- Modern medicine is supposed to be evidence-based.
We're supposed to take what works,
and throw away what doesn't.
But because of medical inertia,
we're a little slow to throw away what doesn't work.
And of course, as a reminder,
none of this is direct medical advice to you.
So always speak to your doctor first
before making any medical decisions.
Let's get started.
Eee whoop!
For some weird reason, in our society,
it's become common practice
not just within the medical system, but in our own homes,
whenever we have a fever,
we reach for a fever reducing medication.
And I don't know why,
because the evidence usually points against it.
Well, I actually know why people wanna lower
their temperatures when they have a fever.
It's uncomfortable.
In order to get hot, first of all, you have to have chills.
That's why you get chills to create the heat
in order to raise your core body temperature.
But the reason your body is raising
its core body temperature is that your immune system
works better at a higher temperature.
The infection you're trying to fight off
is less likely to replicate at higher body temperatures.
So this is done for a very good reason.
In fact, back in the day, they would try
and get patients to increase their body temperature
by provoking a fever in order to fight off some infections.
Prior to antibiotics of course.
But now with the invention of antibiotics,
with the invention of other life-saving interventions,
for most cases, the average healthy person
can withstand having a hundred degree fever
and do just fine.
Now, I'm not saying you should strive to have
the highest fever possible and high score here.
There are times where we do lower a fever.
If I have a very frail patient,
outstanding medical conditions,
if the fever starts climbing very high
where it can cause some damage,
but the typical 100.5, 101 fever,
when you have a upper respiratory infection
and you're otherwise healthy,
it might make you uncomfortable.
But if you can stand it, you might get better sooner.
Up until the year 2000, the American Academy of Pediatrics
actually warned parents to not feed children
peanut based products up until the age of three,
for the fear that they may develop
a peanut allergy later in life.
What did we come to learn?
That actually early introduction of allergenic foods,
like eggs and safe to eat peanut products,
and when I say safe to eat,
you don't give a six month old a peanut
cause they can choke.
So there are peanut paste and things like that.
But you wanna introduce these foods early on,
as early as six months.
And by doing this, it's actually been proven
that you decrease rates of the future development
of allergies to these foods.
So it's the introduction that helps,
as opposed to the avoidance.
Hurt your knee, end up getting an MRI?
find out that you have a torn meniscus?
The knee jerk reaction, pun intended,
is that you think you need surgery.
And the reason for this is because people worry
that the pain will never go away,
or only progressively get worse unless they get the surgery.
Some surgeons even feed into that notion.
And while there are instances
that there should be surgery performed,
especially when conservative measures fail,
this has been tested.
A randomized study took people
who have a torn meniscus and moderate arthritis
and randomized them into one of two groups:
getting surgery and physical therapy.
And to everyone's surprise, after six months,
the improvement in both groups was nearly identical.
If you are trying to get birth control from a doctor,
and they're requiring that you get a pelvic exam
or any other physical exam before the prescription,
know that they are not following evidence-based medicine.
In fact, in a survey of 1,200 US doctors
and advanced practice nurses,
researchers found that one third said
they always require a pelvic exam
before prescribing contraceptives.
This goes firmly against guidelines,
and not guidelines set by an arbitrary organization.
The CDC explicitly states
that you do not need a pelvic exam prior
to receiving a prescription of birth control medications.
End of story.
The harder you make it to access birth control,
the more likely that you are gonna increase
negative health outcomes and decrease the health
of the doctor-patient relationship.
Take a load off, take it easy for a while,
lay down for a bit.
I've heard this time and time again
as advice given to my patients when they strain their backs
or roll their ankles.
But long term, this is actually not great advice.
Maybe for the first day or two for a few hours,
an aching back can benefit from laying down.
But the longer you do this,
the longer it's gonna take for you to recover,
and the more symptoms that you're actually gonna experience.
And this doesn't just go for back pain.
For example, when my patients sprained their ankles,
I don't tell them,
just stay off your ankle and forget
that you have an ankle attached to your leg.
The goal is to get that ankle moving as quickly as possible,
as early as possible.
Maybe without weight bearing.
Maybe just doing small circles with the foot,
maybe just drawing an imaginary alphabet using the big toe.
But it's important to keep the body moving.
A body that is not in motion starts getting stuck,
stagnant, with decreases in circulation,
which ultimately means less healing.
