Did you know that saying “The Twitter” immediately ages you by 9 years? You know that I was only kidding, right…
Here are the highlights of ambulatory medicine from the last few weeks. Follow @ihaterashes to get these in real time.
While you are following new people on twitter, check out @medicalaxioms. This guy is smart, funny,and usually spot on. Some highlights:
A few things came across my screen about overdiagnosis of breast cancer from BMJ and Annals of IM Just a reminder that raising awareness isn’t enough. A ribbon doesn’t provide any information- that’s our job.
I’m starting to tweet Grand Rounds when I can. #uabmgr. Here’s what I learned in the great talk on The Gut Microbiome given by Martin Rodriguez and Casey Morrow
And finally, I feel the need to share a few articles making the rounds some of the frustration in clinical medicine these days: burnout in Washington Post, competing agendas in NYT (here on Danielle Ofri’s site) and irritation with EMRs in The Atlantic. I have mixed feelings about these things, I love my job and want all of you to become primary care physicians. But burnout is real, as are the administrative challenges of practice. We need to be able to talk about it, and I am relying on all of you to help make it better!
I Hate Rashes is practicing restraint during this week of excess. Cleanse your palate with these links from around the web.
I’m beginning to think that the future of medicine is to use less of it. Here’s a great post from one of my favorite bloggers: Gaia and Snake Oil
And here’s something from the New Yorker on Prescription Opiates. We could definitely use less of these. Who is Responsible for the Pain Pill Epidemic
Similarly, two links on insomnia that DON’T mention medicines. Just don’t read these after your turkey sandwich. Sleep Therapy as Depression Treatment and Sleep Help Guide. The second link was mentioned in the last blog post; it’s a great patient self-help website.
Once you finish eating, check out this short commentary from the UK. Green snot does not equal a Z-pack.
After a long weekend with your nieces and nephews, you might appreciate this. The less is more, Babies edition. Contraception Practice Essentials. A quick, comprehensive guide for diagnosis and treatment. (requires Medscape Subscription)
Check this HILARIOUS patient education website for contraception in the real world. bedsider.org.
Finally, after the third helping of sweet potato pie, some more perspective on lipid guidelines. The Statinization of America. Dr. Centor’s (and here)and Dr. Shaneyfelt’s take on the risk calculator in the new ACC/AHA guidelines.
Happy Thanksgivukkah Everyone!
You might have heard about new cholesterol screening and treatment guidelines released this week. I had 3 patients ask me about it during a single clinic session, and would have been clueless if it hadn’t been for a very smart Facebook friend. Social media at work..
Here’s the skinny on the new guidelines.
- it is risk for heart disease that is important, not so much an LDL target. Four major groups are deemed high enough risk to warrant treatment
- Use statins. High potency ones like atorvastatin or rosuvastatin for higher risk patients, lower potency (pravastatin) for lower risk patients.
- If you are going to use it, put people on a good dose and leave them there. Really no need to check lipids every year.
- The four groups to consider treating
- Known atherosclerotic cardiovascular disease: less than 75, use high potency statin; >75 use moderate potentcy statin
- LDL >190: high intensity statin
- Diabetic: moderate potency statin, use higher potency if they otherwise are high risk
- 10 year risk of atherosclerotic CV disease >7.5%: use moderate or high potency statin
The risk calculator to find out if your patient fits into that last group is here. It is a little cumbersome to use, but is NOT the same as the Framingham or Reynolds Risk calculators that you may be used to. This might be a good thing, as the “pooled cohort” risk calculator was validated in White and African American men and women, which is somewhere that Framingham falls short.
So that’s the overview. There are lots of questions about these guidelines that I haven’t delved into here. It really represents a major shift in our thinking about cholesterol, which may be a good thing. It remains to be seen if our performance targets will change based on these recommendations. It follow that if our patients are on appropriate doses of high potency statins and the LDL is >100 or >70, or whatever your target may be, they may still be getting the benefit from statins. Adding more drugs just to lower the number may not do anything for their overall risk of heart disease or stroke.
Smarter people than I have had some good things to say about the guidelines. I suggest you take a look at NY time op eds and Dr. Centor’s take- both below.