Medical version of the self driving car
cstehansen
Posts: 1,984 Member
This is an interesting article from the NEJM:
http://catalyst.nejm.org/videos/decision-support-self-driving-cars/
One of the quotes, "studies from the Rand Corporation that show patient care is consistent with evidence only about half the time; and studies that there could be a 17-year lag between the discovery of life-saving treatments and when they are uniformly adopted into practice."
If I am understanding correctly, the author is suggesting we use all the data in electronic medical records to track what treatment actually worked rather than just follow standard of care. This would be a monumental shift where we would see a shift in how diabetics are treated - currently told to do LF to doing LC since it actually works.
Using a method like this would be faster, cheaper and more effective than doing a litany of research studies. Besides, we all know there are ample studies showing the cholesterol/fat/heart guidelines are completely wrong. However, most doctors in practice will use what they learned in medical school for their entire careers. That means someone trained in the 70's, 80's or 90's will continue to preach LF for decades longer.
For medical studies to change the course of treatment will take years (or decades) to change what is taught in med school and then decades for the new generations of doctors to become the majority. Using the medical records with actual treatments and results could create a game changer within a couple of years IF doctors accurately record treatment including dietary changes in these medical records.
The article isn't very long if you are so inclined. @RalfLott @KnitOrMiss
http://catalyst.nejm.org/videos/decision-support-self-driving-cars/
One of the quotes, "studies from the Rand Corporation that show patient care is consistent with evidence only about half the time; and studies that there could be a 17-year lag between the discovery of life-saving treatments and when they are uniformly adopted into practice."
If I am understanding correctly, the author is suggesting we use all the data in electronic medical records to track what treatment actually worked rather than just follow standard of care. This would be a monumental shift where we would see a shift in how diabetics are treated - currently told to do LF to doing LC since it actually works.
Using a method like this would be faster, cheaper and more effective than doing a litany of research studies. Besides, we all know there are ample studies showing the cholesterol/fat/heart guidelines are completely wrong. However, most doctors in practice will use what they learned in medical school for their entire careers. That means someone trained in the 70's, 80's or 90's will continue to preach LF for decades longer.
For medical studies to change the course of treatment will take years (or decades) to change what is taught in med school and then decades for the new generations of doctors to become the majority. Using the medical records with actual treatments and results could create a game changer within a couple of years IF doctors accurately record treatment including dietary changes in these medical records.
The article isn't very long if you are so inclined. @RalfLott @KnitOrMiss
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Yes, but from what I've seen, most very low carbers tend to lie or at least aren't completely honest with their doctors about the diet.
So they let the doctor think their recommendations are working just to keep them off their backs.2 -
That is true @Sunny_Bunny_ I tell my DR , I'm doing LC but I don't mention HF cuz its too hard to get into that conversation.1
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That is true @Sunny_Bunny_ I tell my DR , I'm doing LC but I don't mention HF cuz its too hard to get into that conversation.
^^^^ This, not a lie, just not the whole truth.
My PCP is a fan of Mediterranean diet, but the pasta and whole grain breads variety. I am trying to get in to see another dr. who is sponsoring/hosting the low carb conference in Breckenridge this week, but can't even get into the phone line. Maybe after the conference, I can speak to a person in his office. How cool would it be to have a dr. who is like "yeah, LCHF is the way to eat, do it. We have a support group that meets monthly to support you in your way of eating." He is 20 miles away but I would love to get on his patient list. He is even in my insurance's network.8 -
retirehappy wrote: »That is true @Sunny_Bunny_ I tell my DR , I'm doing LC but I don't mention HF cuz its too hard to get into that conversation.
^^^^ This, not a lie, just not the whole truth.
My PCP is a fan of Mediterranean diet, but the pasta and whole grain breads variety. I am trying to get in to see another dr. who is sponsoring/hosting the low carb conference in Breckenridge this week, but can't even get into the phone line. Maybe after the conference, I can speak to a person in his office. How cool would it be to have a dr. who is like "yeah, LCHF is the way to eat, do it. We have a support group that meets monthly to support you in your way of eating." He is 20 miles away but I would love to get on his patient list. He is even in my insurance's network.
OMG that would be awesome! Crossing fingers, toes, eyes for you!4 -
I found one using Jimmy Moore's site. It lists LCHF friendly doctors. I posted the link before. I think it was added to the launch pad somewhere.1
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cstehansen wrote: »This is an interesting article from the NEJM:
http://catalyst.nejm.org/videos/decision-support-self-driving-cars/
One of the quotes, "studies from the Rand Corporation that show patient care is consistent with evidence only about half the time; and studies that there could be a 17-year lag between the discovery of life-saving treatments and when they are uniformly adopted into practice."
