The Paradocs Podcast with Eric Larson

Entrepreneurs are funny creatures. Some seem to be born to innovate and create businesses. Others, like today's guest, create new businesses out of necessity because they can't find a system that works for them. Dr. Rick Rosenfield is an OB/GYN who enjoys gynecological surgery. He didn't feel that he could do that in his first job with a large health system so he struck out on his own and started doing something no one else had thought to do - outpatient laparoscopic hysterectomies. Learn more about your ad choices. Visit megaphone.fm/adchoices

One thing you can be certain of with COVID-19 is that there is no shortage of controversy. Whether it is lockdowns, treatment, vaccines, or testing there have been volumes written about what should or should not happen. So today, we're going to learn about the most common test in the middle of the controversy - the PCR. That's why I reached out to expert, Kevin McKernan of Medicinal Genomics to understand the test, its advantages, and limitations. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Diana Bitner describes herself as a survivor. As an OB/GYN, she had what one would describe as a typical practice. She was employed in a large multi-specialty physician group that later got acquired by a large health system. But within this traditional insurance based practice, Dr. Bitner looked to deliver care to her OB/GYN patients in a different way. She thought of herself as an 'intropreneur' where she was continuously trying to innovate processes within the large health system. Learn more about your ad choices. Visit megaphone.fm/adchoices

In his excellent book, From Killer to Common Cold: Herd Protection and the Transitional Phase of COVID-19, Dr. David Graham lays out the upcoming evolution from pandemic to endemic for SARS-CoV-2 virus. Although published months ago, the book has proven to be right on with how the virus is progressing and we now find ourselves in the transitional phase of the pandemic. The virus is transitioning from a global pandemic to one where it will live forever in the worldwide human population. Learn more about your ad choices. Visit megaphone.fm/adchoices

Pain. We all experience it. It is as much a part of life as breathing itself. But what is pain? Is it physical? Is it mental? Is it emotional? Is it mechanical? Also, how does pain become chronic? One of the few things experts on pain can agree on is that our ability to treat pain - especially chronic - is not very good. My guest, Dr. Melissa Cady did a pain fellowship and realized that it wasn't working. So she wrote a book, Paindemic, where she describes the system and how it can be better. Learn more about your ad choices. Visit megaphone.fm/adchoices

As COVID-19 continues to rage across the globe, everyone has been trying to figure out how to protect themselves from getting infected. Although we know a lot about what puts people at risk (age, diabetes, heart disease), not much is talked about as far as preventative care goes. That might be where we should begin our discussion about vitamin D. Perhaps this common vitamin is a linchpin to preventing severe disease and maintaining immunological health. Learn more about your ad choices. Visit megaphone.fm/adchoices

The most obvious statement we can make about the US health care system is that it's a mess. It's complicated, expensive, and rarely delivers what patients expect. The unserious answer to how you fix the health care system is to blow it up and start over. As the largest sector of the economy that hires the most people, there are far too many interests in keeping the system just as it is. The solution will have to come from entrepreneurs, employers, and patients. Learn more about your ad choices. Visit megaphone.fm/adchoices

Direct primary care (DPC) is a style of practicing medicine we have discussed many times. The way DPC works is that instead of using insurance to cover the cost of doctor visits with copays, patients contract directly with the doctor – usually on a monthly basis. What happens when care has to be episodic like with a pregnancy? And if you're that doctor covering all the patients in your panel for 24/7/365 how do you ever take time off if one becomes pregnant and needs to be delivered? Learn more about your ad choices. Visit megaphone.fm/adchoices

Well, it finally happened, the COVID-19 vaccines have started to arrive and get administered to health care workers in the United States. Both vaccines use a revolutionary new technology for inducing an immune response, messenger RNA (mRNA). As millions of doses start rolling out throughout our hospitals and nursing home care workers we need to reflect on whether the vaccine is effective, safe, and how it should be distributed. Learn more about your ad choices. Visit megaphone.fm/adchoices

What does it mean to feel grief? Is it sadness? Anger? Resignation? Unfortunately, life will almost certainly present you with grief at some point. Where there is love there will also be grief when the love is lost. But always, grief is a human emotional state that we will all have to struggle with before our life is over. As a physician, one treats not only physical illness but also mental anguish. We see people at their worst and lowest points when they are scared, angry, and anxious about the future. Learn more about your ad choices. Visit megaphone.fm/adchoices