You're trying to go to sleep at night
and you start experiencing what's known as
nocturnal leg cramps.
So many people will quickly recommend
that you take magnesium supplements for these cramps.
The evidence, good quality evidence.
Randomized clinical trials have been conducted here,
and found that magnesium has zero effect on leg cramps.
So instead of spending your money on buying supplements
that are proven not to work,
find out the real cause of your nocturnal leg cramps
and treat that.
Anyone who feels that they should be diagnosed with pink eye
ideally should be seen by a medical professional.
Why? Because we need to figure out first
that this is in fact pink eye, also known as conjunctivitis.
It could be a whole host of other conditions.
And the way you really diagnose pink eye
is by ruling out the more serious cases.
Now, pink eye does not always need antibiotics.
In fact, most of the time it does not require antibiotics.
I can't begin to count the number of encounters,
my patients that come in either with their children
or on their own with pink eye,
usually viral pink eye,
and request antibiotics or think they need antibiotics.
Or their children's daycare slash school
is requiring them to get antibiotics.
Most cases of conjunctivitis are caused by viruses.
Therefore they definitely don't require antibiotics
and those could actually cause harm,
even in cases of bacterial conjunctivitis.
It will usually resolve on its own
even without the antibiotics.
And while there are certain instances where
antibacterial ointments or drops
would be necessary for pink eye,
this would be in very rare instances
of contact lens wearers, preexisting conditions,
very unique symptoms like severe symptoms.
So let medical professionals decide that,
not the staff at the local kindergarten.
It's been said that everyone who has flat feet
would benefit from some kind of magical
or even customizable insole.
Maybe it's a custom orthotic just for the patient.
The reality is, with a flexible flat foot,
meaning not a rigid one or very painful one,
maybe something that's minimally symptomatic
or asymptomatic altogether, meaning no pain,
you actually don't need insoles.
In fact, this is part of the Choosing Wisely campaign
to advise doctors to not overprescribe
these very very costly insoles for no reason.
Granted, if there's pain,
there's other conditions going on, that's a different story.
In fact, the use of these custom orthotics
doesn't actually aid in the development of the foot.
So while parents may think that by putting in the insole
they're gonna get better outcomes later in life,
that hasn't been borne out with the evidence.
Nowhere is there a clearer example of CYA medicine,
"cover your butt" medicine,
then in preoperative clearances.
Look, preoperative clearances are actually a great way
to reduce the risk of complications
during and after surgery.
We wanna get ahead of problems before they happen.
That's smart.
But now, if the patient's risk is low
cause they're otherwise healthy,
or if the procedure is very low risk
and we already have some data about the patient's
overall wellbeing from past tests
or getting a thorough history,
more tests does not create better outcomes.
Nowhere is it more clear than when it comes
to getting preoperative testing for cataract surgery.
This is a procedure that does not
require general anesthesia.
It takes about 20 minutes to perform.
It's a very low risk procedure.
And yet some ophthalmologists that send patients
to my office for these preoperative screenings require EKGs.
Now, while EKGs are not expensive on an individual level,
but if you calculate the aggregate cost,
the aggregate headache that it creates for a patient
if there's a slightly abnormal finding,
with no benefit on the other end,
the cost to our healthcare system is huge.
Now, obviously if you have a very complicated
cardiac history and you're going for surgery,
yeah, I'm getting an EKG,
I wanna make sure you're well.
But I'm not just ordering them willy-nilly.
If your doctor is recommending that you have
cardiac screening before a surgical procedure,
don't be afraid to ask why and if you really need it.
Being a family medicine doctor,
I tell patients quite often that they have
an upper respiratory infection due to a virus,
but most of the time, in fact the majority of the time,
I have no idea what virus is causing their symptoms.
When patients come in,
they want to know what virus they're having.
And in some instances we do testing for influenza,
for COVID as an example, because we actually
have treatments to shorten the symptom severity,
or the rate of hospitalization, even death.
But for the average common cold,
you actually get no benefit to try and figure out
if it's adenovirus, parainfluenza virus, et cetera.
Look, while I understand it's tempting to know
which common cold virus you have,
in many instances, it's just not worthwhile
to do such an expensive test to find out
because the management won't change.
The conservative management is still gonna be conservative
and there are no magic cures.
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And as always, stay happy and healthy.
(upbeat music)