Fixing Healthcare Podcast

Goodbye, Marcus Welby, M.D., that lovable TV doctor from the early ‘70s whose humble private practice dealt with everything from impotence to Alzheimer’s disease. Hello to integrated, team-based, 21st-century medicine that enables doctors to work smarter, together, rather than harder (and less effectively), alone. That’s the vision of Don Crane, president and CEO of America’s Physician Groups (APG). Crane is the second guest on season 6 of the Fixing Healthcare podcast. This season, cohosts Dr. Robert Pearl and Jeremy Corr go in search of solutions from people like Crane who lead and represent the healthcare system’s various parts—from doctors and nurses to insurers, drug companies, hospitals, entrepreneurs and others. APG is a professional association made up of 340 physician groups that contract with about 170,000 physicians who, in turn, take care of 90 million patients in 44 states. In this interview, Crane weighs in re-educating doctors for the future, holding them accountable for better care at lower costs, and improving America’s “toxic” diet. Donald Crane Interview Highlights On how to pay for healthcare   “We believe that physician groups should be accountable for cost and quality. We’re very much wedded to the (prospective) payment model, where the physician group is paid in advance per member, per month, a defined amount of money to care for the individual patients. This prospective payment creates aligned incentives all through the physician group enterprise where everybody is trying to keep the patients healthy. Let me repeat that, we try and keep the patient healthy.” On accelerating the value movement “I used to go back to Washington, D.C., and talk to congressmen and senators and so forth and say, ‘Fee for service is bad and capitation is good,’ and they were looking at me like I had two heads. Now, when we’re in Washington, D.C., talking about capitation, it’s conventional wisdom; it’s commonly accepted that we need to move there … I think legislation is part of the answer and then I think we need to look to employers clamoring for more value.” On the causes of physician burnout “The volume of cries of despair from physicians has risen year over year, and it’s at a high pitch right now … The single biggest cause is the fee-for-service payment model. Physicians needing or wanting to make more money, whether it’s to put children through college or whatever, need to work more in order to make more. So, they’re on the hamster wheel. They run faster and faster and they work longer hours. This is almost a Sisyphus kind of a model of working more, working harder in order to make more money. That is the nature of fee for service.” “The other part then moves into administrative areas. Indeed, physicians not fortunate enough to be employed by well-staffed and well-resourced groups, they’re having to do a lot of administrative work and they’re trying to keep up with quality measurement programs that vary from payer to payer to payer. There’s a lot of reporting requirements. And so the amount of time they spend in nonpatient care has risen year after year and it’s burning them out. And we need to fix that and fix this payment model.” On compensating physicians “[APG] honor(s) physicians. We do, and we feel they should be honored and well compensated. The talk we hear out of Congress about sequesters and reducing physician compensation and physicians are overpaid, just makes my head spin, frankly. We need the best and the brightest. We need to compensate them accordingly. If we don’t, we won’t have the best physician workforce in the world, which I think we presently do. But we’re going to need to take better care of our physicians.” On restoring the patient-doctor relationship “Patients have relationships with physicians, not with health plans and not even really with hospitals. So the core of our system is the patient-physician relationship. Those physicians do best when they’re operating in an organized group, where they’re supported by others, whether it’s nurses or nurse practitioners or data analysts, etcetera … And my hope and I guess request or prayer would be that we proliferate this capitated, integrated organized group model across the country just as quick as we can and we will be far better off for having done so.” READ: Full transcript with Donald Crane * * * Hundreds of listeners participated in the 2021 Fixing Healthcare survey and the results offer surprising insights into medicine’s cultural issues. Learn more » Dr. Robert Pearl is the author of a new book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Google, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #36: How physician teamwork makes the dream work appeared first on Fixing Healthcare.

