Doug Larson สาธารณะ
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The Paradocs is a fun and lively discussion with a couple of docs on the practice of medicine. Occasionally serious, other times lighthearted, and accidentally informative. A show for physicians to learn more about what is going on and a great place for them to direct their friends and family to better understand the challenges they face.
 
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When I began this podcast in the Spring of 2018, there were a lot of things I felt needed to be said about the US Health Care system. Foremost among them was the problems with the third party payment system (using both commercial and government insurance to make most of the payments for services). Also, the system was becoming more and more consoli…
 
In April, 2020, serendipitously, my high school classmate reached out to me after one of my podcast episodes where I was talking about mask usage. I was incorrect in one of my assumptions with the use of masks and the spread of particles which he pointed out. I then read his blog post about COVID and how it pertained to his home state of Montana an…
 
A big struggle for doctors is when they watch what goes on in the state and national legislatures and realize that there is very little knowledge of what they do, how they practice, and what they did to get where they are. There are no better examples of this failure to understand the nature of what physicians do than the debate over the Affordable…
 
Bitcoin was invented in 2008 by a pseudonymous programmer (or group of programmers) called Satoshi Nakamoto. It is a currency issued in a decentralized fashion using a complex mathematical equation on a block chain. Bitcoin then launched in 2009 and was adopted by very few people but it held out a promise to usher in a new way we can look at money …
 
Bitcoin was invented in 2008 by a pseudonymous programmer (or group of programmers) called Satoshi Nakamoto. It is a currency issued in a decentralized fashion using a complex mathematical equation on a block chain. Bitcoin then launched in 2009 and was adopted by very few people but it held out a promise to usher in a new way we can look at money …
 
Today we're going to wade into the uncomfortable land of mandatory vaccinations for COVID. You're already seeing these spring up in hospital systems, federal work forces, and universities.There's a lot to understand with these and I only offer my own perspective while hopefully acknowledging accurately my own biases to help you better understand th…
 
Ask any primary care physician and they will tell you the toughest thing about helping their patients change lifestyle is that they don't have enough time or contact with the patient. Especially when it comes to weight loss control, primary care docs are stretched so thin on time that they struggle to have the impact they'd like on their patient's …
 
Being an expert has a lot to do with muffins. Or rather, when I was eating a fresh muffin the other day for breakfast it certainly got me thinking about experts. You see, I eat my muffins differently than the rest of my family. They break off the top of the muffin and butter the top and then the bottom. I felt like it would be better to cut my muff…
 
Essentially, there are two main ways to classify physicians - independent or employed. Today's health care in the US is becoming increasingly consolidated as health systems and corporate entities (venture capital groups, etc.) are purchasing physician practices. With the advent of the pandemic of COVID-19 and the partial and complete shutdowns in m…
 
There has been no shortage of people or schemes to fix the US health care industry. US medicine consistently fails to deliver quality care at affordable prices and manages to irritate both doctors and patients alike. Politicians and think tanks come up with grandiose plans every day to treat what plagues the system. Likewise, big tech companies lik…
 
There has been no shortage of casualties in the last year and half with the COVID pandemic. Schools have been closed, businesses shuttered, and families torn apart with different levels of concern for the virus. But one surprising victim has been science itself. The practice of scientific inquiry, discussion, and debate disappeared. Instead of scie…
 
If you want to get a doctor's blood pressure up or make her sweat, just tell her that you have a great electronic health record (EHR) to use. EHRs are the bane of a physician's life because they don't work well with your work flow, create extra work and inefficiencies, and cost a ton of money. That's why I spoke to Dr. Richard Sztramko of Hamilton,…
 
"Beware the variants!" scream the headlines all over the news. Now that the vaccine is available for SARS-CoV-2, we are pounded with an almost endless daily fear-filled stories about how the variants of COVID are coming and will continue to put people in the hospitals, ICUs, and funeral homes. But are the variants really that dangerous? Are there r…
 
This year, the Colorado legislature introduced a bill to radically change the way health care would be delivered in the state. HB 21-2132 was introduced this year with the hope of creating a public option health insurance for everyone in Colorado. In essence, the insurance product created by the state would set minimum standards for coverage and be…
 
Dr. Anthony Fauci has been the head of the United States National Institute of Allergy and Infectious Disease since 1984 and the presidential chief medical advisor for two presidents. His rise to prominence began in February and March of 2020 and continues to this day as he was thrust forward as the main spokesman for the US federal government in i…
 
Perfection. We all strive for it. Some more maniacally than others, but we all look to be better versions of who we are. In medicine, we tend to be high achievers so, of course, we want to 'conquer' parenthood and be the best we can. But being perfect isn't any more possible in parenting any more than it is in medicine. Human relationships are mess…
 
