35 Burst results for "Dr. Michael Wilks"
"This is dr. Michael wilks with a second opinion for several weeks drew appointments to see me and then canceled them at the very last minute when he finally showed up. He was concerned about a rash on his lower legs. I diagnosed flea bites. But he just didn't look good. I asked him all sorts of general questions about his health and he kept saying he was fine but given his age and his smoking history. I ordered a long. Cat scan and tests for colon cancer. Even though he'd had one just four years ago the student who was working with me asked why was ordering those tests. When i'm usually so careful about not over ordering tests. She reminded me that. I always make her. Tell me why she is ordering every test. She wants to order on every patient. But all i could offer her was. I had a gut feeling. She told me that. I didn't seem like a gut feeling sort of doctor. And all i could say was that something. Just doesn't seem right. She asked me what i saw. And i really couldn't identify any one thing. It wasn't something he said. Perhaps it was a subconscious summing up of his words or actions are nonverbal behaviors regardless we moved on to the next patient clinicians gut feelings while not scientific or evidence based need to be acknowledged as a component of clinical decision making perhaps spike gut feeling. I meant it was a intuition or a suspicion or an instinct or even a clinical impression. I realized that gut feelings are very subjective and are prone to my bias. So i usually try to focus on objective findings when i went to fill out the request for this et scan. I wasn't even sure what to put in the blank. Where it said reason four-test i could imagine the radiologist laughing at me. If i wrote. I just have a gut feeling. A recent study looked at research on gut feelings related to cancer diagnoses. The study found that clinicians had difficulty specifying what their guts were saying. However win the gut feelings were present. Clinicians generally acted on them either through referrals or through a careful. Workup of seventeen thousand patients included in the study. The odds of a cancer diagnosis were four times higher. When the doctor had had a gut feeling than when they did not gut feelings were more accurate with older physicians and were more accurate. The better the doctor knew the patient it turns out that often these gut feelings were even more predictive than a combination of described symptoms. One week later drew. Cat scan came back showing lung cancer. The student was impressed. But i didn't pat myself on the back rather as a researcher. I've been trying to figure out what it was that gave me that gut feeling.
"dr. michael wilks" Discussed on Second Opinion
"The early developing brain is uniquely malleable. . It takes in and incorporates a huge amount of the surrounding environment and shapes who we are and how we approach problems. . This is Dr Michael Wilks where the second opinion brandon now, , seventeen grew up in a rural part of California surrounded by economic and social stressors. . For most of his life, , his parents have both been addicted to methamphetamine his father was constantly in and out of jail and his mother couldn't take care of the five children. . So. . Brandon was put in a succession of foster homes, , but he tells me it didn't work out because he constantly felt rejected and he couldn't trust people. . He would never let them get close to him for fear that they would reject him again he couldn't trust people who were just trying to help him. . He was constantly moved and changing schools so he developed. . No friends and no relationships with teachers he considers himself dumb in unable to learn. . So with no self esteem brandon stopped attending school he began constantly fighting with everyone andy found that the negative attention he received was the only way he could feel seen will drug use landed him in juvenile hall and recently his fifteen year old girlfriend found out that she was pregnant. . This pattern of childhood trauma extending through generations is not a tall uncommon in some ways social and institutional trauma surrounded brandon and compounded his problems collectively these childhood traumas are called aces or adverse childhood experiences, , and we know that aces are a risk to both. . Emotional health it's amazing. . The correlation between high. . Act Scores measured on a scale of one to ten and subsequent health problems. . The ACE's scale asks questions about activities that occur during childhood such as childhood, , domestic violence, , parental substance, , abuse incarceration, , or being deprived of food or love. . The higher person like, , Brandon's Ace's scores the more likely they are to develop in the future diabetes heart, , Disease Substance Abuse Domestic Violence, , cancer suicide, , and much more. . While the mechanism by which aces impact later health is still being worked out. . We do know the toxic stress has biologic effects including impacting hormone release, , altering immune functioning, , and creating havoc with the accuracy by which DNA is transcribed. . We are all creatures of habit and as we move from children to adults, , people often unintentionally tried to create what they had growing up because that feels most familiar will people with high aces often end up running their own households much as they did when they were growing up with lots of screaming and heading and even drug use. . So how can we intervene? ? Well, , the emerging field is called trauma informed care and it seeks to address the root causes of aces. . Next week, , we'll take a look at what constitutes trauma informed Care Mrs. . Dr Michael Wilks with a second opinion. .
ACES and Trauma Informed Care
"The early developing brain is uniquely malleable. It takes in and incorporates a huge amount of the surrounding environment and shapes who we are and how we approach problems. This is Dr Michael Wilks where the second opinion brandon now, seventeen grew up in a rural part of California surrounded by economic and social stressors. For most of his life, his parents have both been addicted to methamphetamine his father was constantly in and out of jail and his mother couldn't take care of the five children. So. Brandon was put in a succession of foster homes, but he tells me it didn't work out because he constantly felt rejected and he couldn't trust people. He would never let them get close to him for fear that they would reject him again he couldn't trust people who were just trying to help him. He was constantly moved and changing schools so he developed. No friends and no relationships with teachers he considers himself dumb in unable to learn. So with no self esteem brandon stopped attending school he began constantly fighting with everyone andy found that the negative attention he received was the only way he could feel seen will drug use landed him in juvenile hall and recently his fifteen year old girlfriend found out that she was pregnant. This pattern of childhood trauma extending through generations is not a tall uncommon in some ways social and institutional trauma surrounded brandon and compounded his problems collectively these childhood traumas are called aces or adverse childhood experiences, and we know that aces are a risk to both. Emotional health it's amazing. The correlation between high. Act Scores measured on a scale of one to ten and subsequent health problems. The ACE's scale asks questions about activities that occur during childhood such as childhood, domestic violence, parental substance, abuse incarceration, or being deprived of food or love. The higher person like, Brandon's Ace's scores the more likely they are to develop in the future diabetes heart, Disease Substance Abuse Domestic Violence, cancer suicide, and much more. While the mechanism by which aces impact later health is still being worked out. We do know the toxic stress has biologic effects including impacting hormone release, altering immune functioning, and creating havoc with the accuracy by which DNA is transcribed. We are all creatures of habit and as we move from children to adults, people often unintentionally tried to create what they had growing up because that feels most familiar will people with high aces often end up running their own households much as they did when they were growing up with lots of screaming and heading and even drug use. So how can we intervene? Well, the emerging field is called trauma informed care and it seeks to address the root causes of aces. Next week, we'll take a look at what constitutes trauma informed Care Mrs. Dr Michael Wilks with a second opinion.
Leaving the World Health Organization
"This is Dr Michael Wilks with. The pinion over the past few years. Our President has made some incredibly ill informed policy decisions even in the face of clear evidence to the contrary, these decisions have negatively impacted people's lives through policies around covid climate change, immigration health care women's rights, lgbt rights education, and of course, our relationship with foreign countries, but the president's recent decision to leave the sixty year. Old World Health Organization is among the very most irresponsible decision will. Will hurt the US every bit as much as it will hurt the rest of the world the W. H.. O. Is not a perfect organization. It is plagued by politics and infighting and a low budget, but it's still serves a super important function. The whol plays a key role in many decisions that directly or indirectly affect our lives more than ever before our global interconnected world create great risks particularly with regard to the spreading. Spreading of diseases, it is the WHO that is. Our First Line of defense the WHO. I alerted the world to the infection that came to be called covid in early January, and it advised healthcare workers how to protect themselves from the spread. Perhaps it could have been more aggressive with its policies, but if there is a problem, conduct an audit help improve the organization. Don't be a baby and take your toys and walk away. Away and it's not just covid were who plays a vital role. It coordinates the global response to diseases like polio Ebola Malaria HIV TB and yellow fever. The near nation of diseases like polio has saved the US tens of billions of dollars in treatment costs, and the WHO isn't the only Health Organization the US refuses to work with as the US decided to focus inwardly. We have already stopped funding the pan. American Health Organization. Pan. America is the area that is currently home to half of the top ten countries with co Vid. Now aside from helping ourselves, we also have a social responsibility to help resource poor countries by helping to provide education laboratory training tools like p. p. e. and clinical trials drugs to treat emerging and reemerging diseases. When we step back from these responsibilities, China steps in, and they're now in our backyard, working with countries that will old them a big favor. The WHO also directly benefits the US for example each year influenza virus mutates resulting in new variants around the world. It is the W. H. O. that leads the. The flu vaccine development process each year which includes several American researchers and organizations like our FDA and CDC. The US depends on data from the WHO to predict which strain of the flu will spread to the US so that we can make ineffective vaccination in the end the total US funding for the WHO is equivalent to the overhead of about one ass hospital about three hundred seventy million dollars. It would be very hard to get better value for that
A practical steps to protect those at risk of suicide
"Last year firearms were responsible for fifty one percent of suicides about twenty four thousand lives and seventy four percent of homicides about fourteen thousand lives. This is Dr. Michael Wilks with a second opinion. Berry is a forty one year-old Roofer who reported to me feeling suicidal when he told me he'd purchased a gun. My worry level went way up. There's little worse than knowing that someone is at risk of. Of hurting themselves or others, and not being able to do anything to stop it over the past four years or so nineteen states, including California have passed laws called extreme risk, protection orders or your P. O.'s these laws make it illegal for a person who is believed to be a danger to themselves or others to possess access, receive, or have in their custody, a firearm or ammunition for the. The duration of the order typically one year, the civil process begins with an immediate family member, a household member, law, enforcement, or sometimes a health professional, petitioning the court for an immediate ERP oh. If granted, the police requested to enforce the order, so the law sounds like it makes sense, but does it work well. The first report I've seen was published this week in the annals of internal medicine and And it looked at two hundred and thirty eight Erp owes filed over about a three year period in Washington state in Washington the petitioner requesting the ER. Peo- fills out detailed form explaining why they feel. The person is at risk of causing personal injury to themselves or others by way of a firearm. If the situation is deemed to be urgent, they can request an emergency implementation of a temporary. Which lasts only twenty one days longer EERP does then require an appearance before a judge of the two hundred and thirty P. O.'s filed. Eighty percent were granted of those that were granted thirty percent related to fears of suicide, thirty six percent, related to fears of harming someone else, and the remainder involved fear of both the vast majority of Europeans were filed against white men who were. Were in the age group of twenty, five to forty, four about half had a history of prior mental health problems and half reported to have problems of substance abuse, interestingly, a third of the ER PEOs resulted in a court, ordered mental health evaluation, and many of those people were able to access long-term treatment. It also turns out that well over a third of E. R. P.. P. O. Orders were to people with substance abuse problems prior domestic violence attempts or a prior arrest. In most cases, police removed only one firearm, but in other cases police reported removing a dozen or more, so the study suggests that for every ten to twenty RPO's ordered. One life is saved by preventing suicide reports suggest that often when families know of a person's risk to themselves or Or others they are not aware of their ability to have firearms removed from that person. Of course, another problem is at families, or even doctors could fear retribution. The e Rpo we got for Berry was to protect him because we cared, but I'm not sure that Barry will ever want to return to see me as his doctor.
