Weight control planning – Day 1/7 #weightcontrol
Friends and colleagues still ask me how I lost weight and maintained my new weight. I have some short answers, but after careful consideration, I realized that my planning is somewhat complex. Therefore, I decided to illustrate a week’s worth of my planning process and what I really do.
The planning for today and this week started a couple of days ago. Each day and each week I plan two things – exercise and eating. Let’s consider exercise first.
Sundays are usually a golf day. Golf provides modest exercise, and some golf days do not have additional strenuous exercise. I originally planned to a...
Source: DB's Medical Rants - June 5, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Are you ready to control your weight?
As I have reflected on my own weight control journey, several concepts have emerged. Have you ever wondered why some people have great success in weight loss and maintenance, and some people never make progress?
External forces rarely spark weight loss. Nagging does not work. Almost every patient whom I have counseled about their weight already knew that weight control would help them.
Over the years I have read and heard about the stages of behavior change I understand the theoretical basis of behavior change, but how does that really apply?
As I recall my decision to start a weight loss journey, I suspect that ...
Source: DB's Medical Rants - June 2, 2016 Category: Internal Medicine Authors: rcentor Tags: Fitness & weight Medical Rants Source Type: blogs
The argument for time based billing
In 2003 (yes this blog is that old) I wrote this piece – Billing like lawyers
Today Bob Wachter tweeted this article – Time-Based Billing: What Primary Care in the United States Can Learn From Switzerland
Time-based billing may offer a simplified payment method that maintains physician autonomy and sense of professionalism. For smaller primary care practices that may not organize into accountable care organizations, time-based claims may offer an alternative means to align payment with meaningful work while simultaneously simplifying documentation and billing. Alternatively, within accountable-care organizati...
Source: DB's Medical Rants - May 31, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Comparing personal training with #Orangetheory
Readers know that I have become a bit obsessed with my Orange Theory workouts. I have written about them and retweeted often. So why do I find this such a great concept? Prior to starting Orange Theory workouts, I have worked with a number of personal trainers. The personal trainers all helped me, but I have made much more progress with Orange Theory.
Just to remind readers, an Orange Theory workout generally has 2 parts – cardio and resistance training. Most workouts fit into one of 4 groups – Endurance, Strength, Power or ESP (a bit of each of the 3). The cardio part varies in several ways. Remember th...
Source: DB's Medical Rants - May 30, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
In defense of medical societies – especially ACP
A recent comment attacked medical societies as being impotent on several issues. The commenter clearly expects these societies to work quick visible changes. Here is my take:
My recent leadership role at ACP makes this answer biased, but I believe your expectations of medical societies are harsh. These societies are not impotent, but they are also not potent enough to drive policies. I can speak best for ACP. Let’s take your concerns:
Defining quality
Please read the ACP’s performance measurement evaluations – https://www.acponline.org/clinical-information/performance-measures
These evaluation...
Source: DB's Medical Rants - May 25, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Incentives without forethought
Long time readers know that I worry greatly about the incentives in our health care system. “Every system is perfectly designed to get the results it gets,” But here is the problem. Few managers and leaders think through the implications of their incentives – explicit or implicit.
Farnam Street Blog has a brilliant post on incentives – Incentives Gone Wrong: Cobras, Severed Hands, and Shea Butter
As you read this post, you will quickly recognize that the incentives get created without including any forethought about what could go wrong. Gary Klein’s pre-mortem exam process can potentially help u...
Source: DB's Medical Rants - May 22, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
The sad corruption of the performance measurement movement
This rant reflects conversations with experts, but it does not qualify as good reporting. I will take some liberties, and have not done careful checking of information. Nonetheless I believe everything that I am typing.
Too many decision makers in the performance measurement field ignore the evidence. While the initial impetus for performance measurement came from the belief that with measurement we could improve adherence to evidence based treatments or testing. If one truly believes in evidence based medicine, then the evidence should be indisputable and we should even have evidence that measuring performance act...
Source: DB's Medical Rants - May 19, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tip for those getting ready to start internship – focus on poopology
You read that right. Hospitalized patients often develop constipation. Almost every day on rounds, patients complain about their lack of movement. The best interns have a systematic approach towards helping these patients.
The word poop has increased in usage since this century started. I cannot recall when it became popular, but I do know that patients do not find poop jokes vulgar or inappropriate.