In this episode of Coronavirus: The Truth, Jeremy Corr and Dr. Robert Pearl dive deep into the ever-thickening plotline around booster shots. Drug companies like Pfizer are pushing for them. Government agencies like the CDC and FDA are pushing back. Some critics say drug companies are acting out of greed and not in the interest of the public. Others are turning to the data for answers, noting that new variants and uncertainty around antibodies should drive the discussion. Tune in for more on this debate and answers to the following questions: [01:02] Each show begins with the most recent and relevant facts concerning the Covid-19 pandemic and its impact on American life. What’s happening and what does it mean? [05:20] How dangerous is the Delta variant for vaccinated and unvaccinated people? [16:29] Dr. Pearl asks listeners: If you’re still vaccine-hesitant, what’s standing in your way? Contact the hosts here (your privacy is guaranteed) [18:18] Why would the FDA approve the controversial Alzheimer’s drug but not a Covid-19 vaccine booster that’s proven to be effective? [21:50] Why are so many healthcare workers still unvaccinated and what’s being done? [29:43] A listener asks: “I had Covid-19 and recovered fully. Do I need the vaccine?” [32:03] What do scientists know about vaccine side effects, such as neurologic disorders, nerve problems and blood clotting? [34:22] With Covid-19 infections rising again, how are team sports being affected? [37:08] With schools opening next month, what are public health officials recommending? [38:22] What’s good this week? [39:31] What’s the big non-Covid healthcare story? [41:14] What reasons have people given co-host Jeremy Corr for not being vaccinated? [45:40] Is it safe to travel by plane with unvaccinated children? [46:29] What do we know about Covid-19’s impact on U.S. life expectancy? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #43: To booster or not to booster? appeared first on Fixing Healthcare.

“How worried should people be about the Delta variant?” asked one listener of Coronavirus: The Truth. The answer: Very. “Data published online this week shows the Delta variant spreads 225% faster than the original coronavirus,” said cohost Dr. Robert Pearl in this episode, adding that there are approximately 1,000 times more copies of this coronavirus strain in the respiratory tracts of infected people. What’s more, those infected with the Delta variant tend to become infectious far earlier in the clinical course. Combined these factors make this mutant coronavirus more dangerous, both for those who come down with the virus and those who remain unvaccinated. This troubling trend, plus a deeper dive into the science and the following questions—all in this episode of Coronavirus: The Truth with Jeremy Corr and Dr. Pearl. [01:00] Each show begins with the most recent and relevant facts concerning the Covid-19 pandemic and its impact on American life. What’s happening and what does it mean? [05:21] How worried should people be about the Delta variant of Covid-19? [11:06] Can the Delta infect and sicken vaccinated people? [14:43] How do we explain Israel’s experience with this variant (given high vaccination rates)? [17:23] Listener question: “Our family is fully vaccinated, so why did LA County just recommend that we continue to wear masks inside?” [19:07] Listener question: “Thank you for your global coverage of the pandemic. I want to know what is the current thinking on the vaccine that was developed in China and is being distributed to many countries around the world?” [25:28] U.S. vaccinations have fallen from 4 million per day to about half a million. What do we know about the vaccine holdouts? [28:09] What’s good this week? [30:36] What’s the big story in non-Covid news this week? [33:46] Will patients take advantage of price-shopping elective services after Covid-19? [34:38] What about other the healthcare transparency measures recently introduced? [35:39] Why has American longevity declined and will numbers rebound this year? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #42: How dangerous is the Delta variant? appeared first on Fixing Healthcare.