Medical Leadership and Conflicts of Interest
"This is Dr Michael Wilks with a second opinion, despite years of concern over conflicts of interest in medicine, substantial evidence exists that financial ties between health professionals and drug companies impact medical decisions, patient, care, medical research, government, policies and medical education. It's a funny thing that studies funded by drug companies or device manufacturers almost always show more favorable outcomes for the company's product than for the competitor. Perhaps this is just a coincidence, but what about data that shows that educational seminars funded by drug companies results in increased prescribing for that company's product, even when objective data shows no benefit for their drug another coincidence. and. It's an odd occurrence that when expert committees developing practice guidelines contain members who have a financial relationship with a drug company, the guidelines favor policies or practices that benefit the drug company, professional medical organizations with names like the American Society of this or that or the American College of so-and-so play large advisory roles in healthcare. We know that in the US. About twenty percent of healthcare is unnecessary. It doesn't benefit the patient. Although doctors and healthcare systems grow richer by offering these inappropriate services, will professional groups advise government, insurance, companies and other doctors on. On the best way to treat certain conditions, their job is not to maximize markets for companies, but to drive toward best practice based on available evidence, these scholarly professional groups need to be objective and conflict-free. For example they cannot accept money from the makers of synthetic hip, and then advise government or health insurers on the use of synthetic hips. The recent study from the B. M. J. looked at funding received from three hundred and twenty eight medical leaders, serving on ten professional medical associations organizations like the American College of Cardiology or the American psychiatric association. It turns out that seventy two percent of the three hundred and twenty eight leaders had financial ties to industry. Some of the financial ties were several hundred dollars, but others were several hundred thousand dollars. These conflicts of interest are unacceptable, and they must stop. A person cannot serve in leadership without independence and integrity, no leader, serving an any medical advisory or leadership group should be allowed to have any conflict of interest that means receiving gifts, grants, lab, construction, costs, new lab, equipment or Actions, either that or we need to get rid of these professional societies as advisory groups and create new independent groups that we can trust this. Is Dr Michael Wilks with a second
Racism and Medicine
"This is Dr Michael Wilks with a second opinion. It may seem that police brutality, racial discrimination, Kovic, nineteen and injustice have nothing to do with each other or with health care, but they are completely related and share. Root causes related to the social determinants of health. Earning a living wage having affordable housing with a safe environment paid leave an equitable and high quality, education system, or all mission, critical objectives for a healthy civilized society, but we are failing across the board. We have seen the disproportionate impact of covid nineteen on Latin X and black communities, but this disproportionate death among people of color is not new. We've known about it for decades and have done little to address the underlying systemic. Systemic problems that lead to premature death and disease in healthcare there are powerful and wealthy stakeholders that seek to maintain their power and wealth, and are unwilling to engage fairly resource. Poor communities, doctors, pharmaceutical companies, insurance companies, clinical laboratories, pharmacies and hospitals are all politically powerful, and you don't mess with them. They use this power to stay in power and increase profits working to fix poverty reduce racism improve how or reduce food insecurity. Insecurity are simply not in their self interest the journal Health Affairs points out that if we could consider the US healthcare a country, it would have the fifth highest GDP in the world. CEO's have healthcare organizations earn millions of dollars. Doctors earn hundreds of thousands of dollars and other healthcare providers are compensated way above the average American so they have little in common with those of lesser means one pervasive problem. Is that we? We have sub groups that are walled off and sees those outside of their group as others, this concept of the other and feeling, those groups as less than is what drives toward racism disrespect for genders and other divisions, those who get the best healthcare in America are the wealthy. When a wealthy person comes to the emergency department, they are taken aside away from the riffraff and get admitted quickly to a nice hospital room. Many parts of the University of California Healthcare System won't even provide chronic care or follow up care to poor patients those on medical, and certainly not to the uninsured. Why because they can't make a profit and that's important to them. Do we consider this acceptable behavior for our public hospitals? Over the years, medicine has contributed greatly to creating myths and justifications for racist behavior. It is time for healthcare to move from being part of the problem to being part of the solution, but power and wealth stand in the way of caring for those who are excluded from healthcare or suffer from the deadly condition of skin color, related to stop talking about disparities and create a healthcare system that is focused broadly. unhealth is caring and is truly an integrated system. This is Dr Michael Wilks with a second opinion.