Cancer. It is a word that evokes feelings of fear, pain, hopelessness, and loss. It also brings to mind images of chemotherapy, nausea, weight loss, hair loss, and loved ones suffering in pain. Cancer is all of these things and so much more. What is more interesting is why do people get cancer? Why do all cancers end up looking the same despite originating from different parts of the body? And why is something so common that it is a leading cause of death in the United States still so difficult to treat? Learn more about your ad choices. Visit megaphone.fm/adchoices

It's been a while since we have discussed medical liability on the show but malpractice is a large and expensive part of what doctors have to face in today's medical landscape. Physicians are often under attack not just from frivolous lawsuits but also attacks from disgruntled patients online or office disputes. It is important for doctors to understand the risks they face both to their careers and personal reputation and to their practice and business. Learn more about your ad choices. Visit megaphone.fm/adchoices

Direct primary care (DPC) is a movement that is growing quickly in the United States. Patients and physicians are looking to bypass the traditional box store medical practice and deal directly with one another. The shift to this sort of practice can be scary for a doctor. In order to answer some of these questions I asked nine DPC practices from around the country what is the one question you wish you knew before you started a DPC practice? Learn more about your ad choices. Visit megaphone.fm/adchoices

What's it like living a year without health insurance if you are a family with two doctors? Well, we found out sort of by choice and sort of by chance. It was one where we learned a lot about expenses, prices, and the utter insanity of medical system pricing. We become better shoppers of medical services. We hired a doctor to help navigate buying drugs, getting labs, and imaging tests. Best of all, we saved over $3000 by using a sharing ministry and direct primary care doctor. Anyone can do it. Learn more about your ad choices. Visit megaphone.fm/adchoices

Since 2010, the number of NPs in the United States has grown from 109,000 to 290,000. It is transforming the health care landscape in the United States. But is it improving overall health? Is it providing more care for patients? Is it allowing for improved access? Is the quality improved or at least the same with physician-led care? Does that solve the problem of rural care? These questions are the ones Drs. Rebekah Bernard and Niran Al-Agba attempt to answer in their book, Patients at Risk. Learn more about your ad choices. Visit megaphone.fm/adchoices

The last few years have seen a resurgence in the use of fasting. Fasting is an ancient practice tied to religions and culture. In many ways, how and when we eat developed based on the availability of food. My guest is Dr. Jason Fung, a nephrologist and expert in intermittent fasting for the treatment of diabetes and weight control. His first argument, however, is a simple one - fasting is old, safe, and simple. One doesn't need to do extensive planning, dietary food restrictions, or break the bank. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. David Graham returns again this week to discuss his newly published book, From Killer to Common Cold. The book touches upon the topics we have discussed on this show for a few months now. The central theme of the book is how SARS-CoV-2 will transition from the pandemic killer COVID-19 to a common cold coronavirus. Dr. Graham expertly lays out his case in a short book that is easy to digest. He sets a background of what viruses are, basic physiology and epidemiology, and history. Learn more about your ad choices. Visit megaphone.fm/adchoices

Episode 100 is a momentous achievement for a podcast about medicine where I had only about 3 show ideas in mind when I launched. My guest host today is my wife, Marcy, who has been by my side throughout the show and obviously, the loss of our son Andy in a car accident. His death has served as a dedication to the show, a way to honor him with his audio track closing every show, and a reminder to me of the importance to treat every day and person as special. Learn more about your ad choices. Visit megaphone.fm/adchoices

Okay, so today's title to the show is a little provocative. But it's meant to convey the most important takeaway from the discussion. Our problem is the recent news that asymptomatic people and athletes showed signs of myocarditis (heart inflammation) on cardiac MRI and there was concern that this put them at immediate risk of heart diease. To explain the controversy, I brought Dr. Rohin Francis onto the show. He is an interventional cardiologist from London who is getting his PhD in cardiac MRI. Learn more about your ad choices. Visit megaphone.fm/adchoices