If I am understanding correctly, the author is suggesting we use all the data in electronic medical records to track what treatment actually worked rather than just follow standard of care. This would be a monumental shift where we would see a shift in how diabetics are treated - currently told to do LF to doing LC since it actually works.
Using a method like this would be faster, cheaper and more effective than doing a litany of research studies. Besides, we all know there are ample studies showing the cholesterol/fat/heart guidelines are completely wrong. However, most doctors in practice will use what they learned in medical school for their entire careers. That means someone trained in the 70's, 80's or 90's will continue to preach LF for decades longer.
For medical studies to change the course of treatment will take years (or decades) to change what is taught in med school and then decades for the new generations of doctors to become the majority. Using the medical records with actual treatments and results could create a game changer within a couple of years IF doctors accurately record treatment including dietary changes in these medical records.
The article isn't very long if you are so inclined. @RalfLott @KnitOrMiss
Brilliant.
Patients' basic informational needs are modest enough. All we require is one website where we can find the info that will give us that 15+ year jump on our doctors. (I've looked. It's not Consumer Reports, which is still spouting the ADA's eat-carbs drivel.) Where do we turn?0 -
I suspect that a large part of the medical profession's reluctance to go against conventional wisdom stems from the fear of malpractice suits. If you prescribe the same thing as 99.99% of all other doctors, you can't be sued if it turns out to be ineffective or even fatal. Prescribe something unconventional that works for all but one of your patients: Cue the lawyers.5
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That's exactly why the ADA's pathetic recommendations err so heavily on the side of hyperglycemia...1
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I heard an interview recently with an author who was recounting the case of one doctor who originally had a PhD in another discipline and then went into medicine. He said his frustration is that in a traditional PhD program (and higher education in general), the student is expected to question everything but in medicine he was chastised for doing this and told to just accept and memorize what he was told. There is apparently no tolerance in med school for independent thought.
This may be the larger problem which is why mentioned the slowness of change being dependent on getting what is taught in med school changed.
Based on my experience with doctors throughout my life, this idea of blind acceptance of what was taught seems like it may be accurate. I am a questioner. I question everything - including my doctors. Based on not just what they answered but how, this explanation from the author made more sense than the fear of lawsuits thought I had previously held.
I think this is especially the case for GP docs as they have to be the jack of all trades and master of none in the medical world. In reality, it is impossible to expect them to keep up with all the research on all the various things they see. They have to just rely on doing what they were taught.1 -
cstehansen wrote: »I heard an interview recently with an author who was recounting the case of one doctor who originally had a PhD in another discipline and then went into medicine. He said his frustration is that in a traditional PhD program (and higher education in general), the student is expected to question everything but in medicine he was chastised for doing this and told to just accept and memorize what he was told. There is apparently no tolerance in med school for independent thought.
This may be the larger problem which is why mentioned the slowness of change being dependent on getting what is taught in med school changed.
Based on my experience with doctors throughout my life, this idea of blind acceptance of what was taught seems like it may be accurate. I am a questioner. I question everything - including my doctors. Based on not just what they answered but how, this explanation from the author made more sense than the fear of lawsuits thought I had previously held.
I think this is especially the case for GP docs as they have to be the jack of all trades and master of none in the medical world. In reality, it is impossible to expect them to keep up with all the research on all the various things they see. They have to just rely on doing what they were taught.
I still feel like even if it is simply expectation to blindly accept what's taught, I still feel like there is the underlying fear of lawsuits and/or of being ridiculed and damaging ones career.
I heard it somewhere recently, can't remember where or who, a doctor being interviewed said you don't want to be the first one to do something but you also don't want to be the last.
I think the current state of the medical profession is somewhere after the point of being first, but it's still awfully early for most so they are waiting to make decisions. There will of course, be plenty of them that come in last, but I hope to see the next few years bring more of them to a point of acceptance and implementation.
My own doctor asked how I was losing weight and wanted to know why I felt I needed to reduce my ADHD meds. Originally, I just told him very low carb/no grains no sugar. Then when I went back to reduce meds again, he asked a few more questions. I admitted I was eating keto and that included a lot of natural fats. Both times he only nodded approvingly. He literally said not one single thing about it. I had the feeling he did approve but he felt he couldn't speak about it. He did not ask me to have blood work or anything. I have no history of major health issues though, other than IBS and ADHD and gall stones about a million years ago.