The right to NOT know a medical diagnosis
"Herald has been sexually active with three people in the last two weeks. He came into the office with symptoms of sexually transmitted infection. He agreed to be tested for multiple infections including HIV. But when the test came back he told me he didn't want to be told his HIV test results. It would be too upsetting this. Dr Michael Wilks. With a second opinion wilt heralds. Hiv result was positive in the US. People have a clear to no information about their health. Even if doctors feel that he person would be harmed by knowing a diagnosis. Say their cancer diagnosis or the results of genetic asked doctors have a moral ethical and legal duty to inform. The Person Courts have held that people have a right to receive information and ask questions about treatments and engaged in what we call shared decision making with their doctor it was in nineteen seventy-two that A. Us Appeals Court in Canterbury Verse Spence defined informed consent as what a reasonable person would want to know about their condition and any risks of treatment. So that the patient can make an intelligent decision and in the US. We respect people's right to make decisions and guide their own care so we would all agree. That herald has a right to be told. His HIV asked results. This would allow him to decide if he wishes to inform his partners begin treatment or refrain from sexual activity completely and of course once he learns he should tell us partners so they can make informed decisions about engaging with Harold and being tested it becomes much less clear what to do when we think about whether people have a right to not know their health information one reason for people knowing their diagnosis so that they can make these informed decisions about treatments. It is hard for a doctor to talk to a person about surgery or chemotherapy. Say for cancer. If the person doesn't even know they have cancer because they haven't wanted to be told it is even more complicated with HIV because the knowledge that they have that they're infected can impact not only them but their past and future partners. So does the doctor have an obligation to tell herald his. Hiv test result is positive and that he needs to make some important decisions or that Aj Nedic test came back positive and they need to know the results because the results could impact their health but it also could impact their family in that case they would have a moral obligation to tell their brothers and sisters and maybe their children so they could all be tested with Herald. I tried to discuss his fear of finding out the result. Perhaps he had some misconceptions but he wouldn't go there. I gently pointed out the negative effects of remaining ignorant of his test results and that it could have a significant impact on his health. He said nope thanks anyways. Doc as he left the
Missed lessons from the Ebola Outbreak
"This is Dr Michael Wilks. With a second opinion history in general and the history of medicine in particular is greatly underappreciated. For the lessons it can teach US scholars. Tell us that those who cannot remember. The past are condemned to repeat it. Well it seems that valuable lessons learned in the recent past around epidemics have been ignored and disregarded for example although there are differences between the novel Corona Virus Cova Nineteen and the abol outbreak. There are valuable lessons that we missed. What's similar between the two diseases is the fear the distrust of government recommendations the role of the family and spreading the disease the importance of social distancing and the lack of a plan to attack the illness. Dr Brian Bird is a leading veterinarian. An infectious disease epidemiologist and the associate director of UC Davis one health institute. He's worked on the front lines of the Bulla epidemic and other epidemics round the world. He says the major lesson we might have learned was simply to have a plan being prepared or at least having a plan to be prepared is is the key doctor Bert. Also points out that. When Ebola was first recognized in west Africa the concept of a spreadable lethal virus was a totally new concept. That virus was a completely new disease to the people living in that region. They had no experience with the boulevard versus much like the job. Now for Cove it just like with Corona early in the Ebola outbreak. There was also fear no testing and a huge need for socialized relation that tore families apart. There were no treatments or vaccines for either a bowl or Cova and there was a fragmented healthcare system required to care for a large number of sick people and there was no trust in the public health response to prevent the healthy from getting sick West Africa. Bola was a warning to the world. Bit viruses will emerge from relatively distant and remote places. But what we've done no places remote and distant anymore because of the transportation networks whether it'd be roads airplanes in disease management it is essential that people trust their government and believe that they are telling them the truth you look in West Africa. There was a period of time when there was a lot of mistrust and disbelief that the disease was real so in the early months there were large campaigns that just to say a bola is real. There were many opportunities to learn from the Ebola outbreak. That were missed. A lot of those lessons learned have been laid by the wayside because it was appeared that that diseases the disease over there not here. Dr Bird explains the health of the people depends on a strong and coordinated government response during the Ebola outbreak governments in west Africa. Were eventually very heavy handed. But communities came to understand that self isolation was in their own self interest governments need NBC Straw and have a consistent and thoughtful approach to how they want to tackle the emergencies of the day. Today there are important lessons. That could be learned. Some countries and states and cities that could greatly benefit others it requires a willingness to learn and an openness to recognize that. We are all very much in this together. This is Dr Michael Wilks with a second
Reducing Hospital Infections
"Acquired in hospitals are the number one cause of hospital harm hospitals. Those are fabulous breeding grounds for infections and hospital infections cost America about thirty eight billion dollars a year and result in about one hundred thousand deaths each year and among hospital acquired infections. Pneumonia is at the very top of the list list. which is the type of infection that I'm interested in? That's Dr Diane Baker. I'm a professor of nursing at California State University Sacramento Manam. Getting pneumonia in the hospital is not good. These infections or hard to treat they cause people to spend more time in the hospital and and they cost money to treat and they often cause death. That's why we're so interested in taking all the steps necessary to prevent these types of infections actions. It won't surprise you. That hospitals encourage frequent hand washing and the wearing of masks gowns. But Dr Baker's team team has discovered that a dollar thirty five intervention can significantly decreased pneumonia and patients like it. Dr Baker Acre observed that often nurses just don't have the resources to deliver fundamental nursing. Care things like helping people to get out of bed. Providing leading skin care and oral care the consequence of omitting this care of course is that it puts the patient at increased risk for hospital acquired infection. It it turns out that a good number of cases of hospital acquired de Monja can be prevented the Monja comes from germs in the mouth. If we omit ah basic or or care the germs over Berlin. The mouth and they can easily slip into the lungs causing an infection. That's what we call the MONJA. Hospitals are the perfect storm for pneumonia is to develop in part. This is due to patients lying in bed. Being given medicines that suppress their koff having dry. Maoz and an ultra diet. So Dr Baker's team began to think how they might change this pattern. That's got the idea idea that we kept the mouth clean and stopped the germs from Boeing. That perhaps we could prevent this the MONJA and indeed. That's exactly actly. What we did. Dr Baker got three large healthcare systems to give her idea. Try Simple as it might be. Nurses made sure or that. Mouths were healthy. And then encouraged hospitalized people to brush their teeth three to four times a day. This means that they're given a good couth brush. Toothpaste antiseptic now. France and we started brushing teeth before surgery as kind of a logical step. You're having a big surgery as someone's like they put a tube your throat without surgery. Your mouth should be as clean as possibly could be. It's a simple step. But does it reduce pneumonia. Absolutely did reduce the MONJA and one of our studies have to seventy percent saving about thirty one lives savings. I'm about six million dollars a year and the results from the Kaiser permanent case system were equally as impressive literally saving millions of dollars for the organization and hundreds of lives so the solution is simple low cost and low tech but believe it or not. Hospitals are still not adopting this a dollar thirty five intervention. Why because so far no accrediting organization has officially told hospitals. They need to to do it. Come on really. This is Dr Michael Wilks with a second opinion.
Vaccines and the N-Corona Virus
"Medically the world is not the same as it was last week. A virus that started in China perhaps from an animal source has caused dozens of human deaths and infected hundreds. It is likely that more infections and deaths will follow in the weeks to come. It has already wreaked economic and social havoc in China coming during the festivities associated with the Lunar New Year families. leaser separated from each other. Entire cities are on lockdown and hospitals are simply overwhelmed. The culprit is a virus called N Corona for for Novelty Corona. We've known about this family of viruses for a long time as a common cause of colds and sore throats but things changed just in two thousand and two with these SARS corona epidemic that started again in China and caused illness in thousands and killed over. Eight hundred Dr. Peter Hotels the dean of the National School of Tropical Medicine at Baylor College of Medicine in infectious disease. Specialist and CO Director of Texas Texas Children's Center for Vaccine Development picks up the story in two thousand and twelve it arose out of Saudi Arabia. Middle Eastern Respiratory Syndrome. There's quota virus virus also very serious infection spread from Saudi Arabia elsewhere in the Arabian Peninsula to Korea. Viruses are often preventable with vaccines. Well unfortunately we do not have a licensed vaccine for any of the those three major corona viruses even though the technology to make it. Not that complicated. So the technical feasibility. Making these vaccines is not very difficult. It's a matter of contracting invest your support or finances to do the clinical trials. The problem is that these epidemics pass was what happened with our SARS vaccine that we were developing we developed and manufactured. We think a very promising vaccines for the SARS virus and then when SARS was gone there was no longer a lot of interest starting and continuing clinical trials which lead to licensure so the vaccine more or less sits in the freezer. The problem is that these epidemics pass and when they do. There's little appetite for investing vesting in developing vaccines with the feeling that the epidemic is now over. This isn't just unfortunate for Dr Houghton says his group. It's unfortunate for all of us because it may have helped out with this new epidemic. This new and corona virus looks like it's quite similar to the old SARS Corona Corona virus has about eighty percent similarity in terms of genetics and amino acid sequence. So we think there's a good likelihood that our SARS vaccine that we previously we developed in response to that first step attic could potentially cross protect against the current and Cronin of ours but their vaccine will require extensive sensitive testing for safety and effectiveness testing. And this could take years. Unfortunately we end up being very reactive and not so label to think ahead had Dr. Houghton and his group been able to finish their testing years ago. Things would be different today with a vaccine ready for rapid dissemination as hotels points out. These serious corona viruses. Now seem to be the new normal. We've seen one every decade in this this new century so he had SARS in the early two thousands. We have mayors in the two thousand ten in the early twenty twenty. We've got this new end corona virus. There's has every reason to believe that history will repeat itself and when it does. We need to be prepared. This is Dr Michael Wilks with a second opinion.