Now that we are entering the last transition phase of COVID-19 in the United States where we are moving from an epidemic to endemic for the SARS-CoV-2 coronavirus, we need to focus on how safest to get there. Clearly, the introduction of a highly effective vaccine is abbreviating the time it would normally take to get our population immunity to thi…
 
We're talking about COVID and our American Independence Day from SARS-CoV-2 on June 1, 2021. There is some additional background information that we will leave off but I would suggest that you listen to episodes 101 and 114 for a deeper dive into the science. The first thing I need you to do is look down and if you're wearing a red shirt, take it o…
 
Today's episode strikes right to the heart of the reason I started this podcast - the injustice of maintenance of certification. We've talked about the corruption of the American Board of Internal Medicine, the shakedown by the neurology and psychiatry board, and general state of MOC in America. If you're a doctor, you know all about the unfairness…
 
Health care, according to today's guest Dr. Eric Bricker, is filled with euphemisms. One you hear a lot is value based care. The claim is that we need to restructure insurance plans to reward health systems that provide care focused on outcomes instead of activity. Conceptually, it makes a lot of sense that you would reward the people providing sup…
 
Today, we depart from our pandemic of SARS-CoV-2 to discuss what was easily the number one killer of colonial Americans in the Revolutionary War - infectious disease. Ten times as many died from small pox than died as a casualty of fighting in all the battles of the war. It is estimated that battle casualties totaled 5-6,000 while disease (infectio…
 
Although the idea of vaccine passports have been floated about for at least half a year, the concept has really begun to pick up steam over the last month. Public health advocates have been pushing for their adoption as a means for 'returning to normal' for Americans. Also, the concept is starting to gain some popularity not only in people who will…
 
One gigantic headache that both patients and health care providers face is getting reimbursed for out of network claims. If a particular doctor or health care professional (physical therapist, psychologist, etc.) does not have a contract with an insurance company, then the care they provide is considered out of network. This doesn't mean that the v…
 
It is now a year into the SARS-CoV-2 pandemic where we began locking down the United States. Churches, restaurants, health care facilities, general retail, schools, and entertainment were sidelined for much of 2020 and even 2021. We have struggled to understand the new coronavirus strain and predicting how the pandemic will progress. Now that Ameri…
 
Trust is essential in medicine. Not only between a doctor and patient but between a community and the health care system. A unique difference between the United States and Africa is the relative recency of colonial powers controlling the country. Our colonial past is distant dating back to the 1700s. For Africa, it's as recent as the late 20th cent…
 
Today is a departure from a direct discussion of the medicine or the US medical system. We delve into food. Food, is medicine in a way since it has physiological effects on how our bodies function. There's also a lot of rules and regulations around food that prevent people from being as healthy as they could. Finally, what's the deal with eggplants…
 
One thing few outside of medicine realize are the unique challenges doctors face in their personal relationships. Marriage, especially to someone without a background in medicine, can be especially difficult due to the unique responsibilities and expectations placed on doctors for their jobs. In some ways, life isn't all that different for physicia…
 
Entrepreneurs are funny creatures. Some seem to be born to innovate and create businesses. Others, like today's guest, create new businesses out of necessity because they can't find a system that works for them. Dr. Rick Rosenfield is an OB/GYN who enjoys gynecology surgery and having the ability to work the way he wants focused on patient outcomes…
 
One thing you can be certain of with COVID-19 is that there is no shortage of controversy. Whether it is lockdowns, treatment, vaccines, or testing there have been volumes written about what should or should not happen. So today, we're going to learn about the most common test in the middle of the controversy - the PCR. What is PCR? "PCR (polymeras…
 
Dr. Diana Bitner describes herself as a survivor. As an OB/GYN, she had what one would describe as a typical practice. She was employed in a large multi-specialty physician group that later got acquired by a large health system. But within this traditional insurance based practice, Dr. Bitner looked to deliver care to her OB/GYN patients in a diffe…
 
In his excellent book, From Killer to Common Cold: Herd Protection and the Transitional Phase of COVID-19, Dr. David Graham lays out the upcoming evolution from pandemic to endemic for SARS-CoV-2 virus. Although published months ago, the book has proven to be right on with how the virus is progressing and we now find ourselves in the transitional p…
 
Pain. We all experience it. It is as much a part of life as breathing itself. But what is pain? Is it physical? Is it mental? Is it emotional? Is it mechanical? Also, how does pain become chronic? One of the few things experts on pain can agree on is that our ability to treat pain - especially chronic - is not very good. What is Pain? My guest toda…
 
As COVID-19 continues to rage across the globe, everyone has been trying to figure out how to protect themselves from getting infected. People wear masks, avoid gatherings, travel, and work from home to prevent the disease. We also know that there is a lot of discussion about COVID and what are the correct measures and what we should do which we ha…
 
