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Episode 427: How not to do what didn’t need to be done

In episode 427, James and Mike invite Mark McConnell back to the podcast to discuss the philosophy around how not to do what didn’t need to be done. You start with a differential diagnosis then think about what are the possible causes of this presentation? Next, is the patient a candidate for the end product (med/surgery/device) should a diagnosis be found and are they interested in it (their values and preferences)? Then consider the best test(s) to diagnosis it if the patient makes that informed choice.

Show notes

1) Do You Need That Test?

April 8, 2012 NY Times

2) Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016

JAMA. 2019;322(9):843-856. doi:10.1001/jama.2019.11456

3) Toward a positive theory of consumer choice

Journal of Economic Behavior & Organization 1980;1:39-60

4) Prevalence and Cost of Care Cascades After Low-Value Preoperative Electrocardiogram for Cataract Surgery in Fee-for-Service Medicare Beneficiaries

JAMA Intern Med. doi:10.1001/jamainternmed.2019.1739

5) Treatment of Fatty Liver Disease—Time to Implement Common Sense Measures

JAMA Intern Med. 2019;179(9):1272-1273. doi:10.1001/jamainternmed.2019.2244

6) Competing demands and opportunities in primary care

Canadian Family Physician 2017;63:664-8

7) Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017

Mayo Clinic Proceedings 2019;94:1681-94

Episode 426: PREMIUM – if you take the polypill for 5 years, what happens?

In episode 426, James and Mike discuss in a PREMIUM way the first large RCT of the polypill. This single pill version contained aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan. Have a listen and find out what happened.

Show notes

Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial 

Lancet. 2019 Aug 24;394(10199):672-683. doi: 10.1016/S0140-6736(19)31791-X

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