly performed in the u s outcomes are similar across the two types there's also stapled hemorrhage opec see removing a circumference will ring of tissue proximal to the dentist in line and then steepling vat to the distill tissue the serbs to lift the hammered columns unfortunately though recurrent heme rights are much more common with this procedure than a conventional henry reduct me so in summary hemorrhoids are associated with conditions that increased pressure in the venus plexus conservative management includes increasing fiber in water instal softeners or sits baths medical management doesn't have the best evidence but conventional henry dr mees are effective at bull symptom reduction and reducing the risk of recurrence next we have implementing arc effectiveness health care reviews the ahrq is the agency for healthcare research and quality here were helping clinicians make better treatment choices arc contracts for systematic reviews to cover important topics that impact practice for common conditions affecting the health of the population this summary is written by doctors bareto and lin doctor lin good friend of the pods new deputy editor of american family physician and the question here is how effective our interventions to prevent and treat claustrophia he'll antibiotics stewardship decreases rates of seat if infection handwashing campaigns also work they decrease the rated seat of infection from sixteen point eight two nine in half cases.

collins opec henry dr mees deputy editor american family physician
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:20 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Thank you my favorite song of 2017 the medical pneumonic song also from bonus episode five live show i was tired of my old ways i've been reading four of the hit with than amsi highlight turn how will all of this big i found myself cibalong gang when it comes to mind this is a way to them everything that i just read view that medical new ma who is easy on your brain if you can't remember sounds as saying the agreements through may in it was zero on you come on down here the pneumonic that's your thing so here that if the podcasts we're a bunch of podcasts nerds and we always aspire to be some of our heroes steve has a great example of that from episode fortysix the september 15th issue this american family physician podcast i'm steve as you know every week who pick a theme and bring you a variety of topics on that theme today on our show things you think might work that don't actually work our program today in three acts stay with us and the best rant of 2017 goes to steven epa said forty six when he goes off about prediabetes impaired glucose tolerance does not inevitably lead to diabetes the first line treatment is something we all should be doing any way which is exercising and having healthy lifestyles labeling people is unhelpful and unnecessary it has virtually no clinical relevance it's a risk factor for a risk factor there is substantial financial social and emotional costs of labeling our patients okay 2017 best joke to share with a thirdgrader jake episode forty seven.

steve steven epa american family physician jake
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:01 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"There some some great things that have been written written recently about the idea of saying you can't make up for a toxic work environment by just trying to make everything else healthier around you so gotta go after your work environment okay so what in 2017 what was the best on the spot spontaneous question and answer this is from episode thirty seven may first evan ten bucks if he's going to find brackish water uh in a dark irri water that perhaps nazi named yes yes may contain a likeness monster to stave it's a mixture of salt and fresh water attempt x later one of my personal favorites from two thousand seventeen episode thirty eight may fifteen impersonations of dr brown a lewies in honor of dr brown let's all try and do our best imitation for uh for the sign on kick it off okay welcome to the american family physician podcast welcome to the american family position podcast welcome to the american family physician podcast vijay singh very expressive i love it dr behalf he'd be proud and the best poetry of 17 we do love our poems here on the podcast this one comes from steve episode thirty nine i wrote of haikou about to act disease yes this hike who is called what to order first if you suspect silly act disease anti tissue trans glue tamin as immuno globulin a test it's kind of hard because a haikou is seventeen syllables balls in that test is sixteen.

haikou evan dr brown american family physician vijay singh steve