This episode kicks off season 6 of the Fixing Healthcare podcast and, this time around, cohosts Dr. Robert Pearl and Jeremy Corr are flipping the show’s format on its head. Instead of asking each guest for a comprehensive plan to fix the entire healthcare system (a la ZDoggMD, Eric Topol and Don Berwick in season 1), Pearl and Corr are going vertical and deep—searching for solutions from those who represent the system’s various parts. Season 6 will feature people who lead and represent doctors, nurses, insurers, drug companies, hospitals, entrepreneurs and others. It begins with Dr. James Madara, CEO of the American Medical Association, the nation’s largest physician organization. Madara, now in his tenth year at the helm, shapes the AMA’s long-term strategy and chairs the AMA’s innovation arm, Health2047 Inc. In this interview, he weighs in on the nation’s “tsunami” of chronic disease and the role doctors must play in making medicine more equitable. He talks about educating doctors for the 21st century and how AMA lobbies on behalf of its members.   James Madara Interview Highlights   On the AMA then vs. now   “We began as an organization that was focused on clinical ethics and education, and getting educational standards established for medicine, and there were none at that time. We were encouraged by the states to step into that space. As to the last 10 years, the more recent end of our spectrum, we have a rolling five-year strategic framework that has three components: Dealing with the tsunami of chronic disease, hypertension and pre-diabetes in particular … lifelong education, training physicians for the 21st rather than the 20th century … and then third is removing the many obstacles that interfere with patient-physician interactions, so that we can get better outcomes and a healthier nation.” On the future of telemedicine “In three months in 2020, telemedicine advanced in a way that I would think that it would’ve taken 10 years to advance … Within a period of two months, it wasn’t a 3x increase in telemedicine or a 10x increase, it was a 100x or more increase in telemedicine. I think not everything can be done by telemedicine. It’s hard to palpate the abdomen by telemedicine. But a lot can be done, and it could be upwards of 30, 40% of what needs to be done, particularly in follow-ups. Hopefully, the regulatory relaxation will be kept, and also the appropriate reimbursement so one can have a sustainable practice will also be kept.” On physician burnout “Burned out physicians retire earlier, they work fewer hours, there are risks in terms of quality and adverse events. So, it’s something that we really need to pay attention to and mitigate … [Doctors] are in a cognitively complex field. Their intrinsic motivation is spent time with patients. Their reality is time with the computer and paperwork, and they end up burned out. And so, we have a lot of time that we could harvest from the physician workforce we have if we just made the environment around them function better.” On the AMA’s code of medical ethics “The first document produced by the AMA after its founding in 1847, that same year, was the first code of clinical medical ethics. I think that was the first code of clinical medical ethics in the world. It’s a one-pager, and a copy of it is hanging on the wall in my office. The current code of medical ethics runs over 300 pages and just went through a major update year before last because of all of the issues around transplant, treatment, harassment, these kinds of things. So, it is a living document. It is very complex and many institutions have adopted it for their own code as well.” On the future of medical education “In the future, how you learn may be more important than what you know. Of course, you have to have a base of knowledge, but having that base, you can never take a base of knowledge that is broad enough given today’s literature and numbers of diagnoses, the expansion of the literature that we have. So, that’s going to be very important. One of the ways that we’re thinking about that with our own ed-hub is to create a digital platform where education is much more easily accessed.” On how the AMA lobbies for doctors “At a meta level, we lobby for one thing, and that’s our mission statement. And the mission statement is to promote the art and science of medicine in the betterment of public health. And then, under that mission statement, are the policies of the house [of delegates] that make what we lobby for more granular. And those relate to the principles that I outlined … [which] include greater access, stronger safety net, stronger children’s health program, consistency in the healthcare system, removal of administrative complexity so people can spend time with patients, and patients seem to want that extra time with their physicians as well.” READ: Full transcript with James Madara * * * The 2021 Fixing Healthcare survey is open for voting through July 30, 2021. Inspired by season 5 and its guests, this survey asks listeners to weigh in on medicine’s most problematic cultural issues. Hundreds of listeners have already voted. Add your thoughts. Vote now » Dr. Robert Pearl is the author of a new book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Google, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. 8XX13kq4uJwdH7FxDnRB The post FHC #35: The AMA vs. chronic disease, racism & physician burnout appeared first on Fixing Healthcare.