The most obvious statement we can make about the US health care system is that it's a mess. It's complicated, expensive, and rarely delivers what patients expect. A large part of the problem is because we use employer based insurance products where there is little incentive to control costs or provide the kind of care the patient wants. It's all ab…
 
Direct primary care (DPC) is a style of practicing medicine we have discussed many times on the show. The way DPC works is that instead of using insurance to cover the cost of doctor visits with copays, patients contract directly with the doctor – usually on a monthly basis. This allows them to establish a nice long term relationship where they int…
 
Well, it finally happened, the COVID-19 vaccines have started to arrive and get administered to health care workers in the United States. The first out of the gate is the Pfizer vaccine which will almost certainly be followed soon by the Moderna vaccine. Both vaccines use a revolutionary new technology for inducing an immune response, messenger RNA…
 
What does it mean to feel grief? Is it sadness? Anger? Resignation? Unfortunately, life will almost certainly present you with grief at some point. Where there is love there will also be grief when the love is lost. It might come unexpectedly or slowly over years. But always, grief is a human emotional state that we will all have to struggle with b…
 
Cancer. It is a word that evokes feelings of fear, pain, hopelessness, and loss. It also brings to mind images of chemotherapy, nausea, weight loss, hair loss, and loved ones suffering in pain. Cancer is all of these things and so much more. But what is more interesting is why do people get cancer? Why do all cancers end up looking the same despite…
 
It's been a while since we have discussed medical liability on the show but malpractice is a large and expensive part of what doctors have to face in today's medical landscape. Physicians are often under attack not just from frivolous lawsuits but also attacks from disgruntled patients online or office disputes. It is important for doctors to under…
 
Direct primary care (DPC) is a movement that is growing quickly in the United States. Patients and physicians are looking to bypass the traditional box store medical practice and deal directly with one another. The DPC relationship is personal, small, and simple without middle men (or hospital systems). Instead of relying on copays and insurance fo…
 
The Story In late Summer of 2019 my wife and I had to make a difficult choice - to buy traditional health insurance or go without. We are both physicians so it is sort of expected that we have traditional health insurance for us and our family. In fact, it is quite funny to see the shock on someone's face when I tell them that we don't have health …
 
Since 2010, the number of nurse practitioners in the United States has grown from 109,000 to 290,000. This explosion in growth is quickly transforming the health care landscape in the United States. But is it improving overall health? Is it providing more care for patients? Is it allowing for improved access? Is the quality improved or at least the…
 
The last few years have seen a resurgence in the use of fasting. Fasting is an ancient practice tied to religions and culture. In many ways, how and when we eat developed based on the availability of food. And that food was usually scarce so fasting was common until only recently in human history. My guest is Dr. Jason Fung, a nephrologist and expe…
 
Dr. David Graham returns again this week to discuss his newly published book, From Killer to Common Cold. The book touches upon the topics we have discussed on this show for a few months now. The central theme of the book is how SARS-CoV-2 will transition from the pandemic killer COVID-19 to a common cold coronavirus. Dr. Graham expertly lays out h…
 
Episode 100 is a momentous achievement for a podcast about medicine where I had only about 3 show ideas in mind when I launched. All I was certain of is that the US Health Care System was seriously flawed and that I had no idea how to fix it. However, now that we are 100 episodes in, it is clear that medicine in the US is not doomed. In fact, it ha…
 
Okay, so today's title to the show is a little provocative. But it's meant to convey the most important takeaway from the discussion. Although there has been a lot of talk over the last few weeks about the occurrence of lingering myocarditis in patients who have recovered from COVID-19 and in athletes who had an asymptomatic infection, it's importa…
 
Today's discussion begins way back in the early 1990s when Congress was trying to figure out a way to reduce its health care expenses. Sound familiar? Some things never change. And this story is as old as Congress itself as legislators try to solve one problem and end up creating a bigger mess that actually ends up creating far more harm than was o…
 
We're breaking from our discussion of COVID-19 and discussing life after pandemic with finding means of passive income. Specifically, how one can earn passive income through real estate. Passive income can be loosely defined as making money without actively trading your time and talent. My guest is Dr. Jeff Anzalone, a periodontist in Monroe, LA wh…
 
Following our discussion last week where we discussed the probable lower herd immunity rate threshold for COVID-19, today we are going to discuss the transition from a global pandemic to endemic state for the virus. This makes one fundamental assumption - that COVID-19 isn't going to go away, ie, it won't get eradicated. The reasons to suspect this…
 
One of the most commonly used expressions regarding the current COVID pandemic is herd immunity. Policy makers, epidemiologists, and lay people are obsessed with reaching the mythical herd immunity as soon as possible so that we can put this pandemic to bed. It is hoped that the development of a vaccine will get us the herd immunity of 60-80% far q…
 
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