MEDICAL EXAM OVERUSE

  Medical exam overuse occurs when tests are ordered with little or no clinical benefit, increase spending without improving health outcomes or carry a risk of harm that outweighs the potential benefit of doing said exam. 

This problem is driven by factors such as lack of knowledge about test utility, defensive medicine, financial incentives, and patient demand. Overuse leads to wasted healthcare resources and can result in the overtreatment of conditions that might never have caused harm. 

EXAMPLES OF OVERUSE EXAMS

SINUS CT SCANS: Ordering CT scans for every case of uncomplicated acute sinusitis is often considered overused, as other treatments are more appropriate. 

ALLERGY TESTING: Certain diagnostic tests for allergies, such as indiscriminate immunoglobulin G (IgG) or immunoglobulin E (IgE) testing, are frequently cited as overused

SOME CANCER SCREENINGS 

     PSA- While screening is important for some excessive or inappropriate screening can lead to the overdiagnosis of indolent cancers. 

MAMMOGRAMS:

  The United States Preventive Services Task Force (USPSTF) recommends biennial (every two years) screening mammography for women 70-74 and they are not recommended after 75

There's a great deal of waste and abuse in our Medicare system. Medicare waste refers to the inefficient or improper use of resources within the Medicare program, leading to unnecessary costs. It encompasses a range of issues, from excessive or unnecessary services to outright fraud. One area that is a huge issue is over-ordering of diagnostic tests and medications.

Concerns about over-ordering of diagnostic tests in seniors over 70 are significant and increasing. Over-ordering of diagnostic tests in seniors over 70 is a complex issue with significant consequences. Addressing this challenge requires a multi-disciplinary approach that includes educating both physicians and patients.

For example:
Mammograms for women over 72 with a history of normal screenings and no symptoms no longer need testing.

PSA testing for men over 70 is no longer recommended, depending on risk factors and history

Over-ordering of medications, or polypharmacy, is a significant concern for seniors over 70. This is defined as the regular use of multiple medications, typically five or more, for various health conditions.  

Here's a breakdown of the key aspects of polypharmacy in older adults:

1. Prevalence and risks

• Increased Risk with Age: As individuals age, the likelihood of developing chronic conditions and being prescribed multiple medications rises significantly.
• Adverse Drug Events (ADEs): The risk of ADEs increases with the number of medications taken. These can range from minor side effects to serious drug-drug or drug-disease interactions.
• Falls and Cognitive Impairment: Polypharmacy is associated with a higher risk of falls, fractures, kidney impairment, frailty, and cognitive dysfunction.
• Reduced Quality of Life: Taking multiple medications can impact a senior's daily life, affecting their ability to participate in social activities or exercise due to side effects or complex dosing schedules. 

2. Contributing factors

• Multiple Healthcare Providers: Seniors often see multiple specialists, who may prescribe medications without full awareness of other medications the patient is taking.
• Chronic Conditions and Guideline-Driven Care: Guidelines for managing individual diseases often recommend specific medications, which, when applied to patients with multiple conditions, can lead to polypharmacy.
• Prescribing Cascade: Side effects from one medication can be mistaken for a new condition, leading to the prescription of another medication to address those side effects, creating a cascade of prescriptions.
• Automatic Refills and Lack of Review: Medications may be refilled automatically without regular review to ensure continued necessity.
• Patient Expectations: Patients may expect or even request medications for every ailment, contributing to over-prescribing.
• Marketing and Promotion: Pharmaceutical marketing and direct-to-consumer advertising can encourage patients to inquire about specific drugs, even if they aren't the best option. 

3. Addressing the issue

• Deprescribing: This proactive process involves identifying and discontinuing or reducing the dose of medications that are potentially inappropriate, no longer necessary, or whose risks outweigh their benefits, according to the National Institute on Aging (.gov).
• Medication Reconciliation: This involves creating and maintaining an accurate and up-to-date list of all medications a patient is taking, including over-the-counter drugs, supplements, and traditional remedies, especially during transitions in care.
• Patient Education: Seniors and their caregivers need clear information about their medications, including purpose, dosage, administration, potential side effects, and risks of drug interactions.
• Involving Pharmacists: Pharmacists, particularly those with specialization in geriatric care, can play a crucial role in medication management, conducting reviews, identifying discrepancies, and educating patients.
• Shared Decision-Making: Discussions about medication use, including deprescribing, should involve the patient, family (if appropriate), and healthcare providers to align decisions with patient preferences and goals.
• Technological Aids: Tools like medication management apps, smart pill dispensers, and electronic health records can help improve adherence and simplify complex regimens, according to Washington State University.
• Policy and System-Level Changes: These include improving information and training for healthcare professionals, encouraging regular medication reviews, and promoting value-based payment models that reward deprescribing when appropriate. 