A close look at data from 2.9 million households revealed something bizarre about birthdays. Results of a study published in JAMA Internal Medicine indicated a 31% higher frequency of Covid-19 infection within two weeks of a birthday between January and November of 2020. Those celebrating a child’s birthday were at the highest risk of all. What does the data mean about the dangers of informal gatherings with children present? The answer to this and the following questions in this episode of Coronavirus: The Truth with Jeremy Corr and Dr. Pearl. [01:00] Each show begins with the most recent and relevant facts concerning the COVID-19 pandemic and its impact on American life. What’s happening and what does it mean? [06:22] Why did the NIH retroactively change its Covid-19 infection numbers? [08:56] Why are young people reporting heart problems after vaccination? [11:37] Do Covid-19 vaccines lower sperm count? [13:45] Listener question: Are there any new medications to treat Covid-19?  [15:56] Listener question: What is Japan doing about Covid-19 with the Olympics coming up? [17:14] Are kids birthday parties becoming super-spreader events? [20:39] What’s good this week? [23:38] You tell us: Should this show cover non-Covid-19 issues? [26:47] Should powerful nations share or store their vaccine surpluses? [29:28] Why are medical licenses handed out by states and not the federal government? [30:49] Is the dip in Covid-19 testing a threat to our nation’s health? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #41: Are kids birthday parties the biggest super-spreader events? appeared first on Fixing Healthcare.

As the pandemic winds down, scientists and pollsters are looking closer at public health decisions in hindsight. A new Axios-Ipsos poll looked into whether masking and social distancing actually saved lives. Relying on self-reported data, the poll results showed that respondents who never wore a mask were twice as likely to get COVID-19 as those who wore masks all the time. Meanwhile, only 10% of people who always kept a six-foot distance from others tested positive whereas 26% of people never followed social-distancing guidelines tested positive. Given that people who social distanced and wore masks all the time got tested more regularly than those who didn’t, we can extrapolate that the infection gap was even greater than indicated in this poll. The conclusion: “Turns out that wearing a mask and social distancing really weren’t a waste of time.” Much more on this and the following questions in this episode of Coronavirus: The Truth with Jeremy Corr and Dr. Pearl. [01:00] Each show begins with the most recent and relevant facts concerning the COVID-19 pandemic and its impact on American life. What’s happening and what does it mean? [06:53] When will the FDA give Covid-19 vaccines full approval? [11:08] Listener question: “Why has the U.S. been reluctant to help other countries with their Covid-19 problems?” [14:47] Listener question: “How are other countries doing with vaccinations? When will the rest of the world open up like [the U.S. is] doing?” [17:22] How will Covid-19 impact the U.S. economy long-term? [23:51] How does the Delta variant in India impact global travel? [28:02] Did social distancing make a difference, according to research? [32:04] What’s good this week? [37:00] Listener suggestion: “Maybe you could expand this program to other new information from healthcare. I love your style of telling it as it is, and so maybe you can give updates beyond the coronavirus.” [49:20] Do other nations struggle with the outsized influence of lobbying and campaign contributions on healthcare policy? [5:3] What’s Jeremy’s take on the controversial new Alzheimer’s drug? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #40: Was social distancing a waste of time? appeared first on Fixing Healthcare.