On a check up once, the nurse practitioner was asking me lots of questions. She sounded interested in it and not disapproving but she did throw out the idea of a cholesterol check.
Which I never felt the need to do.0 -
cstehansen wrote: »I found one using Jimmy Moore's site. It lists LCHF friendly doctors. I posted the link before. I think it was added to the launch pad somewhere.
Yes, that is how I found about this Dr. and when I checked his web site, turns out he is a serious LCHF practitioner.
A few others on Jimmy's list are in the Front Range, but not in my insurance network, and one is doing research only and not working with patients anymore, and one is a chiropractor, so not covered by insurance again.0 -
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I guess I'm pretty lucky that way. My PCP had been on my case about losing weight for a while, and she always talked about cutting back my carbs, and she could tell I wasn't buying it, so she didn't push...but she mentioned it often. Then, when I finally ended up at the endocrinologist's office, and he diagnosed my insulin resistance/confirmed my PCOS, he pushed me to use this site MORE (he loved it, even reviewed my calories and macros ON THE APP, in the office, at my appointment - and even suggested more aggressive macro numbers when I was ready to try low carb), and actually flat out suggested a low carb, high fat diet, and sent me home to research...
They both have their moments where they slide back into old thinking, but they're always willing to discuss options and such...
However, this list itself - the low carb doctor's list - makes me sad. I'd LOVELOVELOVE to had a functional doctor, or someone knowledgeable in DNA testing and such, but the only one remotely close to me is a Bariatric surgeon, so I question his knowledge base and thinking outside the box, and he's not on my insurance AT ALL...0 -
I dunno. Compared to PCPs, bariatrix specialists are a ways outside the box.
(I've even been thinking about going to see a well-regarded local bariatric surgeon just for his rumored expertise in..... nutrition!
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@RalfLott - dude has his own website...and it seems like fluff and snake oil... Tell me what YOU think... steelmanclinic.com/programs-and-prices1
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Ha. Not that direction outside the box!
That doesn't sound at all like the rather serious bariatric specialist I'm thinking of seeing (who isn't trying to retire next year off this year's supplement sales).
Unless there are anti-insulinogenic properties of snake oil I'm not aware of, I reckon I'd save my shekels, too!1 -
KnitOrMiss wrote: »@RalfLott - dude has his own website...and it seems like fluff and snake oil... Tell me what YOU think... steelmanclinic.com/programs-and-prices
Given that one of his primary diet plans is the hCG diet, I think your description of 'snake oil salesman' is fairly accurate...0 -
@ccdragon - In general, I understand the idea of the HCG diet, and other than the super low calorie part, I could buy in because personally, I was my absolute healthiest in my life when I was pregnant... SO that hormone unto it self does have something going on...but every single person I know who has done that dietary plan has gained back all the weight plus some as soon as they stopped the dietary protocols...1
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@KnitOrMiss - I think the hCG helps a lot with hormone regulation and helps the body even itself out (understandable since it is the pregnancy hormone) - it would be great just for that effect. Like you said tho, the main weight loss benefit is from the dietary protocols which are not sustainable long-term.1
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KnitOrMiss wrote: »...but every single person I know who has done that dietary plan has gained back all the weight plus some as soon as they stopped the dietary protocols...
Stopping any dietary protocol of any diet will yield the same results (weight gain) if one trends back to prior behaviors and is not given or does not formulate and implement an exit plan towards ongoing maintenance. Sad but true.
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Sunny_Bunny_ wrote: »Yes, but from what I've seen, most very low carbers tend to lie or at least aren't completely honest with their doctors about the diet.
So they let the doctor think their recommendations are working just to keep them off their backs.
I think people should be open and honest with their doctors, but I understand why they are not. I was/am completely open with my doctor. She was not happy. But, at least she knows.2 -
I am fortunate with my PCP. I came into my last appointment with my 50 lb weight loss and over 1 point down on my A1C, and when he asked how I did it, I told him LCHF. He said, "Well, it's obviously working, so keep doing it."4
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I was nervous about telling my drs but I ended up coming clean with my cardiologist, former PCP (loved her but she moved) and MS specialist that I'm doing LCHF and I was pleasantly surprised that they were all supportive, especially since I was able to share how it helped with weight loss, joint pain, etc., plus I had great blood work to back it up.