Today's discussion begins way back in the early 1990s when Congress was trying to figure out a way to reduce its health care expenses. Sound familiar? Some things never change. And this story is as old as Congress itself as legislators try to solve one problem and end up creating a bigger mess that actually ends up creating far more harm than was occurring with the original. It goes by the rather harmless name of the 340B program. Learn more about your ad choices. Visit megaphone.fm/adchoices

We're breaking from our discussion of COVID-19 and discussing life after pandemic with finding means of passive income. Specifically, how one can earn passive income through real estate. My guest is Dr. Jeff Anzalone, a periodontist in Monroe, LA who has created a website to help other high income earners find ways to earn passive income through real estate. He is an advocate for investing in real estate syndications. Learn more about your ad choices. Visit megaphone.fm/adchoices

Following our discussion last week where we discussed the probable lower herd immunity rate threshold for COVID-19, today we are going to discuss the transition from a global pandemic to endemic state for the virus. This makes one fundamental assumption - that COVID-19 isn't going to go away, ie, it won't get eradicated. The reasons to suspect this are all around us in that almost no viruses have been eradicated. Learn more about your ad choices. Visit megaphone.fm/adchoices

One commonly used expression regarding the current COVID pandemic is herd immunity. People are obsessed with reaching herd immunity as soon as possible so that we can put this pandemic to bed. It is hoped that the development of a vaccine will get us the herd immunity of 60-80% far quicker than waiting to reach it through natural infections. But my guest today is convinced her modeling puts the actual immunity threshold at only 10-20% meaning we may already be there in some cities and countries. Learn more about your ad choices. Visit megaphone.fm/adchoices

Pharmacy benefit managers (PBMs) are one of the 'middle men' in health care that have recently come under fire for the added expense they bring in the prescription drug market. What was once a relatively unknown player in the health care delivery process, PBMs are now finding themselves with a target on their back for the first time. Learn more about your ad choices. Visit megaphone.fm/adchoices

One driver of health care inflation in the United States are pharmaceuticals. Although we usually associate rising drug prices with prescription medicines, that is not always the case. In fact, the purchase of generics through insurance plans can be surprisingly expensive. This is because the 'discount' provided by your insurance carrier may not really be much of a discount and your copay could be many times more expensive than the wholesale price of the drug. Learn more about your ad choices. Visit megaphone.fm/adchoices

Maintenance of Certification (or MOC) is a requirement by all the specialty boards in the United States that is above and beyond what the original certification is to become board certified. In the 90's specialty boards put time limits on the original certification and began to require MOC and its outrageous fees and busywork. Dr. Torie Sepah is a board certified psychiatrist in Pasadena, CA and feels that the MOC process has become nothing more than a new shakedown. Learn more about your ad choices. Visit megaphone.fm/adchoices

Now that we're approaching the half way point of summer it's time to start thinking about what we're going to do with school for K-12 (and college) kids. States and communities are starting to finalize their plans with how they expect to conduct elementary and secondary education in the face of the COVID pandemic. The only certainty is that there is a lot of uncertainty in what will happen. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hydroxychloroquine is an old medicine and treatment for conditions causing cyclical fevers like malaria. But hydroxychloroquine has been used in the treatment of infections like SARS, influenza and others. Why did this happen? Where did it start? And what is its place today in the treatment regimen for COVID-19? My guest today is Dr. Adam Rodman of Bedside Rounds Podcast. He is an internist and amateur medical historian who has studied in depth on the origins of hydroxychloroquine. Learn more about your ad choices. Visit megaphone.fm/adchoices

What does it mean to have a virtual telehealth doctor's visit? Can artificial intelligence (AI) and telehealth actually work in a medical setting in a way that doesn't frustrate doctors or patients? Well, my guest today is the chief medical officer of 98Point6 which is a text based primary care service for patients. That's right, patients use their phone or tablet with texts to receive their primary care. Learn more about your ad choices. Visit megaphone.fm/adchoices

Today I'm joined by my friend and colleague Dr. Randy Lovell who has opened his own innovative practice in Grand Rapids where he looks to become fully transparent. Dr. Lovell has implemented and perfected the technique of WALANT or Wide Awake Local Anesthesia No Tourniquet. He describes in great detail the advantages of this practice technique not just for the patient and physician experience - but also for the way it allows him to build a private practice that simplifies the billing too. Learn more about your ad choices. Visit megaphone.fm/adchoices