The first four seasons of the Fixing Healthcare podcast focused on how to fix the U.S. healthcare system—its perverse payment model, clunky computer systems and regulatory dysfunctions. However, contrary to what most people believe, fixing the system won’t be enough to solve healthcare’s biggest problems. We must also address the invisible and highly influential culture of medicine, which is rooted in the norms and values doctors learn in medical school and carry throughout their careers. Culture was the focus of Season Five of the Fixing Healthcare podcast, which featured eight insightful episodes. In this final episode of the season, co-hosts Robert Pearl and Jeremy Corr recap the lessons learned from some of nation’s most respected leaders in public health, technology, medical culture, and patient advocacy. Note: Take the new Fixing Healthcare Survey to offer your opinions on medicine’s biggest cultural challenges.    LOOKING BACK AT SEASON FIVE   Episode 1: Zubin Damania Listen to the episode | Read the transcript Fixing Healthcare welcomed its first ever returning guest, Zubin Damania, a physician and entertainer known to his legions of followers as ZDoggMD. Damania hosts the internet’s No. 1 medical news and entertainment show, and is a leading voice for patient-centered healthcare, focusing on prevention and team-based medicine. Key quote: “Part of the culture of medicine is that our payment models have changed how we actually view what is right and wrong. And that’s been a real problem in moving forward with any kind of real change in medicine. So, medicine by its nature, by its culture, resists change.” Episode 2: Amanda Calhoun Listen to the episode | Read the transcript Dr. Amanda Calhoun is an Adult/Child Psychiatry Resident at Yale and an emerging voice in the national discussion about race relations in medicine. She gained national attention at Yale’s White Coats for Black Lives event. She believes every doctor should be an anti-racism advocate. Key quote: “You’re either actively working against racism and you’re actively supporting policies and behaviors that are working to rectify a racist system, or you are upholding a racist system … because if you’re just silent, that’s not anti-racist, that’s racist.” Episode 3: Eric Topol Listen to the episode | Read the transcript Dr. Eric Topol is a cardiologist, geneticist, researcher and pioneer in the field of digital care. He has published three bestselling books on the future of medicine and serves as editor-in-chief of the popular healthcare news site Medscape. As founder and director of Scripps Research Translational Institute, he is on the cutting edge of genomics and individualized medicine. Key quote: “The problem we have in AI medical research, it’s always ‘man versus machine.’ With few exceptions, what it should be is man plus machine. The sum of the parts is greater than either of the components.” Episode 4: Leana Wen Listen to the episode | Read the transcript Dr. Leana Wen is an emergency physician and a public health professor at George Washington University. She’s also a contributing columnist for Washington Post and an on-air medical analyst for CNN. Previously, she served as Baltimore’s health commissioner. Wen spoke powerfully about the difficulties patients face in their communities and how physician culture has been reluctant to take on the social determinants of health. Key quote: “Isn’t it our responsibility as physicians and as healthcare workers to tackle [societal] issues when that’s ultimately the root of illness? Otherwise, we’re only addressing the symptoms and not the cause.” Episode 5: Lisa Sanders Listen to the episode | Read the transcript Dr. Lisa Sanders is an associate professor of internal medicine at Yale and a contributing writer for New York Times Magazine. Her career served as the inspiration for the television series House for which she was a medical consultant. In 2019, Dr. Sanders created the Netflix miniseries Diagnosis. She talked on Fixing Healthcare about the struggles of primary care in the context of medical culture. Key quote: “We pay an invasive cardiologist five to 10 times more than we pay internists, even though I think it can clearly be shown that general internists save more lives than those interventional cardiologists.” Episode 6: Jen Gunter Listen to the episode | Read the transcript Dr. Jen Gunter is an obstetrician gynecologist specializing in chronic pain. She’s also a New York Times columnist, and the author of “The Preemie Primer: A Complete Guide for Parents of Premature Babies.” Her new book “The Menopause Manifesto” is now available in paperback. Gunter’s comments focused on women’s health and the issue of sexism in medicine. Key quote: “I was in medicine 20 years before there was a woman who was the chair of my department, so I think that says something.” Episode 7: Alison Hadden Listen to the episode | Read the transcript Alison Hadden is a lifelong athlete, an adventurer and was, by age 38, a marketing executive at three different billion-dollar tech companies. But in 2018, Alison says “life burst through the door.” She was diagnosed with advanced breast cancer. Three years later, she is grappling with a terminal diagnosis. In this interview, Hadden shared her perspective as a patient. Key quote: “I wasn’t eager to talk about death or dying because in my mind, I was going to beat this thing. And now, I feel that if doctors only knew that talking about [death] is actually healing.” Episode 8: Marty Makary Listen to the episode | Read the transcript The final guest on Season Five was Dr. Marty Makary. He practices surgical oncology at Johns Hopkins, wrote the book “The Price We Pay” and has published over 250 scientific articles, including many on the redesign of healthcare. He has spent most of his career trying to improve the quality and safety of healthcare. Key quote: “Let’s talk about patients falling through the cracks of our complicated system. Let’s talk about [doctors] doing unnecessary things or prescribing [medications] people don’t need. We just went from 2.4 billion prescriptions 10 years ago to 5 billion last year. Did disease really double in 10 years?”   Read: The full transcript from the Season Five recap Take the Season Five survey For Dr. Robert Pearl, the culture of medicine is a topic of vital importance. For years, he has been researching and reporting on physician culture—efforts that led to the publication of his new book, “Uncaring: How Physician Culture Is Killing Doctors & Patients.” * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.   The post Season 5 recap: Fixing the culture of medicine appeared first on Fixing Healthcare.