Bias can have a large impact on health
"Twenty years ago official reports documented the many ways in which health is impacted did by our genes and our behaviors but also by external social determinants. Some of these like race economic factors and insurance coverage may seem obvious but other external social factors like transportation education housing and food security. Thirty also play an important role. This is Dr Michael Wilks. With a second opinion about twenty years ago official reports documented the many many ways in which health is impacted by our genes and our behaviors but also by external social determinants. Some of these. He's like race. Economic Factors and insurance coverage may seem obvious but other external social factors like transportation education education housing and food security also play an important role in how healthy we are. Bias is another factor that contributes to disparities in care but is often ignored particularly with regard to marginalized communities including racial minorities. LGBTQ he cute communities those who are beasts or disabled and many more since the report was written twenty years ago not much has changed with regarding differences in the health among marginalized groups obamacare certainly helped improve access and health equity for nearly fifteen and million people but disparities in life expectancy infant death rates. Malnutrition diabetes and many other markers just have not changed much. Some of these social issues are hard to change. But one factor that is not if given sufficient attention is implicit bias by healthcare workers. Implicit bias sees are those opinions and assumptions that we all have that affect our behaviors and beliefs toward others unconsciously and without our awareness. Even when you look at the highest highest income and highest education levels and you compare the health of blacks and whites blacks have worse outcomes in fact. Hi income educated. Black women have worse health outcomes than even poorly educated poor white women as I have mentioned in past reports. Blacks also get treated less aggressively for documented pain in our offer fewer treatment and options when they have a serious disease. Healthcare teams are composed of human beings who hold biases and prejudices. Joss lost like everybody else. In the general population but healthcare workers are unique in their positions of authority and control over our lives lives. Rudeness and mistreatment in the healthcare system is a common experience for blacks and Latino patients and are black and Latino medical students didn't and nursing students all have their own stories about staff and patients who regularly mistake them for people working in facilities food service or janitorial services. There is the distrust that grew out of historical racism such as the to Ski Gi experiments whereby by hundreds of black men were denied treatment for syphilis in order to observe what the CDC called the natural history of the disease so now a generation or two later how do people begin to trust the CDC and doctors who are the ones that enrolled enrolled them in ethically bankrupt studies so it turns out that some of these social determinants of health are nut so external but are actually usually internal to the healthcare system. Implicit bias is hidden subconscious and unintended to the offender but it is very real and very explicit to the offended. It is often easier to get food to a neighborhood or change our approach approach to say health insurance then it is to acknowledge and address our biases as an article in the Journal. Health Affairs recently pointed out. Attitudes can be changed but only when they are acknowledged an owned the process of making us all aware of our biases needs to be a part hard core education but there is no better place to start then in the healthcare system where people are vulnerable and dependent on
Unnecessary lab tests pushed by a vendor
"This is Dr Michael Wilks with a second opinion just as we can be confident that the sun will rise each morning we can also be confident that health both care costs across. Most categories will rise each year. One area that has not attracted much attention but is helping to drive up. Healthcare costs are labs and radio logic tests. Doctors Order Way too. Many tests and many are unnecessary and wasteful. There are lots of reasons for this increase test ordering but today let's focus on just one important area dishonest marketing and promotion by laboratory vendors. I was recently invited to hear a lecture by a speaker from quest laboratories according to their factsheet quest labs based in New Jersey is the world's largest provider of diagnostic testing generating over for seven billion dollars in revenues twenty eighteen touching thirty percent of American adults lives and serving over fifty percent of physicians in hospitals in the US so they are huge. The medical lecture was supposed to introduce me to several new blood tests that that could benefit my patients several of them were part of quests new cardio Iq test that promise to quote uncover hidden risks for heart attacks and strokes. It turns out that none of the tests being pushed to the medical staff offered any advantages to patients. The tests may eh someday. Help US identify patients who might be at higher risk of stroke and heart disease but today not a single evidence based group of experts in the US or internationally recommends any of these tests. Why because they test for abnormalities in cardiac inflammation that may turn out to be related to heart disease but for which we have absolutely nothing to offer patients that we don't already reddy offer after we test for their lipids and blood pressure. For example quest is pushing tests called high sensitivity C reactive protein like oh protein associated phosphoryl light pace eighty two and my low peroxidase testing. All of these have complicated names and all sound sound very important but every expert. I've spoken to has told me the exact same thing based on our knowledge. Today these are a`research tests that have no clinical value. But the doctor's sitting around me were buying the sales pitch hook line and sinker. When I ask ask the speaker for research proving that the results of these lab tests could improve patient outcomes. He could offer me non. When asked Tim about price twice. He refused to answer telling me only that most insurance will cover the cost of the test. When I asked a third time and insisted did he answer me. He did tell me that the cost for the test was over three hundred dollars. His lecture then moved on to promote other tests. LIKE QUESTS NEW DIAGNOSTIC INSULIN Resistance Panel that he claimed could detect risks for type two diabetes earlier. But why do we need to know this. Even if if we can detect risk factors for diabetes several months earlier than we do now. Will it make any difference to our patients knowing this information information. Would we do anything different than we already do. The answer to both is no quest. Should stop pushing. These is unnecessary. Tests the doctors with incomplete information that only serves to increase their profits and drive up. National Healthcare Costs Insurance. It's companies should stop paying for these tests until they can be proven to be relevant to patient care. Doctors will come on. Don't take requests word for what lab tests. We should order any more than you would take the word of a drug company to tell you to use their drug. Do Your own online align research and look for objective critical appraisals of the research.
The Plague of Romanian Health Care
"This is Dr.. Michael wilks reporting from Romania in eastern Europe Romania as a country came into existence in eighteen. Seventy seven it became communist monistic one thousand nine hundred forty seven and with the overthrow of dictator in nineteen eighty nine. It began transition to democracy in two two thousand seven. Romania joined the European Union while Romania is considered a developing nation. It has a fast-growing economy. Despite extremely poor wages Romanian doctors make less than a thousand dollars a month and nurses often less than half of that. What this means is that many maybe even a majority of graduates of Romania's twelve medical schools leave the country for better wages and working conditions. It's about a third of medical job. Openings are unfilled when talking with Romanian doctors and medical students. They are adamant about the need for higher wages ages. They explain though. It's not only to keep train doctors dentists and nurses from leaving the country and going to another country but it is also to to stop the practice of Romanians paying bribes. To doctors to expedite care. Bribery is a huge concern of governments. But it is also a concern to jobbing doctors who see it as a conflict with their professional obligation to provide care to those in need. Not just us. Those who can afford a bribe. Many Romanian doctors worry that the culture of bribes is so deeply ingrained in modern culture. That it will be impossible to eliminate the same worry exists in. Hungary where bribes or how doctors heavily augment their salaries well Romania me offers universal healthcare. Their healthcare is among the worst in Europe while America spends roughly seventeen percent of gross national product on healthcare healthcare. Romanians spent just under two percent. Not only are there too few doctors but the infrastructure is poor. Hospitals are run down down and equipment is old. According to the Economist. No new hospital has been built in Romania since the fall of communism in nineteen eighty nine fine without modern facilities. Inappropriate sanitary standards. It's no surprise that hospital acquired infections are the highest in Europe Europe and many are deadly. The private sector has also not treated Romania. Well a pharmaceutical company was recently found to be selling dilute dilute antiseptics to hospitals and then offering hospital directors a large cut of the contracts but there are some mighty bright spots. I met with doctors and nurses who are paid very little but still work fourteen and sixteen hour days because they are needed and there is no one else. I met with one pediatric infectious disease doctor. Who is one of the most devoted clinicians I have ever met. She covers an entire hospital and has not taken a vacation or a day off in fourteen years. The good news is that medical students and faculty are hungry for Change Change. They want desperately to be part of offering Romanians something better from Romania. This is Dr Michael wilks reporting.
Dr. Michael Wilkes discusses the use of Epigenetics
"This is Dr Michael Wilks with a second opinion growing up sorry experienced all sorts of childhood trauma. Her father was regularly in prison prison. Her mother used drugs. She was physically abused and she had no adults around to look up to robust. Research has shown that this type of childhood trauma can impact Saris Mental Health but also her physical health. It's not surprising. That trauma has an impact on mental health but physical health has been far more difficult to understand until the field of epigenetics came along. Well it turns out we are more than just. The sum of our genes epigenetics literally means on top of genetics. Each of us has has many genes some of which are turned off and others are turn done to make us who we are when a gene is turned off. It's still present in the cell. It's just not active. There are at least two hundred fifty types of cells in our body and in every single cell there are genes for say nerve cells and muscle cells and skin cells but for example in skin and sells certain genes are turned off and others are turned on. That's what makes the cell skin selling not muscle cell. What turns cells on and off is often? The result of the cells environment and that environment can change constantly cells are bathed by hormones hormones and enzymes and the level of those chemicals increase and decrease in response to say diet or cigarette smoking or stress or other lifestyle choices the hormones and enzymes can turn off or on specific genes for example example the chemical environment can change the structure of a gene. So it no longer works or it can cause a gene to curl up so tightly that the cell cannot read the genes instructions or even recognize the gene so epigenetics or the jeans. The environment is thought to affect the development of cancer and diabetes but it also turns out that the environment in which ourselves function and can affect our behaviors for example nurturing. Maternal care such as regular breastfeeding can impact a baby's B.'s. Gene expression and as a result the baby's brain's response to stressful situations particularly the ability of a child to reduce reduce stress and relax. The study of epigenetics is in its infancy but a key. Unanswered question is can epigenetics genetics be reversed and at least as it relates to cancer. It looks like natural chemicals can alter gene expression and may impact the growth of certain cancers. There's still a lot to be learned before we can use epigenetics to alter disease but it turns out that just like global climate change kid impact species internal climate and environmental changes can impact cells and thus human health. This is Dr Michael Wilks with a second opinion.
