Healthy Skeptic, MD

We often think of homelessness as a problem of the young. But recent projections suggest that the number of unhoused older adults will triple over the next decade. Today's guest is Ms. Jean Galiana, the Coordinator for Older Adult Services with the Los Angeles Homeless Services Authority. Jean discusses creative approaches for increasing housing options for the geriatric population. Jean also describes her recent book, Aging Well. Solutions to the most Pressing Global Challenges of Aging. Make sure not to miss this one, since after today's episode the Healthy Skeptic, MD will take a hiatus .

In the Healthy Skeptic, MD we've covered the harms of overuse of medical services in adults. But what about children? According to Dr. Samantha House, unnecessary care is a problem in Pediatrics too. In today's episode, she describes a recent JAMA analysis she authored showing that overuse of medical services in children is both common and costly.

Until recently -- and to the surprise of many -- there were no diabetes treatments definitively proven to lower cardiovascular risk. Over the last 5 years, that has changed. There are now two new classes of medications that not only prevent heart attacks and strokes for patients with diabetes, but they also help with weight loss, and may have other benefits. Still, as with any new treatment, caution is in order as we are just starting to understand the full benefits and risks. To help us break it down I am joined by Dr. Nihar Desai, the Associate Chief of Cardiology at the Yale School of Medicine.

Plastic surgery is often associated with high end cosmetic procedures, but it is much more than this, as we discuss today with Dr. Elliot Hirsch, the Chairman of the Division of Plastic Surgery at the Providence Cedars-Sinai Tarzana Medical Center. Plastic surgeons are among the most versatile of all surgeons, doing everything from wound care, to tissue reconstruction, to breast augmentation. In today's episode, Dr. Hirsch provides an overview of the field and offers practical tips for patients.

If you've done any work in the fields of Geriatrics Medicine or Healthy Aging, you've almost certainly come across Jennie Chin Hansen, my guest on today's episode. Jennie is the former President of AARP, the former CEO of the American Geriatrics Society and currently a Board Member of the SCAN Health Plan (which funds the Healthy Skeptic, MD Podcast). Jennie also spent 25 years as a nurse leader at the San Francisco-based On Lok program developing creative care models for older adults, including the Program for All-Inclusive Care for the Elderly (PACE), which has become a national Medicare program. In today's episode, Jennie and I discussed what the next several years may look like for the field of Geriatrics and the care of older adults.

Since the last Covid-19 surge, many things are different. More Americans are vaccinated; there's an important new pill to prevent Covid-19 complications; and there are new public health guidelines recommending a shortened isolation period after an infection. To help us break it all down, my guest today is Dr. Pieter Cohen, an internist at the Cambridge Health Alliance and the lead author of the chapter on outpatient care of Covid-19 in a prominent medical textbook.

See Dr. Cohen's latest YouTube video with his guidance for healthcare professional on the treatment of Covid-19 here: https://www.youtube.com/watch?v=g5LFeurr0RQ&t=2s

If the COVID-19 pandemic taught us one thing about healthcare it was that American consumers are open to new ways of receiving care. But is this also true for older adults -- who are accustomed to the traditional medical office setting? The answer is 'yes', according to Drs. Scott Weingarten and Michael Wang, leaders of a new medical group for older adults. The new group will emphasize telemedicine, home visits and other creative approaches for tailoring care to older patients.

In 2012, Los Angeles Superior Court Judge Craig Mitchell decided he wanted to improve public safety from a new angle. He always loved running, and suspected the discipline it taught him might help others -- particularly those struggling with addiction and homelessness. He founded the Skid Row Running Club, which has now helped hundreds of people improve their mental and physical health. In today's Thanksgiving special episode, I discuss the origins of the club with Judge Mitchell as well as Board Member Eric Barrera, who himself used running to help overcome his addiction and homeless challenges.

Find out where you can stream Skid Row Marathon: https://www.justwatch.com/us/movie/skid-row-marathon

Learn more or donate to The Skid Row Running Club: 
http://www.skidrowrunningclub.com/

When one thinks about healthcare quality, technical issues come to mind. Was the right treatment given? What percentage of patients developed a complication from the procedure? But that is not the entire story, according to Dr. Maren Batalden, the Chief Quality Officer at the Cambridge Health Alliance. If we really care about advancing health, it is the clinician-patient relationship that may matter the most. In today's episode, Dr. Batalden explains how patients and their clinicians co-produce high quality healthcare.

Dr. Batalden's co-authored paper on Coproduction of healthcare service is available here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4941163/

In 2003, Dr. Elliott Fisher published a seminal series of articles. It found that patients living in certain regions of the country receive about 60% more medical care than those in other regions, and these differences do not appear to be explained by differences in the health status or other demographic factors among the regions. To the surprise of many, those living in regions with high rates of medical care use did not necessarily have better health outcomes; in fact, in some cases their outcomes were a bit worse. In other words, more medical care is not always better. In today's episode, Dr. Fisher discusses the implications of his findings, nearly two decades later, and in the wake of significant health policy changes implemented in response to his work.

A basic understanding of statistics is essential for being a savvy medical consumer. But for many, thinking about statistics brings back painful high school memories. In today's episode, primary care physician Dr. Steven Hochman -- my brother -- helps distill it in a manageable and engaging way. And you shouldn't need to dust off your old high school textbooks to understand it!