We're back at it again discussing the Coronavirus pandemic. The shutdowns/lockdowns continue in the United States and the tenor of the debate or discussion had changed within the media and culture. At the beginning of the pandemic the focus was on flattening the curve. Today, it is about stopping people from 'catching' the coronavirus. This is a mistake. Learn more about your ad choices. Visit megaphone.fm/adchoices

Now that we are over a month into the variable stay at home orders in the United States for the coronavirus it is probably a good time to reflect and guess as to how this all unfolds. Today I interviewed infectious disease specialist Dr. David Graham. Dr.Graham lives in Billings, Montana and provides a perspective on the pandemic that I had not yet heard. He suggests that at the forefront of this nationwide panic is that our media and government are not being honest with us. Learn more about your ad choices. Visit megaphone.fm/adchoices

The response from state governments in the United States have varied in how they are responding to the Coronavirus pandemic (COVID-19). Michigan has been in a state of emergency for weeks with it now extending through the end of the month. Our government deems "allowed" instituted more draconian rules in the face of no evidence of benefit. This is not to say that there is no risk to resources or people from the virus - simply that we need to consider the differences within the state and the real tradeoffs. Learn more about your ad choices. Visit megaphone.fm/adchoices

Once again I discuss the coronavirus outbreak in the US. Today, I speak with Dr. Michel Accad about the ways the US has bungled the response. We specifically look at how the mistakes from ossified bureaucracies have prevented decision makers from having necessary data and the ability to make informed decisions. Also, what is the financial impact to doctors and their practices and what about the loosening of scope of practice restrictions within the states? Learn more about your ad choices. Visit megaphone.fm/adchoices

Five months ago, my family dropped our health insurance and switched to a health sharing ministry (Samaritans). So far, so good. We've gotten better medical care by hiring a DPC doctor and have saved over $2000 in five months. What will it be like dealing with coronavirus without insurance? I'm pretty sure fine. However, the second half of the show I talk about the reasons the US response has been so poor to coronavirus. Tariffs, certificate of need laws, the FDA, and more. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dominating the news today is the pandemic coronavirus or COVID 19. It is unique in that its hosts are often asymptomatic but infectious for days making its spread so effective. There is some reason for concern that the response in the US may have been too swift. Perhaps we should have waited another week or so to allow some more community infections to improve herd immunity since there is no vaccine on the near horizon. Learn more about your ad choices. Visit megaphone.fm/adchoices

Child abuse is a something we can all agree is a terrible crime. It is something that we must work to stop. But what is the best way? And how can we be sure that those accused of abuse actually did? Because we can agree that child abuse is bad - so it removing children from their family if people are wrongly accused. My guest is Dr. Niran Al-Agba who details the story of her patient who was taken from his family after sustaining innocent injuries. The story is how they got him back and how it happened. Learn more about your ad choices. Visit megaphone.fm/adchoices

A discussion on where the lines are on making vaccinations mandatory. Are you compelled to get vaccinated to help the overall population's herd immunity? Or do you have a right to control what is injected into your body no matter the consequences to others. We tackle those questions and try to get to the bottom of the question of where your rights end and mine begin. Learn more about your ad choices. Visit megaphone.fm/adchoices

Today I discuss how Dr. Bill Hennessey of Pratter, Inc. is already forcing price transparency in the market for health care products. He helps self insured businesses and unions save money by showing them lower cost alternatives for their members. By showing the price for every imaging exam, lab, etc. in town it is then easy for people to decide where to go to get the best price. Without any laws this is the sort of market disruption that will revolutionize health care as we know it. Learn more about your ad choices. Visit megaphone.fm/adchoices

A new phenomenon of the 21st century is the online attack. This is where people launch a coordinated attack on a business with the intent on destroying its reputation. The attackers hit you on Facebook, Yelp, Google Reviews and aren't interested in a discussion - just destruction. This can be very damaging to a business but also it causes many doctors and professionals to withdraw from the public square.j Dr. Todd Wolynn gives his personal story on the attack and how they won. And how you can win too. Learn more about your ad choices. Visit megaphone.fm/adchoices