The impact of gratitude
"This is Dr Michael Wilks. With a second opinion. ernestine is a seventeen year old homeless woman who came to see me yesterday morning just a few hours after she was discharged from the hospital emergency department. Her arm was in a sling and was wrapped from her fingers. All all the way up to her shoulders in white dressing her other arm also had a white dressing with a large spot of dried blood in the center when when I saw her all wrapped up in bandages. My first comment was holy cow. What happened Ernestine? Her first comment to me was I am so lucky and I have so much to be thankful for. She told me how the previous night. She was viciously attacked and stabbed by her former boyfriend. Friend just two days before she and I talked about her need to get a restraining order. After she explained the details of the assault she again and spoke of how thankful she was to put this in context. For at least six months she had been homeless. She had been living on the street After being kicked out of her home by her mother she had to drop out of school. She lost contact with her brothers and sisters and she usually could only afford board to eat one meal a day and now she was brutally assaulted and she was grateful. Gratitude is a positive emotion. Felt one one one realizes that someone else has given you. Something of value. Psychologists have suggested that gratitude plays a pivotal role in promoting positive social relationships which are essential in a well-functioning society gratitude signals a kindness and and motivates the grateful individual often a relative stranger to reciprocate the pro social behavior studies show that experiencing ingratitude directly facilitates repayment of the favor with a kind act in return. This is a sort of cycle of kindness. Among among a highly social species. Human Beings Ernestine explained that she had so much to be thankful for the medical care she received at the hospital all the woman who found her after the attack and drove her to the hospital and the few people in her life. Who really cared about her? I was silent. How how could this woman practice gratitude at a moment like this in her life? As we approach the Thanksgiving holiday it seems appropriate to consider how how the practice of gratitude supports our own well-being research in the area of positive. Psychology provides evidence demonstrating that practicing. Gratitude has enormous impact on our physical and Army National Health. It turns out that gratitude causes the release of the neurotransmitter Mitterrand dopamine in key areas of the brain the health effects of gratitude range from increasing happiness too focusing less on material objects to reducing burnout to sleeping better being tired and being more resilient as Ernestine discovered if there is one thing a person can can do to increase their health and happiness expressing gratitude. Might be it so happy Thanksgiving and remember how fortunate you are. This is Dr Michael Wilks with a second opinion.
A tale of two dying patients
"This is Dr Michael Wilks. With a second opinion. This is a tale of two dying men. Marcus who is a black man. Dying of what is probably prostate cancer and Armand a white man dying of lung cancer. It is hard to say how long each has to live but both will probably live less than a month. Neither is getting any active treatment to cure their cancer after numerous treatments. They have both failed to respond both need and deserve to be on hospice. Care while cure is not possible care is still our goal treating pain rain and nausea and grief and perhaps loneliness hospice care is comprehensive care. It's geared toward those who want to focus on the quality of life and no no longer want treatments. That won't work or are considered overly aggressive or painful. Marcus will have no part in hospice nor will his his wife. They are not giving up on my Marcus explained his wife. Marcus still hopes for a cure. He told me so. You never know what they may invent tomorrow. Armand was eager to enroll in hospice. He accepted that medicine. Had nothing left to cure him but he he was scared of being in pain and being a burden to his family. It is probably not a coincidence. That Marcus is black and Armand is white. Federal title. Insurance data suggest that blacks near the end of life are thirty percent less likely to enroll in hospice compared to whites and compared to whites. Blacks are also far less likely to ask the doctor for a D. N.. Are Do not resuscitate order in other words requesting that no CPR CPR or intimation be performed if they have a cardiac arrest in both examples. Blacks seem to be opting for more aggressive care ear. When I asked Marcus about this? He explained that there are several explanations. He told me that blacks don't trust the healthcare system. He told me that he he has never forgiven the US government for studies into ski or doctors purposely chose not to treat black men with antibiotics. He is always always afraid that he won't get the same high quality care as whites. I trust you doctor. He told me but I don't trust the system. No Oh hospice for me. Promise I want everything done possible. Another common belief is that we push people into hospice to save the system. Money as I told Marcus I get paid a salary. My goal is to help you make decisions that are best for you. Neither my employer or I get any financial benefit or incentive to push a person toward or away from hospice care so from my perspective. Black people at the end of life are often missing. Good care out of fear of not getting aggressive care. Culture plays a huge. which part in how we deal with issues at the end of our life perhaps black doctors and other doctors from different cultural groups need to take a lead making sure that patients and their families understand the concept of a good death however they define that so that we can make choices to value and respect those
Medicine is plagued by miscommunication
"This is Dr Michael Wilks with a second opinion when people talk there is is often around a word or concept there are words at the Public Webster Dictionary defines congestion as excessively full or crowded.
The unsung heroes of the American health care system
"This is Dr Michael Wilks with as second opinion for three years Kyle has cared for his ninety four year old mother following her serious stroke doc she is confused often scared and unable to do even the most basic activities of daily living despite having no something is clear each disabled person needs one primary care provider who has the time to address their complex needs routines and obligations to help care for their mother Kyle is now seriously burned out he is angry resentful they are the unsung heroes of our hidden healthcare system if they stop providing the services where would we as a society and exhausted his mother's currently stable meaning that she could live in her current condition for some time that is if but those who have debilitating and chronic illnesses often feel abandoned by our healthcare system doctors offices offer little emotional or social stuffing these high need patients into a ten or fifteen minute appointment slot is a recipe for disaster providing extra time with these caregivers feel and it's supports the detrimental effect caregiving can have on our health our healthcare system is just not helpful any disabilities all of this required that Kyle give up his job and his apartment he now lives back at home with his mother for the first time support and we fail to recognize that when the health of one family member deteriorates it impacts other family members in twenty years kyle is one of three children but he reports his siblings have their own families and are unwilling to give up their Kyle has lost three years of his salary and many valued clients his work future is now uncertain he cries as he sits and talks to me as I can tell we have absolutely no plan to address this issue now or in the future this is Dr Michael Wilks with a second opinion
"dr. michael wilks" Discussed on Second Opinion
"This is Dr Michael Wilks with a second opinion. This week is Alabama's governor Kay Ivey signed the nation's most restrictive abortion Bill a near total ban on abortions, it focused attention on how women's health and well-being has become a punching bag. It's also a sad period for women and doctors nurses, who have vowed to take care of them. A doctor who terminates a pregnancy could be sentenced to a far longer term than the man who rapes the woman got her pregnant in the first place, there are some people who value the human life, even before it's a life when an embryo, is no more than an organized collection of cells, like a tumor but they don't care about real kids and families who are standing at our borders, pleading for asylum, because their lives back home are total hell these Americans. They shout from the highest peaks that every. He life is precious. But then they say to children you can't come to our loving, family friendly nation. They have no compassion, or understanding for a woman who just can't handle any more children who can't afford to feed them or as no safe place for them to live, who needs to work to feed her other children know in fourteen of our states. These women will not be allowed to end their own pregnancies in their own bodies. I'm sorry to tell our legislators that committed doctors and other health providers will not stop terminating pregnancies. They just won't you see their drive is not legal. They don't March to the desires of legislators. There's is a moral drive these health providers. They believe in autonomy in allowing women to make choices about their own bodies and they believe that they'll make the best choices. They believe that because they have seen this time and time again, that, if a woman doesn't want to carry a pregnancy to term our societies in new position to force that upon them any more than our government is in a position to raise the children for the women. They see what happens to unwanted children. They see our dysfunctional abusive foster care system. Our group homes are receiving homes. They've seen women who can't stop using drugs, but who can at least make the right decision to not carry an intoxicated, fetus to term our healthcare providers will stand up tall and advocate for our patients, even when there are entire prison wards entire prisons filled with doctors and nurses, sentenced to jail for caring for their patients. More doctors will come behind him to care for and protect women. And when they're arrested more will come. Behind them. We're not training doctors and nurses to be pawns on a chessboard. They're not technicians or followers are health providers are professionals devoted to doing what they believe is the right thing for our patients governor Ivy Brett Cav now and the religious, right? Cannot put this genie back into the bottle. This is Dr Michael Wilks with a second opinion.
"dr. michael wilks" Discussed on KCRW
"Listening to weekend edition from NPR news. This is Dr Michael Wilks with a second opinion health professionals like anyone can make mistakes and sometimes these mistakes can cause death or disability in many organizations. There's an attempt to find the individual at fault and punish them or remove them from their job. However, more often than not this doesn't solve the problem because the problem isn't with an individual it is with the system. So for example, on a busy night shift. A supervising physician tells a junior doctor to get a chest x Ray on a patient. Well, the junior doctor is incredibly busy that night. And well, she forgets the next morning on rounds. The junior doctor is hesitant even scared to tell the senior doctor that she forgot to do the x Ray. So she says the X Ray was normal. Yes. The resident lied and this is wrong. But the system. Mm created a culture where she was afraid to admit to human error. The system also created so much work that the junior doctor forgot about the X Ray. And there was no system to remind her all these problems require systems changes without these kinds of changes. It only perpetuates the problems what is needed is a just culture doctor. Meg Zam Rhody is the assistant provost for interprofessional practice at the university of North Carolina. She is an expert on just culture just culture is when we move away from a system of blaming an individual and start to look in a Justin fairway about how we need to make system changes or how the organization can address it as a whole rather than look at one person to blame. There are three ways in individual can contribute to mistakes one is human error one is risk taking in one is being reckless. The intervention for each is different doctors. Marocchi explains. Using a simple example, you're driving down the road. And all of a sudden, you see the blue lights flashing, and it's because you're being pulled over by policemen. The policeman pulls you over and says, sir or ma'am, you're going sixty five and fifty five and your responses. Oh my goodness. I didn't see the sign change. So that's an example of human or you weren't paying attention. The speed limit changed. And you missed it. The police might scold you and tell you not to let that happen again until you to pay more attention in the future. The second example is risk taking behavior. You are pulled over cop says Hello, you're going sixty five in fifty five. And you say, oh my goodness. I realized that but I'm late for this very important meeting. And you have a strong rationale for the action that you are doing which is speeding in this case. That example, the cop would say I want you to be safe. It's important that you actually go the speed limit bad things can happen when you speed and give you perhaps a warning but educate you in that process. The third example is reckless behavior. You get pulled over and. And you tell the police I yes, I know. I was speeding frankly. I don't care. I'm a great driver. Nothing's going to happen to me speed limits are silly to begin with often errors are not the result of bad people, but poorly designed systems when occur we need to ask was the person doing this because they were reckless because they were risk-taking or because they made an error in a poorly designed system, this is Dr Michael Wilks with a second opinion. Second opinion with Dr Michael Wilks air, Sundays at six thirty five and eight thirty five AM and can be streamed and podcast at.
