Category: health care

Shout Out to University of Iowa Hospitals Doctor Joseph Zabner!

Here’s a big shout out and congratulations to my former University Hospitals colleague Dr. Joseph Zabner who received the 2023 Distinguished Mentor Award.

The Dragon Breathes Fire Again

Sena and I saw a news video about a technology called “DAX” which uses Artificial Intelligence (AI) the other day which promises to reduce or even eliminate pajama time for physicians trying to get their clinical note dictations done during the day instead of taking them home for several more hours of work.

The video was a demo of the technology, which looked like it recorded a clinical interview between the doctor and the news reporter. I didn’t see how exactly DAX was recording the interview without obvious audio equipment. Was it doing it through the smartphone speaker? This was very different from how I and many other clinicians dictated their notes using a headphone set at their desks in front of their desktop computers. It not only records but transcribes the interview.

Later, I discovered that DAX stands for Dragon Ambient Experience, made by Nuance which was acquired by Microsoft in 2022. I posted about Dragon products and their limitations last year. The product often produced hilarious mistakes during dictation which required careful editing. Sometimes more errors turned up after you completed it and these were visible in the patient’s medical record, which would then need to be corrected.

Several years ago, I remember talking to somebody from Dragon on the phone about the problems I was having. She was a little defensive when I told her I’d been having difficulty with Dragon for quite a while because it made so many mistakes.

A recent article on the web revealed that the errors continue with DAX. According to the article, “…it will make mistakes. Sometimes it might omit clinical facts; sometimes it may even hallucinate something.” I remember trying to communicate with the Google Bard AI, which seemed to do this pretty often. It made stuff up.

DAX is not cheap. The article reveals that one hospital pays $8,000-$10,000 per year per physician to use it. And skeptics worry that the system has too many bugs in it yet, which can lead to bias and inaccurate information which could negatively affect patient outcomes.

A recently published JAMA network article also urges caution in adoption of this sort of AI-assisted technology (Harris JE. An AI-Enhanced Electronic Health Record Could Boost Primary Care Productivity. JAMA. Published online August 07, 2023. doi:10.1001/jama.2023.14525).

In this case, I think it’s appropriate to say “I told you so.”

New Dominant Covid-19 Variant EG.5

There is a new dominant Covid-19 variant called EG.5. It’s also called Eris. It’s descended from the XBB strains. It’s in the Omicron family and there is no indication it causes more severe disease and would be susceptible to current vaccines.

UI Hospitals & Clinics Gets U.S. News & World Report Recognition

This is just a shout-out to The University of Iowa Hospitals & Clinics for once again being recognized as one of the top hospitals in the nation by U.S. News & World Report.

The Ophthalmology and Visual Sciences Department ranked 6th in the nation.

Doctors Still Oppose Board Mandated Maintenance of Certification Programs

I got a pang of anti-nostalgia after reading the latest article calling for abolition of Maintenance of Certification (MOC), posted by Medscape on August 1, 2023. There is a petition by oncologists to end MOC. So, what else is new? So far it has almost 10,000 signatures.

I remember my own petition in 2014 to end the American Board of Medical Specialists (ABMS) attempt to establish Maintenance of Licensure (MOL), a kissing cousin of MOC, which would have blocked physicians from getting a state medical license if they didn’t comply with MOC requirements. It was supported by both the Iowa Psychiatric Society and the Iowa Medical Society. It got a lot of signatures and many comments in support of opposing both MOC and MOL. The glaringly obvious motive by member boards to require MOC is money and always has been, in my opinion.

I’m baffled at why this debate still rages on. It looks like almost no progress has been made in the last decade, apparently because the American Board of Internal Medicine (ABIM) and other boards ignore the clear messages from rank-and-file doctors about how MOC actually interferes with efforts to pursue practical continuing medical education.

I have always been a staunch supporter of physician-led continuing medical education. At the hospital where I worked as a consultation-liaison psychiatrist, the consult service ran the Clinical Problems in Consultation Psychiatry (CPCP). It was a weekly case-based conference, which I have written about in a 2019 post.

Ironically, the Performance in Practice (PIP) delirium clinical assessment tool module that I and one of the residents created is still offered for credit on the American Board of Psychiatry & Neurology continuing education web site. I think it demonstrates the ability of individual doctors to establish practical methods for developing their own continuing education programs.

Every Minute Counts in Physical Activity for Health Even If Your Step Counter Does Not Count It!

If you want a quick read for how every minute counts in physical activity for your health, see the JAMA article “Physical Activity for Health—Every Minute Counts” (Katzmarzyk PT, Jakicic JM. Physical Activity for Health—Every Minute Counts. JAMA. 2023;330(3):213–214. doi:10.1001/jama.2023.11014).

Just for fun, I tried to see if about 5 minutes of juggling would result in a change in the step counter on my cell phone. Unfortunately, it didn’t but I sure could feel the effort!

As the authors state, public health recommendations for physical activity set a bar of 150-300 minutes a week of moderate intensity aerobic activity to get substantial health benefit.