In today's special Patreon release we enter the world of politics and discuss independent Rep. Justin Amash from Michigan. I speak with Nathan Leamer, a former state house and federal staffer in Amash's office. This unique exposure to who Amash is as a person and boss leads to a better understanding of what his goals are in politics. We discuss Amash's run for Congress as an independent and whether if he instead chooses to run for president as a Libertarian - can he actually win? Learn more about your ad choices. Visit megaphone.fm/adchoices

Pharmacy Benefit Managers (PBM) have been villains in earlier episodes. Basically, PBM are the largest health care corporations in the US and exert tremendous lobbying pressure. Although their role in health care is to settle claims they make their billions through a complicated series of kickbacks and rebates from drug companies. My guest today is Vinay Patel, a pharmacist who was frustrated by the actions of the PBM and decided to do something about it. Learn more about your ad choices. Visit megaphone.fm/adchoices

It isn't often that people walk into hospitals and ask themselves how does this thing work? In fact, the same can be said for those who work in hospitals too. Whether you're a doctor, nurse, phlebotomist, orderly, or patient - how the whole enterprise works is usually a mystery. Also, what protections are there for patients so that they don't have people who are grossly negligent or dangerous caring for them like what happened with the famous case of Dr. Death - Dr. Christopher Muntsch of Texas. Learn more about your ad choices. Visit megaphone.fm/adchoices

The beginning of a new year is always a good time to reflect on the medical trends on where we've been and where we are going. What are the positive and negative medical trends we're seeing right now. Despite all the negativism about health care I believe that there is much to be hopeful about whether you are a patient or physician. Of course, there is no shortage of potential policy misadventures that could make things much worse too. I discuss both the good and bad medical trends in this episode. Learn more about your ad choices. Visit megaphone.fm/adchoices

As sure as life exists, death will follow. As such, people will continue to try to control not only their life but the circumstances of their death. Life is also full of instances of suffering, pain, and despair. Those who are in significant pain, the throes of depression or despair may not see any solution to suffering except taking their own life. The questions then come down to whether we need to have doctors involved and whether we should encourage those looking to end their life. Learn more about your ad choices. Visit megaphone.fm/adchoices

Many physicians and those supportive of markets in medicine are making a big deal on Trump's proposed executive order to increase price transparency in hospitals. The thinking is that by exposing how much each hospital charges for their services, hospitals will begin to compete on price and the cost of care will go down. Although I believe this to be an admirable goal, I think it is very shortsighted to think that a law or order without a significant market demand will change the behavior of hospitals. Learn more about your ad choices. Visit megaphone.fm/adchoices

One of the most common questions I get asked about the health care system is why are medical bills so enormous? It seems strange that the explanation of benefits you receive after getting care or services are so obviously inflated. Yet those charges which the hospitals, health care professionals, and pharmacies post are there to see which they clearly have no expectation of getting paid. Why does this happen? Learn more about your ad choices. Visit megaphone.fm/adchoices

If you own your own business, which physicians who are independent or run concierge or DPC practices do - you need to focus part of your time on branding and marketing. What words you use to describe yourself is critical to success and an important part of marketing and branding. I speak with Dr. Nitin Gupta about what he did with marketing to turn things around at his clinic. Learn more about your ad choices. Visit megaphone.fm/adchoices

One of the most expensive ways to receive care in the US health care system is thru an emergency room. The use of urgent care centers is a less expensive alternative. Unfortunately, one of the problems with urgent care centers is that the care is often not very good. It is especially poor when it comes to treating children where the average urgent care refers 40% of its patients to the ER even though about half receive no special treatment. Learn more about your ad choices. Visit megaphone.fm/adchoices

Moving from academic medicine to private practice is a scary thing to do for any doctor. But what is it like for a specialist is the city with the highest concentration of her specialty to find patients? My guest today is Dr.Rudrani Banik, who treats patients with vision disturbances, headaches, and other neurological conditions related to the eye. By leaving academics (partly since she still does research) and striking out on her own, she recognized the need to do more than just practice medicine. Learn more about your ad choices. Visit megaphone.fm/adchoices