"dr. michael wilks" Discussed on KCRW
"Is Dr Michael Wilks with a second opinion in America. Our pool of doctors is aging, and of course, we're all aging, but the average age of our doctors is fifty one in some medical specialties. The population is even older than it is in others. For example, forty four percent of the hundred thousand US surgeons are fifty five years of age or older older surgeons have valuable experience that can only come from years of practice. But as the age their performance may Wayne because of age related motoring, cognitive limitations. I assume the same is true for pilots. It's certainly true for older. Automobile drivers surgeons require finely tuned sensory function, clear vision, hearing touch visual spatial, ability the ability to engage in sustained. Attention quick reaction times clinical reasoning skills, and in intact memory, not only to surgeons need their memory of what they've learned in the past. But they also need to engage in continuous learning of new information. Of course, we asked doctors to engage in voluntary self disclosure, if they have any decline, but more often than not humans have very little self awareness of their decline. A survey of nearly one thousand surgeons over the age of sixty five found that most reported no change in their cognitive abilities. But of course, many did have some some studies have shown that surgery performed by older surgeons had no worse outcomes. Then surgery performed by younger surgeons, and in some cases, death rates are actually lower with older surgeons, however, other studies have shown the exact opposite in some way. What may be? Going on is that poor outcomes are more related to surgery volume. In other words, surgeons who do fewer procedures end up doing them more poorly. How do you balance though, the potential age related decline against this deep experience in mature judgment? There certainly are some older doctors surgeons included who should not be practicing. We really have no foolproof system of identifying them. Now, applying a mandatory retirement age seems to me silly. We know there's great variability in function many older. Doctors are very competent airline pilots are required to retire at sixty five FBI agents at fifty seven Park Rangers at fifty seven and air traffic controllers at fifty six and doctors do have a mandatory retirement age in some countries like Russia at sixty for men and fifty five for women. Still I think there is a difference between setting some chronological age as determining ability and a functional assessment. There's another problem with mandatory retirement. We could deplete our pool of surgeons in rural communities. That's where many older surgeons work. We certainly don't want doctors endangering patients, but we also don't wanna push capable doctors out the door because of some arbitrary set age limit this is Dr Michael Wilks with a second opinion..
"dr. michael wilks" Discussed on KCRW
"He's hesitant to go to a free clinic and he generally aids. Doctors Wendy asks me if I can give her. Her some medicine that she can give him. Now. This is an interesting proposition on the one hand it makes perfect public health sense, treating her partner could stop the sexually transmitted infection from spreading others on the other hand there are some uncertainties what if she doesn't give him the medicine medical schools. Have traditionally taught trainees not to prescribe medicine to people that they have not examined themselves, but this is a little bit outdated. What about a for using telemedicine or the internet, and I talked to the patient, but can't examine them. Should. I not prescribe them. Any medication? Also, what if the patient has an allergic reaction to the medication? I prescribe am I responsible because I've never met the guy and asked him about the allergies. Also who should pay for the medicine? The patient me the patients non insurance. The doctor government the medicine isn't horribly expensive. But the cost of filling a prescription is certainly a barrier. That's why I'm handing Wendy the pills in the office says she can take them right away. That eliminates the chance of a well-meaning intention that is in followed up with an action will studies show that people are significantly less likely to be reinfected. If both partners are treated at the same time from a public health perspective, simply telling a person like Wendy to go tell her partner to go. See a doctor is not very effective. That's why the CDC the centers for disease control now recommends giving medication to the patient for their partner. Still. There are states, you can probably guess which ones and you'll be spot on that do not allow that practice and those are the same states that have higher. Rates of sexually transmitted disease and higher rates of reinfection. Of course, it's best for me to see Wendy's partner. So he can be checked for other diseases and educated, but treating a known disease today is better than hoping he might come in someday in the future. I gladly gave Wendy the pills that you would need to give to her partner. This is Dr Michael Wilks with a second opinion..
"dr. michael wilks" Discussed on KCRW
"You're listening to weekend edition from NPR news. Many rates of sexually transmitted diseases or higher now than they've been in a decade while there are several nations for why this might be. So they're still an urgency to reduce their spread. This is Dr Michael Wilks, where they second opinion. Wendy has a serious case of comedian that spread to her abdomen in talking with me. She reports that cheese embarrassed about some poor decisions. She made that led to her having unprotected sex. So she's now infected to make matters worse. It turns out that the man she had a relationship with works in a nearby office. There are no longer together which creates its own social problems. She's told him that he needs to be treated for cla media, but he has no health insurance. He's hesitant to go to a free clinic. And he generally hates doctors Wendy asks me if I can give her. Her some medicine that she can give him. Now. This is an interesting proposition on the one hand it makes perfect public health sense, treating her partner could stop the sexually transmitted infection from spreading others on the other hand there are some uncertainties what if she doesn't give him the medicine medical schools. Have traditionally taught trainees not to prescribe medicine to people that they have not examined themselves, but this is a little bit outdated. What about if we're using telemedicine or the internet, and I talked to the patient, but can't examine them. Should. I not prescribe them. Any medication? Also, what if the patient has an allergic reaction to the medication? I prescribe am I responsible because I've never met the guy and asked him about the allergies. Also who should pay for the medicine? The patient me the patients non insurance. The doctor government the medicine isn't horribly expensive. But the cost of filling a prescription is certainly a barrier. That's why I'm handing Wendy the pills in the office says she can take them right away. That eliminates the chance of a well-meaning intention that isn't followed up with an action will studies show that people are significantly less likely to be reinfected. If both partners are treated at the same time from a public health perspective, simply telling a person like Wendy to go tell her partner to go. See a doctor is not very effective. That's why the CDC the centers for disease control now recommends giving medication to the patient for their partner. Still. There are states, you can probably guess which ones and you'll be spot on that do not allow that practice and those are the same states that have higher. Rates of sexually transmitted disease and higher rates of reinfection. Of course, it's best for me to see Wendy's partner. So he can be checked for other diseases and educated, but treating a known disease today is better than hoping he might come in someday in the future. I gladly gave Wendy the pills that you would need to give to her partner. This is Dr Michael Wilks, where the second opinion. As second opinion with Dr Michael Wilks? They're sending mornings at six thirty five and eight thirty five.
"dr. michael wilks" Discussed on Second Opinion
"This is Dr Michael Wilks with a second opinion, a growing number of high quality medical research. Studies challenge the status quo by providing evidence that traditional things like surgery, just don't work. It turns out that much of what we offer patients has little benefit. But that's only half the story. The other half is that once these studies come out nothing seems to change we still do the same number of useless surgeries. In part. This is due to what is called the Semel Weiss effect. This is the tendency to reject new evidence or new knowledge because it doesn't fit with what we think are what we've always believed Ignace similize was born two hundred years ago this month. He was an obstetrician like every other obstetrician at the time who lost a huge number of babies to infect. His disease. Now remember this was way before we knew about bacteria or other infectious agents. There was no germ theory of disease at the time. It was common for obstetricians to perform autopsies on all babies who died to try to understand the cause of death. But obsta Tristesse were in high demand, and they would go back and forth from what we call labor and delivery to the morgue. Well, similize observed that when doctors washed their hands with a chlorine solution between patients or between, the autopsy and the patient death rates fell not a little poten- fold at the time. This was a remarkable observation he urged his colleagues to engage in regular hand washing. Similize wise could not explain how hand washing prevented deaths, but he was convinced. It did his hand washing. Suggestions. Were resoundingly rejected by his colleagues. They thought this was the height of nonsense. How could a man's hands possibly transmit disease by something you couldn't even see similize continued his careful handwashing and had the lowest death rates by far in his hospital while he saved hundreds bias blindness and ego cost the lives of thousands. Maybe even tens of thousands because his colleagues failed to listen to similize or even evaluate his observation. It was worse than that. He just couldn't convince them the leaders of medicine grew irritated by his letters and his lectures, which accused the medical profession of being reckless even murderers when the establishment could no longer ignore him. They accused him of being psychologically crazy for considering disease caused by things that were unseen. They. You can find him to a psychiatric hospital where ironically he died of an infection years later bacteria or discovered and found to be the cause of what was in similize time. Call child bid fever doctors hands were the main source of spread but the Semel Weiss effect is very much alive. Today. It helps explain why humans doctors in particular reject new knowledge because it contradicts. What we've always believed. 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.