I still need to have that convo with my new PCP. I've only seen her once so far (due for a physical next month) but she did have a poster promoting lowering carbs for weight loss in the exam room so she should at least be accepting of the LC side of things. 3 -
cstehansen wrote: »I heard an interview recently with an author who was recounting the case of one doctor who originally had a PhD in another discipline and then went into medicine. He said his frustration is that in a traditional PhD program (and higher education in general), the student is expected to question everything but in medicine he was chastised for doing this and told to just accept and memorize what he was told. There is apparently no tolerance in med school for independent thought.
This may be why Dr. Atkins was so vilified by his profession his entire career.
@mandycat223 I agree about the malpractice issue. For most physicians, this is a real concern.
However, in my state, malpractice reform happened about 8 years ago now. It is very difficult to sue any medical practitioner and the insurance companies won't even negotiate with victims/lawyers but prefer to take virtually every case to court. Why? Because our laws so favor them in our state that the insurance company wins 80% of the time. And awards are based on total monetary loss only. Like torte law, you can only receive 3 times actual (aka monetary) losses in the rare case the victim does win. I faced this personally in the last year after losing most of my vision following routine cataract surgery of the "dropless" type. I've learned a lot since then like the doctor should never have put the type of lens in my eyes that he did (my eye chamber is too small for the type used) and there is a severe complication that can occur that is immune based and can't be predicted (and happened to me, blinding one eye). However, since I was already on disability, I'm considered to have no loss of income (I have MS and went on disability 3 years ago at age 59). My only monetary loss has been my out of pocket costs and every lawyer I've talked to has said 10 years ago I would have had a case but today I just don't have enough monetary loss to make it worth their while. And the insurance company doesn't return my calls.
So doctors here could use LCHF on any patient who is on any type of fixed income from SS to SSI to SSDI to welfare with no concern. But they don't. Treatment is always based on standard procedures.
One bright spot for me was when I saw my cardiologist this year. I told him I was on LCHF and he told me to keep doing what I'm doing.
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Good God. That's just rotten! The tort "reformers" are much better organized and funded than hapless consumers, and many protections we still take for granted have long since become historical curiosities.
The health care industry is especially good at creating the illusion that ambulance chasers with the ability to hypnotize judge and jury are perched on every telephone pole waiting to loot any honest hospital or doctor who discharges a patient with so much as crooked stitches....1 -
KnitOrMiss wrote: »...but every single person I know who has done that dietary plan has gained back all the weight plus some as soon as they stopped the dietary protocols...
Stopping any dietary protocol of any diet will yield the same results (weight gain) if one trends back to prior behaviors and is not given or does not formulate and implement an exit plan towards ongoing maintenance. Sad but true.
@kpk54 - As far as I know, most of these folks were medical professionals or closely associated with same, and they had exit plans for maintenance and all of that. Some were weight watchers types, some went back on simple calorie restriction, some stayed on low fat diets, etc. Nearly every one of them had a plan with relative adherence. Even transitioning off the plan onto the "advanced protocol" didn't help. Seems as there simply was no after plan that worked - unless during the process of being on the plan that other metabolic issues were addressed and corrected - whether through to plan or otherwise...0 -
Good God. That's just rotten! The tort "reformers" are much better organized and funded than hapless consumers, and many protections we still take for granted have long since become historical curiosities.
The health care industry is especially good at creating the illusion that ambulance chasers with the ability to hypnotize judge and jury are perched on every telephone pole waiting to loot any honest hospital or doctor who discharges a patient with so much as crooked stitches....
Couldn't have said it better. Theoretically, the ophthalmologist could have "accidentally" removed my eyes, but I still wouldn't have a case based on our malpractice laws.
Once this medical situation has entirely played itself out, I plan to send a letter to all our state reps/senators outlining my situation and hopefully the reformed laws will be re-reformed to something fair and reasonable. I believe that those on a fixed income do not have the same protections under the law which speaks to constitutionality at the state level.
Okay, off my soapbox!
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Well, as most everyone here would agree, the moral no matter which state you're in is to do as much research as you can on your own before embarking on any treatment, ever.
I worry about people who don't have the wherewithal to do their own research or ask pertinent questions in advance. It would be nice if you could engage an independent advocate to help facilitate your interaction with the healthcare system, but I doubt the AMA and state medical associations would be amused....0
This discussion has been closed.