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Medication Mythbusters – Home of the Best Science (BS) Medicine Podcast

Episode 3: How clinicians can manage their anxiety about litigation complaints and become more contented

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THE CASE
M is a hard-working clinician in primary care aiming for high professional standards; they passed all their exams at medical school and post grad training, and continue to engage in regular CPD. To their surprise, medicine in practice seems to get more and more difficult as time goes on. Many patients have vague symptoms, unlike any textbooks, the guidelines are complex and hard to remember, they hear a lot about complaints or being sued and some grumpy unsatisfied patients make M wonder what they are doing wrong. Now M gets anxious they may have missed something, going over their cases in their mind, rechecking their case notes, looking for errors. They find it hard to stop worrying about complaints or being sued; why did no one tell them that getting the right answers was so difficult? In this episode, Avril and James invite a couple of younger GPs, Sarah MacDermott and Joseph Rylands, to talk about what their concerns are around litigation. We go over the numbers around litigation and we discuss approaches as to how to reduce that risk, but also how to deal with what you should do if get a complaint. At the end we discuss many tips and suggestions around litigation that may help you, at least a little bit, be a more contented clinician.

Episode 397: Monoclonal antibodies – trying to put these agents into context

In episode 397, James and Mike discuss the evidence around the class of medications called monoclonal antibodies. We talk a little bit about them as a whole and then talk specifically about 6 different agents and the trials that have looked at the effectiveness of these interesting new medications. We come to the conclusion that you need to treat these agents, just like any new medication, by looking at the best available evidence.

Show notes

Handout for MABs

Episode 396: PREMIUM – studies about blood pressure and bone density

In episode 396, Mike and James present PREMIUM information from a premium province (BC). We discuss new studies that looked at measurements of blood pressure and bone density. At the end we put all of this information into a premium perspective.

Show notes

Tools for Practice

1) Association of Repeated Measurements With Blood Pressure Control in Primary Care

JAMA Internal Medicine 2018;178:858-60

2) Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial

Lancet 2018;391:741-7

Episode 392: Aspirin – two more large and maybe unnecessary trials

In episode 392, James and Mike get back to work after a European tour and other reasons. We go over the results from the latest large aspirin trials and, low and behold, the results show pretty much what we already knew. 

Show notes

1) Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial.

Lancet 2018 Aug 24. pii: S0140-6736

2) Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus

N Engl J Med. 2018 Aug 26. doi: 10.1056/NEJMoa1804988

3) The best CVD risk calculator

cvdcalculator.com

Episode 391: PREMIUM – 3 studies that will leave you short of breath

In episode 391, Mike and James have yet again a PREMIUM moment that will leave you short of breath. We go over 2 new studies that looked at asthma action plans and does increasing doses of inhaled corticosteroids work. In the last study we go over a comparison of vaginal estradiol, vaginal moisturizer or placebo for perimenopausal vulvovaginal symptoms, and placebo ends up working as well as anything else.

Show notes

1) Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations

N Engl J Med 2018;378:891-901

2) Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations

N Engl J Med 2018;378:902-910

3) Efficacy of Vaginal Estradiol or Vaginal Moisturizer vs Placebo for Treating Postmenopausal Vulvovaginal Symptoms

JAMA Intern Med. doi:10.1001/jamainternmed.2018.0116

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