"dr. michael wilks" Discussed on KCRW
"News. This is Dr Michael Wilks with the second opinion during the past two weeks in my clinic. I have had more women bring up their sexual abuse with me, then perhaps I've had in the past five years maybe longer some of this abuse has been with strangers or near strangers some with spouses or near spouses and some happened when the woman was a child a common theme for them was how the cabinet confirmation. Brought back memories and empowered them to speak these stories some of these women had recently shared these repressed or unspoken memories with loved ones. But for others. I was the first one that they told as their stories progressed some forgot what they had come in for others thought, it was more important to talk with me about their abuse and suggested they would come back and discuss their sinuses or their heartburn greater than a third of women have suffered some. Sort of physical or sexual abuse. And most have not discussed the repressed memories or the shame or the impact the event has had on their current relationships. I do regularly ask new patients about any adverse childhood experiences. But I rarely go back and ask regular patients the same questions. The Cavanaugh hearings have led women to redefine early adverse experiences and recognize the impact that it might have on their adult lives as a primary care doctor the actual treatment that I can offer them as limited. But I can listen respect them empower them to seek expert help and acknowledged their feelings and vulnerabilities what I can't do is accurately. Imagine what it must be like to have carried such a burden around for years or even decades. I can't imagine the ways the abuses. Effected their romantic their work or their casual relationships or how it has reduced their willingness to trust or feel safe around. Man. I am lucky because I work in a team, and at my side or behavioral specialists, it turns out many of whom have also been the victims of abuse. These specialists have more time in more skill than I at helping person to build back resiliency and process their experience doctors and other health providers are in a particularly awkward position. Our job requires that we ask probing questions that we touch that we examined and that we invade aspects of a person's privacy. Of course, all of this is done with the specific permission of the person. But these job related tasks can retraumatize even when I ask a person if they mind if I ask some follow up questions I'm unclear. If I'm actually doing more harm than good the stories. I hear reverberate my own memory as I drive home wash the dishes, even as I drift off to sleep. I do appreciate that. I was trusted with these darkest secrets but other than listen validate and refer I am regularly left. Wishing I could offer more. This is Dr Michael Wilks with a second opinion second opinion with Dr Michael Wilks air, Sundays.
"dr. michael wilks" Discussed on KCRW
"This is Dr Michael Wilks with face second opinion during the past two weeks in my clinic. I have had more women bring up their sexual abuse with me, then perhaps I've had in the past five years maybe longer some of this abuse has been with strangers or near strangers some with spouses or near spouses and some happened when the woman was a child a common theme for them was how the cabinet confirmation. Brought back memories and empowered them to speak these stories some of these women had recently shared these repressed or unspoken memories with loved ones. But for others. I was the first one that they told as their stories progressed some forgot what they had come in for others thought it was more important to talk with me about their abuse. And suggested that they would come back and discuss their sinuses or their heartburn greater than the third of. Women have suffered some sort of physical or sexual abuse. And most have not discussed the repressed memories or the shame or the impact the event has had on their current relationships. I do regularly ask new patients about any adverse childhood experiences. But I rarely go back and ask regular patients the same questions. The Cavanaugh hearings have led women to redefine early adverse experiences and recognize the impact that it might have on their adult lives as a primary care doctor the actual treatment that I can offer them as limited. But I can listen respect them empower them to seek expert help and acknowledged their feelings and vulnerabilities what I can't do is accurately. Imagine what it must be like to have carried such a burden around for years or even decades. I can't imagine. The ways the abuses affected their romantic their work or their casual relationships or how it has reduced their willingness to trust or feel safe around man. I am lucky because I work in a team, and at my side or behavioral specialists, it turns out many of whom have also been the victims of abuse. These specialists have more time and more skill than I at helping a person to build back resiliency and process their experience doctors and other health providers are in a particularly awkward position. Our job requires that we ask probing questions that we touch that we examined and that we invade aspects of a person's privacy. Of course, all of this is done with the specific permission of the person. But these job related tasks can retraumatize even when I ask a person if they mind if I ask some follow up questions. I'm unclear if I'm actually doing more harm than good the stories. I hear reverberate my own memory as I drive home wash the dishes, even as I drift off to sleep. I do appreciate that. I was trusted with these darkest secrets but other than listen validate and refer I am regularly left. Wishing I could offer more. This is Dr Michael Wilks with a second opinion as second opinion with Dr Michael Wilks airs, Sundays at six thirty five and eight thirty five AM and can be streamed and podcast.
"dr. michael wilks" Discussed on Second Opinion
"This is Dr Michael Wilks. With a second opinion, I have not seen any signs of the opioid crisis abating life expectancy in the US dropped for the first time in decades because of drug overdoses deaths continue to rise. Families are devastated by those deaths or by family members, suffering with addiction and the price of drugs on the streets remains. Low pain is ubiquitous back pain, the pain, muscle pain, or psychic pain people want to live pain free if they think there's a drug that can help, they'll give it a try. Once they try these drugs and they make the person feel good. They are addictive. The problem now is threefold. There is poor insurance coverage for addiction treatment. There are too few evidence based addiction treatment centers. And we're not taking prevention seriously by supporting things like needle exchange programs for those who are injecting drugs. Some might argue that giving free needles to prevent serious complications or providing spots in treatment centers only encourages people to use drugs. Mike experience suggests the exact opposite in all of my years of caring for those who shoot. I be drugs. I have never had someone tell me that they started using drugs because of free needles or because they knew they could get into a treatment center when they wanted to stop. What drives people to use drugs is complicated and had varies from person to person. But at some level, most are trying to escape something bad and ugly loads of research has shown that needle exchange programs reduce hepatitis c. n.. HIV infections and bacterial and ochre. Dainius research has also shown that medication assisted treatment. Combining buprenorphine methadone or naltrexone with counseling and behavioral therapy has excellent results. It decreases opioid use, overdose, criminal activity and the transmission of infectious diseases. But most areas in the US have no outpatient treatment programs that offer this medication assisted treatment. Addiction is a chronic disease and needs aggressive treatment. Diabetes is a chronic disease and needs aggressive treatment. We don't refuse to give people insulin because they can't control their blood sugar, nor do we withhold treatments from diabetics that are known to save lives treatments for those addicted to opioids, can't depend exclusively on these drug treatment centers. There simply aren't enough addiction specialists. So we need to train primary care physicians, nurse practitioners, and physician assistants to offer medication assisted office based addiction treatments. It seems that we could take a giant step to end the opioid crisis, but it will take a coordinated effort with healthcare providers playing a leading role. This is Dr Michael Wilks with a second opinion.
"dr. michael wilks" Discussed on Second Opinion
"This is Dr Michael Wilks with a second opinion, snake bites are a neglected public health issue. It turns out that collecting data on snake bites is difficult in part because many people don't make it to the hospital to be counted. So there is enormous under reporting. We believe about five million snake bites occur each year around the world and of those one hundred thousand people die. Three times as many people have amputations and other permanent disabilities. Most bites occur in Africa, Asia and Latin America where the countries are poor and access to healthcare and anti venom is simply not available. Children are particularly prone to being bitten and often have far more serious affects due to their small body mass. It's been hard to get anybody in a developed nation to take snake bites. Seriously, James Reid is. A journalist and director documented called minutes to live. He believes that part of this lack of attention, particularly compared with media coverage of diseases like A Bola is due to local impact, look at the desk holes of bullets, horrific as it was. We started saying, well, the amount of people who died in the bullet crisis in the whole recorded twenty six months that same amount of people die from snake bite every month. There's no funding for snake by in contrast to other deadly health conditions, often highly effective anti venom. Treatments do exist as of last year anti venoms are now included on the WHO's list of essential medicines, but they need to be available quickly after the snake bite occurs, but they are not. The first problem is that. Very few countries have the capacity to produce snake venom of adequate quality and production oversight is poor. There are reports of fake anti-venom and untested and venom being sold for high prices. Then there is the problem of getting those who have been bitten access to the anti-venom and there's also the high cost of anti-venom itself. As Jim Rita explains those most affected by bites are the rural poor. These are often marginalized voiceless dollar a day, two dollar a day farmers and herdsmen that really they're out doing their job and they get bit by snake, and they lived two or three hours away from even a road to get to a hospital. Once a bite victim gets to a hospital, the problems are not over. Many hospitals don't have electric city or the refrigeration. That is needed to store anti-venom. Many doctors trained in larger cities simply don't have the skills or knowledge of how to treat victims of snake bites who walk or are carried in from many miles away. So they present late in the course of the attack hours after the bite at a time when the symptoms all already severe, and then many people don't know what type of snake bit them. So choosing the right anti-venom isn't always easy in part, the increase that we're seeing in snake bites is likely a result of climate change. We've built into their state that the snake was was enjoying in the farmlands which is now suburban city where snakes are now coming into home. You have the flood juicy, the monsoon seasons. They're saying more and more sick bites in these times than ever before. The good news is that the World Health Organization in part as a result of reads, documentary, has recently formally listed snake bites as a high priority, neglected tropical disease, which means it may get the attention. It deserves. This is Dr Michael Wilks with a second opinion.