4. Importance of communication and continuity of care

• Open Communication: Effective communication between all healthcare providers involved in a senior's care is essential to avoid conflicting prescriptions and ensure a comprehensive understanding of the patient's medication regimen.
• Seamless Transitions of Care: Accurate medication reconciliation and clear communication during transitions (e.g., from hospital to home) are crucial to prevent medication errors and ensure continuity of care. 

In essence, addressing medication overload in seniors requires a multi-faceted approach, involving improved patient education, proactive medication management strategies like deprescribing and reconciliation, and a collaborative effort among patients, caregivers, healthcare providers, and policymakers

HIDE N SEEK

 

Oh this is just too darn cute and made me smile remembering how our sweet Sophia just loved to play Hide-n-Seek. She wanted to play it for hours, didn't matter that I couldn't get into the really neat hiding places. 

WHY PEOPLE WEAR A RED POPPY

 

Have you seen people wear a red poppy and wonder why?

It is a symbol of both Remembrance and hope for a peaceful future. Poppies are worn as a show of support for the Armed Forces community.

Millions of people in the United Kingdom, Canada, France, Belgium, Australia, and New Zealand wear red poppies during November to commemorate the anniversary of the 1918 armistice. Some in the U.S. such as many coaches and staff of the NHL wear them as well.

DIFFERENCE BETWEEN VETERANS DAY AND MEMORIAL DAY

 

Do you know the difference between Veterans Day and Memorial Day?

Veterans Day Honors all veterans who served in the military, in wartime or peacetime while Memorial Day honors those who died in service

Veterans Day was originally called Armistice Day and was celebrated to commemorate the end of World War I in 1918. In 1954, Congress and President Dwight D. Eisenhower changed the name to Veterans Day to honor all veterans.

WITH GREAT RESPECT AND GRATITUDE I THANK ALL VETERANS!!

P.O.W RECOGNITION DAY -- THIRD FRIDAY IN SEPTEMBER

 

National POW/MIA Recognition Day is observed on the third Friday in September.

We honor the brave men and women who were prisoners of war and those still missing in action. Their courage and sacrifice will forever be remembered, and their families' strength will never be forgotten.

THE LOST ART OF COMMUNICATION

 

Two ways to surprise a friend or loved one that will make them happy and cost you nothing but a bit of time.

1. Give a friend or loved one a call.
2. Go visit a loved one, especially one who may be homebound and lonely.

Many people in today's society have lost the ability to communicate and sadly, many young people will never learn the basic principles, joy and importance of communication. Instead of being connected to each other people have created a bond with the online world which robs them of the most important aspects of interpersonal communication; tone of voice and body language. Less than 10% of effective communication comes from words while about 90% comes from tone of voice and body language.

Letters no longer written or received, notes to a friend no longer a fun thing to do, phone calls and visits to friends and family seldom done leaving many people forgotten and completely alone in a world numb to the feelings, needs and intention of others.

The process of putting your thoughts and feelings into words then taking the time to write them down or make a phone call is far more personal and thoughtful and creates a stronger bond than clicking a like button, texting or emailing and are much more appreciated by the receiver.

It seems, in today's world, if you are not posting about your life online many people think you have no life. Many people think having hundreds of so-called friends increases their self worth. Most importantly many people feel it is important to post every aspect of their life rather than share the events of their life with a phone call or face to face interactions with their loved ones.

Social media does have a place in our society. Connecting with vast numbers of strangers for business purposes is certainly a positive outcome. The ability to share photos and events with those far away certainly is a positive aspect but this does not negate the importance of actually talking to or visiting with those we claim to be near and dear. 