But you benefit from just about any increment below that level. Your step counter probably won’t register it, but you can feel it.

I made a short demo video to show what good exercise juggling is. I didn’t cut any mistakes (and obviously increased the speed on it because 5 minutes is a bit long). Anybody can tell I’m pretty puffed out at the end.

Try juggling for physical activity!

Thoughts on Battery Powered Toothbrushes

Sena bought a couple of Equate Polaris Vibraclean non-replaceable battery-powered toothbrushes with charcoal bristles (see below for remarks on charcoal) for us. When the battery dies, you just throw the brushes away. We had a rechargeable electric toothbrush a long time ago, but getting replacement parts for it was too expensive. We went back to manual toothbrushes.

You just press the on button and you’re buzzing. You press the off button when you’re done. It’s a little tough to refrain from trying to manually brush, but the internet entries say you should do that anyway.

Sena says the battery-powered toothbrush feels weird rumbling in her mouth. I think it does a good job of massaging the gums and tongue as well as cleaning teeth.

I found a couple of studies published about twenty years ago that compared electric and battery-powered toothbrushes. They didn’t find any difference. The few studies that have been done generally find the battery-powered toothbrushes are superior to manual brushing.

The American Dental Association (ADA) says either manual or electric brushing works fine—compared to not brushing at all, I guess. The ADA web site has list of the organization’s preferred electric products. The Equate brand of battery powered brushes apparently didn’t make the cut.

Some brushes (including ours) have charcoal bristles, which supposedly whiten teeth. After looking on the internet, I’m not so sure that’ll work. In fact, the ADA has a low opinion of charcoal-containing dental care products. There’s no evidence that they’re effective or even safe, according to the September 2017 issue of The Journal of the American Dental Association. They might even wear away the enamel.

Hmmm. Maybe charcoal is not the best thing?

The brushes were a bargain—oh well, back to manual brushing. On the other hand, there’s plenty of evidence that regular brushing with toothpaste along with flossing is good practice.

What’s Up with Shared Clinical Decision Making for the RSV Vaccine?

There are probably some questions about the new Respiratory Syncitial Virus (RSV) vaccine. Because I’ve seen TV commercials about the new website RSVandMe, I checked on a few things the other day.

The RSVandMe website and the companion website are both produced by the RSV vaccine maker GlaxoSmithKline (GSK). As such, I consider them marketing commercials.

I checked the Centers for Disease Control (CDC) website and saw that the CDC Advisory Committee on Immunization Practices (ACIP) recommended approval of the RSV vaccine at their June Meeting (covered earlier on this blog):

Adults 60 years of age and older may receive a single dose of Respiratory Syncytial Virus (RSV) vaccine, using shared clinical decision-making.

The term “shared clinical decision-making” is clarified on the CDC webpage at this link.

The upshot of shared clinical decision-making is that it’s up to the provider (the list of providers include pharmacists). So far the list of recommended vaccines does not yet include RSV, so it probably needs updating. It looks like the ACIP MMWR recommendation page also needs updating.

Beat the Heat with Cold Snap and Common Sense

Sena likes to be out in the garden no matter how blisteringly hot it is. A few days ago, she was planting some yellow coreopsis and lantana, whatever that is. It was 82 degrees and with the heat index (about 60% humidity), it felt like 86 degrees. Later in mid-afternoon it rose to 95 degrees with the heat index.

She came in for a break to get some cold water and suddenly remembered the cooling cloth called “Cold Snap” you can wear around your neck to stay cooler outside. You just run it under cold water from the tap and wrap it around your neck.

She also put on her headband to keep the sweat out of her eyes to prevent her tear ducts from plugging up. That happened a longish time ago. She had a lot of tearing, and went to the eye clinic where a faculty ophthalmologist thought she might have a more complicated problem than a blocked tear duct (nasolacrimal duct obstruction).

The Cleveland Clinic differential diagnoses of a blocked tear duct include infection, injury, or nasal and paranasal tumors. Just getting older can make your more susceptible to blocked tear ducts. Procedures include the polysyllabic dacryocystorhinostomy (DCR, in which a bypass ductal drainage system is created) or alternatively, something which sounds like a last resort, the punctal plug.

The ophthalmologist recommended a complicated diagnostic and surgical treatment pathway the name of which she can’t remember (possibly something like those mentioned above) and said it was probably the only intervention that would work. Sena took exception to this and asked for something simpler. They arm wrestled, best two out of three, and Sena won.

So, the ophthalmologist finally just used a needle and syringe full of water and hosed the puncta. He and Sena both heard a small popping noise, and the obstruction was removed. The ophthalmologist was astonished and said it was a good teaching case for the residents. The problem was likely grime related to sweat and dirt—hence her use of a headband. She also uses baby shampoo to wash her eyes nowadays.

She never complains about the heat outside. She just gets out there in the garden and often stays out most of the day—no matter how worried I get about her.

There are ways to be heat aware in summer. The ReadyIowa web site on heat is a great resource.