"dr. michael wilks" Discussed on Second Opinion
"This is Dr Michael Wilks with a second opinion, nearly one hundred and fifty years ago. A French doctor applied pressure to a person's chest in an attempt to save their life from a heart that had stopped beating the person survived. It wasn't until the late nineteen fifties that we defined cardiopulmonary resuscitation or CPR as the first treatment for cardiac arrest. When the heart is unable to pump blood to vital organs, out of hospital cardiac arrest is a leading cause of death. And the one situation where the community can make a real difference in a person survival as such. CPR has been taught to millions of people around the globe, despite all of the changes to the process, including eliminating the mouth to mouth part of CPR and the sprinkling of automatic differ in strategic locations where people congregate play. Bases like shopping centers and airports survival remains dismal in the US fewer than seven out of every hundred people who have an out of hospital cardiac arrest receive CPR and leave the hospital alive. Of course, if you watch TV or the movies, this will surprise you given that most of the people who get CPR on TV seemed to survive. You see when a person's heart stops its most often because of underlying serious illness. So CPR is really only the first of many steps and treatment. The studies have shown us that the sooner CPR begins the better the chance of survival. So in Norway, we're starting in the early nineteen sixties. Every single person has been taught CPR in school. The survival rate after cardiac arrest is almost twenty five percent. Not surprisingly, there are lots of barriers to a bystander starting CPR. Some people don't know how or have forgotten how. Do it others are afraid of causing more harm such as breaking bones and for others, they worry that doing CPR will cause emotional distress and still others are afraid of litigation if they make mistakes or wrong. Poor outcomes from CPR can be related to four factors. There are patient factors, including the age and health of the person. There are event factors such as the location of the cardiac arrest and whether a bystander is nearby. Then there are system factors, for example, the ambulance response time, and there are treatment factors such as the quality of the CPR and the quality of the care that the person will eventually receive at the hospital. But small steps are making a difference in Seattle. There is an integrated community response that includes the public dispatchers, EMS hospitals and schools. When a person goes down and somebody calls nine one one. The dispatcher asks two simple questions is the person, unconscious? And is the person breathing. If the answer to both is no via telephone, the dispatcher coaches the person through the process of CPR easing their worry about not being an expert. It is only through a community effort that we can ever hope to improve out of hospital cardiac arrest. And CPR is just the first step. This is Dr. MO Wilkes with a second opinion.
"dr. michael wilks" Discussed on Second Opinion
"I'm bob carlsson and unfixed analysts back with a new season telling original truce stories that will grab you and keep you true story radio movies that will stick in your head like a memory listened to unfixed journal from kcr w on apple podcast or wherever you get your podcasts this is dr michael wilks with a second opinion in a few weeks a couple of thousand california medical students we'll find out where they will be assigned to do their internships in medical circles this is called the match the process is based on a computer algorithm and it is signs graduating medical students to internships in states across the country based on the competitiveness of the student and they're specialty interest many but not all of california's medical students we'll stay and practice in california this is a good thing because the state is desperate for doctors particularly in rural areas kelly on your ranks first in the us for the percentage of doctors who train in the state and then selected to stay in practice in the state but with a population of thirty nine million people we need lots of doctors we currently have one hundred in one thousand active physicians which translates to one doctor of some sort for every four hundred and thirty one people but we only have one primary care doctor for every 1200 people this assumes that people and doctors are distributed evenly around the state which they are not world and wore urban areas are grossly under doctored and parts of los angeles in san francisco have some of the highest doctored a patient ratios in the world the us department of health and human services defines a shortage area as having fewer than one primary care dark dror for every three thousand people well california has six hundred and seven federally designated shortage areas and it has seven million people living in those areas now hospitals and elected officials are getting creative as they think of new ways to persuade or entice young doctors to settle in underserved areas some communities are offering to forgive tens of thousands of dollars in loans summer providing new doctors housing and all are looking to
"dr. michael wilks" Discussed on Second Opinion
"This is dr michael wilks with a second opinion pain is a serious problem affecting nearly a quarter of the us population it cost hundreds of millions of dollars and is poorly managed by the medical profession are under treatment of pain is still to common particularly in persons of color on the other hand doctors are too quick to writer prescription for a narcotics when other interventions may be more appropriate this is in part because of aggressive an inappropriate marketing by perdue and other drug companies but it's also because doctors just assume that patients all want strong drugs certainly nothing about the opioid epidemic is easy and solutions will not involve quick fixes from a doctor's perspective a patients question of is there any way i can get something stronger for my pain is a heart sank question it suggests the need for a long conversation were each party feels vulnerable and the likelihood of both doctor and patient leaving with disappointment is high doctors and patients come to these discussions with very different goals and expectations and there is a soft competition for control the patient in pain often feels vulnerable childlike that they won't be believed and that they'll be labelled with morally loaded terms such as being a drug seeker the doctor feels the conversation will be timeconsuming uncomfortable and adult feel pressure from the patient to prescribe a dangerous drug that has the potential to be misused and diverted to others there hasn't been a lot of research but there has been some on these types of discussions including a study by.
"dr. michael wilks" Discussed on Second Opinion
"This is dr michael wilks with a second opinion a project in africa has just improved access to clear filtered drinkable water for an entire village the new supply comes from deep wells and provides clean filtered water directly from a metal spigot with a shiny pump handle it is expected to decrease childhood diarrhea by eighty percent and improve health enormously villagers need to walk about the length of a us football field from their homes to the pomp and fill up large yellow plastic bottles and carry them back home now before the whale was drilled villagers would need to walk about the same distance of a football field but down a steep slope to a narrow turgid creek and use the same fivegallon yellow bottles which they would fill with murky water and then climb back up the hill the water pump is a no brainer but still each morning and each afternoon children and grownups walk in lines down to the creek to fill up their bottles no one is standing at the pump in india and elsewhere large percentages of populations use agricultural fields and lightly worded areas when they need to use the bathroom in an attempt to reduce water contamination improve sanitation and promote safety by reducing rape and violent crimes and animal attacks in the fields governments and nonprofit foundations have committed significant amount of money to dig latrines and supply millions of subsidised toilets near the house now a study mentioned in the economist found that even with functional safe toilets millions refuse to use them in some cases the detached toilet room was too close to the house and people were.
"dr. michael wilks" Discussed on Second Opinion
"This is dr michael wilks with a second opinion let's say you been having stomach pain for nearly a week and you finally decide it's time to go to the doctor your doctor asks you a few questions about the pain minutes on said and associated symptoms and signs she then tells you that you have mentioned terek at night us oh my gosh you think how bad is it i mean is the end near well it is not mess enteric adam ideas is the doctor's attempt to medical eyes what your grandmother would have described as a tummy ache eat simple starches keep yourself hydrated stay away from alcohol and pain medications you know the drill after the doctor reassures you that the condition is likely a viral infection and we'll pass in a few more days you breathe a big sigh of relief this idea of using language to medical ice common human conditions is more than just cute it has serious implications when doctors tell us we have gastropod safa jio reflex disease or poly cystic ovary disease or carcinoma insitu we worry he sound really bad in fact the castro is safa jill reflex disease is indigestion a disease the poly cystic ovary send them is hormonal irregularity and carcinoma insitu means abnormal cells in the brass dark it's not cancer in the bmj researchers studied language and found that when doctors use medical lies terms patients are much more likely to want or expect something medications tests are treatments compared to win the exact same condition is described in common in glitch so those people with poly cystic ovary syndrome they wanted x rays those with the carcinoma insitu they wanted surge.
"dr. michael wilks" Discussed on Second Opinion
"This is dr michael wilks with a second opinion it's fall which means sports season is in full swing now this means that a significant portion of my time as a doctor is spent doing sports physical exams from a medical perspective these exams are silly in an otherwise healthy person there is almost nothing that i pick up that would limit a person's ability to play sports the forms that the school systems have me fill out are a joke i have to have a high school athlete stand on one foot and jump up and down for thirty seconds and take their pulse i have no idea what i'm looking for and have no idea what would be an abnormal finding sure i can look for knee injuries and detect obesity but these young people don't need me to tell them that they're having those sorts of problems but the exams are not completely useless particularly for young man after all these are the folks that never come to see me for routine care guys are tougher so they think and they hate going to the doctor for fear that will check them for ernie yet but having them in my office allows me to talk to them and ask them how they're doing are they sexually active in our the engaging in safe practices are they putting themselves at risk with drugs or alcohol and have they been having thoughts of hurting themselves or others while i almost never pick up an unknown serious physical problem i do pickup emotional and family problems all the time but when it really gets tough is around football to me the evidence of longterm effects from head injuries that take place in a routine play is overwhelming in my medical opinion kids should just not play football among the three million people who do play football concussion.