#109: Things We Do For No Reason: A High Value Episode

Things We Do For No Reason #TWDFNR highlights some widespread practices that are difficult to justify based on lack of proven health benefits, but significant cost (both financial and non-financial harms). Avoid these low value practices and inflated medical bills with tips from expert, Dr Lenny Feldman, MD, FACP, Associate Professor of Medicine Johns Hopkins. Topics include: renal ultrasound and urine electrolytes in acute kidney injury (AKI), folate deficiency and anemia work-up, prealbumin and malnutrition, blood transfusions, shellfish and contrast allergies, monitoring after switch from IV or oral antibiotics, and “against medical advice” discharges.

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Credits:

• Written and produced by: Justin Berk MD, MPH, MBA
• Editor: Matthew Watto, MD
• Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD, FACP
• Guest: Lenny Feldman MD, FACP

Time Stamps

• 00:00 Announcements
• 00:38 Disclaimer, intro, and guest bio
• 03:53 Guest one liner, some recommendations, and advice
• 08:35 Defining high value care and things we do for no reason (TWDFNR)
• 12:40 Why do clinicians order useless testing?
• 14:58 Urine electrolytes for acute kidney injury
• 20:30 Renal ultrasound for acute kidney injury
• 25:54 Stop ordering folate for anemia workup
• 31:47 How many units should I transfuse?
• 34:40 Prealbumin and albumin for malnourishment.
• 43:24 Iodine, shellfish and contrast allergy
• 50:28 Patient leaving against medical advice
• 56:45 Switching from IV to oral antibiotics
• 63:27 Dr Feldman’s plugs
• 65:36 Outro