Over the last several years, a handful of states have passed legislation authorizing physicians to provide medical aid in dying for terminally ill adults. This typically comes in the form of a prescription to relieve discomfort and promote a peaceful death. According to our guest today, medical aid in dying should not only be legal everywhere, but this compassionate option should be made more accessible. For example, Dr. Chandana Banerjee, a palliative care specialist at the City of Hope Cancer Center, says that extended waiting periods before patients can avail themselves of this option should be eliminated. Dr. Banerjee also discusses her poetry books in today's episode!

American medicine is fast-paced, high tech and aggressive, but it does not consistently produce excellent outcomes. In the U.S., life expectancy, maternal mortality and patient satisfaction, among other indicators, compare poorly to those in many other nations. My guest today -- Dr. Elena Hill, a family physician at the Bronxcare Health System in New York -- recommends a shift in our approach to what she describes as "Slow Medicine." Dr. Hill believes that a greater focus on the simple things -- which often require more time and patience -- may help our health system get back on track.

Other episodes mentioned:

Dr. Steven Hochman on the challenges and joys of serving the homeless population - https://youtu.be/xzEOZj-2b6k

Dr. Rita Redberg on Statins and Cholesterol Medication - https://youtu.be/7psjRfJ-uXc

National Health Insurance with Drs. Steffie Woolhandler and David Himmelstein -  
https://youtu.be/B8f1ojsr7MQ

Anyone following the news has probably seen the alarming headlines about the recent COVID-19 surge and children. Pediatric hospitals – particularly in southern states – have been filling up. Could this mean that the delta strain is more aggressive than prior strains in kids? Let’s not panic quite yet, says today’s guest, Pediatrician Dr. Jessica Hochman. While rates of COVID-19 are indeed surging, overall kids continue to have excellent outcomes with COVID-19, and with effective vaccines now available for those 12 and older, there is reason to be optimistic.

Dr. Drew Pinksy -- better known simply as "Dr. Drew" -- is one of the best known media doctors in the nation. But unlike some other "TV doctors", he has spent decades working on the front lines with patients. In fact, he has dedicated his medical career to the care of one of the most vulnerable populations: those experiencing addiction. In today's episode, Dr. Drew offers his take on the COVID-19 pandemic: what policy makers have done well and where they have fallen short. He also provides insights on a topic near and dear to his heart: healthcare for the homeless.

John Maceri has spent his career working with those experiencing homelessness. He now leads "The People Concern", one of the largest social services agencies in the western United States. In today's episode, he makes the case that homelessness is a solvable issue -- we just need the political will to fix it.

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Growing up in the deep south and facing the challenges of discrimination, Joe Greer’s journey to medical school – and ultimately to the inner health policy circles of the George H. Bush and Clinton administrations – might have seemed unlikely. But his journey getting there was fascinating, and in the process he established one of the most renowned healthcare programs for patients experiencing homelessness in Miami. During the second half of his career, Dr. Greer turned his attention to the future, helping found two medical schools, including the Roseman University College of Medicine, where he now serves as Dean. In today’s episode, we hear about Dr. Greer’s journey, and his thoughts on the future of healthcare.

**Be sure to subscribe to The Healthy Skeptic MD on your favorite podcast app and on Youtube!

Link for our channel on podcast apps and Youtube: wavve.link/healthyskepticmd

In 2020, Kaiser Permanente launched a new medical school in Southern California – the Kaiser Permanente Bernard J. Tyson School of Medicine. Dr. Mark Schuster was charged with leading this new school, in his role as the Founding Dean and CEO. In today’s episode, Dr. Schuster talks about why doctors of the future may require a different skillset than the current generation, and how Kaiser plans to prepare them for this new frontier.

**Be sure to subscribe to The Healthy Skeptic MD on your favorite podcast app and on Youtube!

Link for our channel on podcast apps and Youtube: wavve.link/healthyskepticmd

Loneliness correlates more strongly with health outcomes than many other traditional risk factors, such as tobacco use and high cholesterol. In today’s episode, Julianne Holt-Lunstad, PhD, a Professor Psychology at Brigham Young University and Lisbeth Briones-Roberts, the Chief Togetherness Officer for SCAN Health Plan, talk about the problem and what to do about it. Also hear the latest on the Delta variant of COVID-19.

**Be sure to subscribe to The Healthy Skeptic MD on your favorite podcast app and on Youtube!

Link for our channel on podcast apps and Youtube: wavve.link/healthyskepticmd

In his new book The Problem of Alzheimer’s, Dr. Jason Karlawish from the Penn Memory Center traces the history of a condition that impacts nearly 6 million Americans at a cost of more than $225 billion annually. These numbers may triple over the next decade. In today’s episode, Dr. Karlawish discusses potential breakthroughs in the years ahead – both pharmacologic and social – that can help us weather this storm. We also review the FDA’s controversial approval last week of aducanumab, the first new drug for Alzheimer’s in nearly two decades.
**Be sure to subscribe to The Healthy Skeptic MD on your favorite podcast app and on Youtube!

Link for our channel on podcast apps and Youtube: wavve.link/healthyskepticmd