Morning Report: Not Your Typical Medical Newsletter

A Splash of Cold Water on the COVID-19 Vaccines 

This just in: the FDA and CDC “out of an abundance of caution” recommend pausing administration of the Johnson & Johnson COVID-19 vaccine because of a possible link to cerebral venous sinus thrombosis (CVST) and low levels of blood platelets (thrombocytopenia). To date, 6 recipients of the 6.8 million doses of this vaccine have developed this; 1 woman died, and another was in critical condition. All 6 cases were women aged 18 to 48 years, and symptoms appeared 6 to 13 days after vaccination.

We hate to utter a disparaging word about any of the COVID-19 vaccines, given that they are our ticket back to normalcy, but we must share the news of this rare but concerning side effect, found not only with the J&J vaccine, but with the others as well.

More Background

Last week, the Association of American Physicians and Surgeons (AAPS) called for clinicians to monitor patients for blood clotting disorders after receiving any of the COVID-19 vaccines. At least 37 people have developed a rare platelet disorder after receiving either the Pfizer-BioNTech or Moderna vaccine, and several countries have paused administration of the Oxford AstraZeneca vaccine because of deaths from blood clotting disorders. The cases are extremely rare, and researchers can’t confirm causation, but the AAPS warns that this could be the tip of the iceberg.

We know that at least 37 people have developed a rare platelet disorder after receiving either the Pfizer-BioNTech or Moderna vaccine, and several countries have paused administration of the Oxford AstraZeneca vaccine because of deaths from blood clotting disorders. The cases are extremely rare, and researchers can’t confirm causation, but the AAPS warns that this could be the tip of the iceberg.

Although this news may seem frightening, keep in mind that the risk of developing a blood clot from COVID-19 remains much, much higher. To date, millions have been vaccinated without any issue. So, vaccinate on!

For other COVID-19 news, check out these articles:

U.S. Healthcare Dollars Down the Drain

We have long known about the excessive waste in our U.S. healthcare system and speculated about the total dollar amount. Well, according to new research, our guesstimates may have been way off, and surprise, surprise, the overspending is not related to clinicians’ high salaries.

Researchers looked at 6 studies from 2008−2019 that examined our national medical waste and crunched the numbers to find out how much we squander annually. The sum is offensive: $600 billion to nearly $2 trillion. Whoa, that could fund the new infrastructure bill or buy every American their very own pony. Here’s the breakdown in median annual dollars:

1. Excessive prices ($169 billion)

2. Fraud/abuse ($185 billion)

3. Clinical inefficiency ($202 billion)

4. Administrative waste ($281 billion)

5. Missed prevention opportunities ($310 billion)

6. Overuse ($451 billion)

Open Notes Is Officially a Thing

You know that feeling when a colleague forwards your email—meant only for that colleague—to the group, or worse yet, the boss? We want to spare you that moment and let you know that as of April 5, it’s finally official: your patients can read your notes about them.

The long-anticipated “Open Notes” mandate from the US government is here. All healthcare institutions must now offer patients free, unencumbered access to their health records, including your notes. This includes consultations, histories, discharge summaries, exam findings, imaging interpretations, lab reports, progress notes, you name it.

The legislation points out that clinicians don’t have to change their note writing style, but with patients as part of the audience, many have acknowledged that they will. In a recent Medscape poll, 47% of clinicians anticipated writing their clinical notes differently with the implementation of Open Notes. What about you?

  1. Cancer Screening Guideline Update

The American College of Gastroenterology (ACG) is one more society throwing its log in the fire of screening guideline updates for colorectal cancer (CRC). With adults developing CRC at younger ages, this is a win for patient care. However, some patients may not agree. Here are the highlights:

  • For anyone 45 to 49 years of age and of average risk, CRC screening is suggested
  • For anyone 50 to 75 years of age and of average risk, CRC screening is recommended
  • For anyone older than 75 years of age, CRC screening may be considered on an individual basis

The screening modalities of choice are still colonoscopy and fecal immunochemical testing (FIT). However, for individuals not fit for colonoscopy or who simply take a “hard pass” on either modality, the guidelines offer some alternatives.

If you’re interested in more information on CRC screening in adults, check out Dr. Kimmie Ng’s recent Pri-Med CME/CE course: The Latest in Colorectal Cancer Screening and Prevention: Do Diet and Lifestyle Really Matter?

  1. Millennials Swipe Right on Dr. Google

According to a new survey, millennials—the generation that never had to pay for music—may not want to pay for healthcare either. Of the 2,000+ millennials (23−28 years old) surveyed by Harmony Healthcare IT, nearly 78% took their medical concerns to the internet instead of a clinician.

It makes sense. With their proclivity for technology, wellness, creativity, and resourcefulness, most millennials prefer doing their own health research. And 48% trust the results of an online search to accurately diagnose their condition. Their top search resources are WebMD (82%), news articles (27%), YouTube (22%), and Reddit (22%).

The obvious danger is that the younger generation could misdiagnose themselves. Did you know that more than one person has posted a photo of their bare back on Reddit with the caption “Is this scoliosis?” Yup, that happens.

  1. Healthcare Humor

A man says to his physician, “Doc, I think I’m a bit hard of hearing.”
The physician replies, “Can you describe the symptoms?”
The man says, “Sure. Marge has blue hair and Homer is overweight and bald.”

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

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