Several recent news stories have revived the debate over whether the novel coronavirus was first transmitted from a bat to a human via a wet market in Wuhan, China, or whether its origins can be traced to the Wuhan Institute of Virology as a result of a laboratory error. A U.S. intelligence report found that three researchers at the institute were sick enough in November 2019 to require hospital care—meaning they had symptoms consist with Covid-19 a full month before the first case was officially reported in China. If that’s the case, how might the virus have made its way into the institute? And would this explanation legitimize past internet conspiracy theories? Much more on this and the following questions in this episode of Coronavirus: The Truth with Jeremy Corr and Dr. Pearl. [01:01] Each show begins with the most recent and relevant facts concerning the COVID-19 pandemic and its impact on American life. What’s happening and what does it mean? [03:07] How effective are current vaccines against the new global variants? [05:08] Wet market or lab: where did the novel coronavirus originate? [11:59] Why is there still so much distrust in the U.S. pertaining to Covid-19? [13:38] Will vaccinated Americans need booster shots? [18:47] Can schools and employers legally mandate vaccination? [23:36] What’s good this week? [26:46] What are “breakthrough infections” and should we be concerned? [29:24] Was cancelling the Olympic Games a smart move by Japanese leaders? [31:01] Would a financial incentive combat vaccine hesitancy? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #39: What’s the truth about Covid-19’s origins? appeared first on Fixing Healthcare.

Dr. Anthony Fauci recently called for schools to reopen “full blast,” with in-person classes five days a week. Meanwhile, CDC officials said that schools should resume in-person learning as soon as possible *if* social distancing and masks are properly enforced. When it comes to this pandemic, it’s always risky trying to predict what public health guidance will look like four months into the future. But a “more normal school experience” seems likely, according to Fixing Healthcare co-host Dr. Robert Pearl. More on that and the following questions in this episode of Coronavirus: The Truth with Jeremy Corr and Dr. Pearl. [00:58] Each show begins with the most recent and relevant facts concerning the COVID-19 pandemic and its impact on American life. What’s happening and what does it mean? [03:30] What’s the latest Covid-19 news for parents? [05:11] Are Americans afraid of returning to life as (pre-pandemic) normal? [08:09] What are the options for school in the fall? [10:57] What exactly is herd immunity? [18:55] What’s happening with pandemic in India? [23:51] Can Ibuprofen decrease immune-system response to Covid-19? [25:26] What’s good this week? [27:44] How does heart disease correlate with Covid-19 risks? [29:51] Do Americans really observe or understand CDC guidelines? [32:58] How could CDC guidance and public health messaging be clearer and more consistent?    [39:33] Should parents vaccinate young kids? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #38: Masks in classrooms for students this fall? appeared first on Fixing Healthcare.