I often use the term poopology (probably not a real word, but perhaps it should be), and patients instantly understand and smile.
So if you are an impending intern, learn about laxatives, and develop a systematic appr...
Source: DB's Medical Rants - May 17, 2016 Category: Internal Medicine Authors: rcentor Tags: Attending Rounds Source Type: blogs
Maintaining weight loss
Long time readers know that I lost approximately 35 pounds over the course of 1 year (starting Memorial Day 2013). Losing weight required persistence, smarter eating and increased exercise. Unlike the Biggest Losers , I have maintained my weight loss, now for 2 years. The data on why are not clear, but these links raise some thoughts that I will use to explain the success.
How Weight Loss Affects Metabolism
Program participation results in long-term weight loss
These articles and others that I have read suggest a couple of reasons for my continued success:
I weigh regularly, and pay attention to my weight.
I lost w...
Source: DB's Medical Rants - May 14, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for clinician-educators – give them their money’s worth
Medical students pay exorbitant amounts for their schooling in the US. They deserve the highest quality teaching. They deserve well trained clinical teachers.
Many years ago I began asking the students if they received their money’s worth on rounds or in conferences. This question does two things. First, the students know that I am trying to provide a return on their investment. Perhaps more important, the question reminds me that I owe them my best teaching. They do not owe me anything, they have already paid dearly.
How do we convince medical educators that we owe all learners our best every day? If y...
Source: DB's Medical Rants - May 9, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Fix our notes – our patients deserve meaningful notes
Stephen Martin and Chris Sinsky have a brilliant piece in the Lancet – The map is not the territory: medical records and 21st century practice. Unfortunately, you will have to download the piece or get a copy from the library.
This concept echoes a common theme from this blog. Here is a collection of posts that I have written over the past many years on the topic:
The movement to improve patient notes
We should require meaningful notes – attention CMS
Progress notes – poor match between billing and medical information
J’accuse – our notes are meaningless
The degradation of physician’s notes
This theme re...
Source: DB's Medical Rants - May 3, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for clinician educators – practice your talks
This week I will give a talk on acid base and electrolyte disorders. I teach these subjects regularly, yet designing this talk has challenged my skills. My problem is the curse of knowledge.
The problem is that once we know something—say, the melody of a song—we find it hard to imagine not knowing it. Our knowledge has “cursed” us. We have difficulty sharing it with others, because we can’t readily re-create their state of mind.
At the board in morning report I have learned to “show my work”. I give the learners plenty of opportunities to ask questions if I become obtuse. But in designing a ta...
Source: DB's Medical Rants - May 2, 2016 Category: Internal Medicine Authors: rcentor Tags: Attending Rounds Source Type: blogs
Medical schools owe their students more
Readers know that I believe that servant leadership should inform leadership and management decisions. We who have the privilege of having leadership positions at medical schools therefore have as a primary responsibility to our students.
Being a medical student, while a reward and a privilege, is nonetheless a stressful experience. The first two years at most US MD schools have the students grinding through the basic sciences related to medicine. The volume of material that our students try to absorb is massive. Then they must take a high stakes test (Step 1) and pass it so that they can progress to the clinical y...
Source: DB's Medical Rants - April 21, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for clinician educators and aspiring clinicians
Charles Bukowski once said, “Wherever the crowd goes, run in the other direction. They’re always wrong.”
How does one become a master? What process do we use to have the highest probability of success? Here are some examples.
Picasso was an extraordinary craftsman, even when measured against the old masters. That he chose to struggle to overcome his visual heritage in order to find a language more responsive to the modern world is an important triumph that has had a vast effect upon our world. (from Picasso’s Early Work)
Great musicians practice their scales and learn their chords. They play dif...
Source: DB's Medical Rants - April 17, 2016 Category: Internal Medicine Authors: rcentor Tags: Attending Rounds Source Type: blogs
Evidence and clinical judgment should complement each other
The term evidence based medicine provokes strong feelings from its proponents and its skeptics. I spent a full day recently in discussions about EBM. As the day proceeded I understood that evidence is wonderful when it fits the clinical question, but that too often the clinical question does not, and probably will not have adequate evidence.
We have great evidence for some clinical questions. We all know that ACE inhibitors decrease mortality in patients having systolic dysfunction. We know that antibiotics help a variety of documented infections. We know which biologically active DMARDs improve the course of rhe...
Source: DB's Medical Rants - April 13, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