Marty Makary, a nationally renowned surgeon and educator at Johns Hopkins, goes about life as if having ingested a truth serum for which there is no antidote. Hear him speak or read his writing, and you’ll find no punches pulled. On Fox News, where he’s a regular commentator, Makary was openly critical of the CDC’s double-masking recommendation, calling it “mostly a show.” And in a WSJ article published in February 2021, he claimed the U.S. would achieve herd immunity by April, arguing that experts had radically under-calculated the nation’s “natural immunity.” In his latest book, The Price We Pay, Makary boldly confessed to having overprescribed opioid medications to his patients. Some view Makary’s self-imposed honesty policy as a public service, both righteous and good. Others call him reckless and attention-seeking. He is aware that his unique brand of candor isn’t for everyone: “It’s a lonely place, when you try to talk truth to what you truly believe based on the best information.” Dr. Robert Pearl and Jeremy Corr called upon Makary to share his unfiltered views about the culture of American medicine. The doctor did not disappoint. Marty Makary’s Interview Highlights On useless memorization in medical education  “I would get rid of all the useless sh*t we teach our medical students and pre-med students and residents and fellows—all the 16 years of education that I went through, learning stuff that has nothing to do with patient care that you don’t need to memorize. And it came at the exclusion of so many other things that are important to know, like how to break bad news … We do that all the time to our young. It’s disgusting what we’re doing, making every medical student memorize the Krebs Cycle at six different points in their education, for what?” On humility “I have enormous respect for … Dr. Fauci and many others, but I think it would help their credibility if they showed more humility and apologized for some of the big things they got wrong. I tried to do this myself in my recent book, The Price We Pay, with all the opioids I prescribed. All my colleagues were doing it as well.  It didn’t make it right. I still feel bad about it. I mean, probably some people had fatal addiction from opioids that I gave them, they should not have received. Now, I could justify it, but you know what? It’s therapeutic to me at least to say, ‘I had it wrong.’ And it’s probably good for people to see that humility.” On the oligarchy of medical journals “The journals have been largely controlled by a very small group of like-minded people and they tend to use cronyism to hire their editorial boards … The value of diversity is to bring multiple points of view, sometimes points of view that challenge preexisting ideas.” On letting doctors be doctors “Can I say something a little radical here? How about we get the monkeys off our back as doctors? All this peer-to-peer, pre-authorization, you can’t do this on this, the all-or-nothing clinical pathways that disregard the fact that every patient is unique. They’re individuals with their own wishes and their own goals and their own unique circumstances, especially when they’re older. How about we let doctors be doctors, accept practice variation but do it within certain boundaries where we can look at the practice on an annual basis or on a six month basis and say that this practice pattern appears to be reasonable or this practice pattern appears to be a pattern of concern, a yellow flag or this practice pattern exceeds a threshold that a broad consensus of experts believe to be indefensible.” On suing patients for unpaid medical bills “I’ve yet to find more than a handful of people that think it’s reasonable to sue the socks off an everyday Walmart worker or food-service worker who had insurance and couldn’t afford to pay their bill. The hospitals do this to garnish their paychecks, and it’s a disgrace. It harms the precious public trust. That incredible heritage of taking care of anyone in need … been eroded by this horrible corporate practice of price gouging and predatory billing. And every healthcare professional in America should be offended by this disgusting practice.” On futile care in the ICU “If you look at the appropriateness of care, we’ve got two problems: over-treatment and under-treatment. But by far, over-treatment is dominating the problem right now. In the ICU, we have the problem of futile care, care that’s entirely senseless and disrespectful and provides no dignity. And it’s painful for anyone to watch. Any reasonable person would know no one would want to be treated that way. We see that, and sometimes we’re helpless with that because ultimately it’s the family’s decision.” On living in a nation of extremes “Why does everything in America have to be one extreme or the other? Why do you have to be all pro-universal, double masking after vaccination or no masking whatsoever; masks are BS. Why is it that we have such a hard time, being in this lonely place in the middle where you’re actually just intellectually following what you believe to be the best science and what’s reasonable?” READ: Full transcript with Marty Makary  Fixing Healthcare is in its fifth season, which focuses on the culture of medicine. For Dr. Robert Pearl, this topic is of vital importance. For years, he has been researching and reporting on physician culture—efforts that culminate May 18, 2021 with the publication of his book “Uncaring: How Physician Culture Is Killing Doctors & Patients.” * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #33: Marty Makary on eliminating waste in medical education appeared first on Fixing Healthcare.