TIDBIT ABOUT OCTOBER

 

October was originally the eighth month.
Octagon, octopus… most words that begin with the Latin prefix “Oct” have some connection to the number eight. For the ancient Romans, who created the earliest form of the calendar we use now, October was originally the eighth month.

In ancient Rome, the year began in March and ran through December, with the first four months named for Roman deities. The next six months had more straightforward, numerical names that referenced their place in the year. The remaining weeks of winter (which would eventually become January and February) were largely ignored on paper; when the harvest season ended, so did the calendar, until the next spring planting season rolled around.

Over time, the calendar expanded by two months; January and February were added around 700 BCE

APRIL FOOLS DAY

 

HAPPY APRIL FOOLS'

Some historians speculate that April Fools’ Day dates back to 1582, when France switched from the Julian calendar to the Gregorian calendar, as called for by the Council of Trent in 1563. In the Julian Calendar, as in the Hindu calendar, the new year began with the spring equinox around April 1.

People who were slow to get the news or failed to recognize that the start of the new year had moved to January 1 and continued to celebrate it during the last week of March through April 1 became the butt of jokes and hoaxes and were called “April fools.”

V E DAY--MAY 8, `945

 

Today is May 8 and in 1945 it became V-E Day - Victory in Europe Day. It is the day we celebrate the formal acceptance by the Allies of World War II of Germany's unconditional surrender of its armed forces.

Remembering World War II history is crucial because it helps us understand the causes and consequences of such a devastating global conflict, learn from past mistakes, and hopefully prevent future atrocities.

D DAY

 

Let us Never Forget
D-Day, the Allied invasion of Normandy, France, is today and it is the 81st anniversary of this pivotal moment in World War II

D-Day was the name given to the June 6, 1944, invasion of the beaches at Normandy in northern France by troops from the United States, Canada, the United Kingdom and other countries during World War II. France at the time was occupied by the armies of Nazi Germany, and the amphibious assault—codenamed Operation Overlord—landed some 156,000 Allied soldiers on the beaches of Normandy by the end of the day. Despite their success, some 4,000 Allied troops were killed by German soldiers defending the beaches. At the time, the D-Day invasion was the largest naval, air and land operation in history, and within a few days about 326,000 troops, more than 50,000 vehicles and some 100,000 tons of equipment had landed. By August 1944, all of northern France had been liberated, and in spring of 1945 the Allies had defeated the Germans. Historians often refer to D-Day as the beginning of the end of World War II

MEDICAID FRAUD

This one change in Medicaid is long, long overdue. Heck when I did home visits years ago I saw so much fraud and raping of the system it was mind blowing.

The biggest take away from Medicaid changes
Most coverage losses are expected to come from the GOP’s proposed work requirement. People aged 19 through 64 will be required to work, volunteer or go to school for 80 hours per month (not even fulltime work folks) in order to qualify for Medicaid under the new law. They’ll be exempt if they’re disabled, pregnant or parent a child who is 14 or younger.

Other changes to try and curtail fraud
1. States will need to verify a person’s income to check Medicaid eligibility every six months.
2. States will be required to check enrollees’ addresses and death records more frequently.
3. States that offer Medicaid coverage to cover immigrants who may not be here legally will also receive less money from the federal government

 

SIMPLE WORDS TO USE EVERYDAY

 

Simple words/phrases we all should use more often and parents/educators should insist children learn and use. Unfortunately number 7 is most often replaced these days by what it is in it for me?

KIDS TODAY

Sadly kids don't even learn to ride bikes or play outside anymore, they learn how to text and watch other kids on YouTube, usually in very inappropriate situations or poor examples of family interactions and behaviors.

So many youngsters will never know the fun of bike riding, making forts, playing backyard ball or making mud pies, dancing in the rain, etc. all while building lifelong friendships

Group play is so important. Get kids outside with friends and/or involved in a sport. Group play is more than just play, it is crucial for children's development, fostering essential social, emotional, and cognitive skills. It provides opportunities to learn cooperation, communication, empathy, and conflict resolution, all while having fun and building friendships

 

LABOR DAY

 

Sadly in our new world of what's in it for me many of our children of this era will not even know the milestones and sacrifices made by our forefathers to help build our country.

The purpose of Labor Day is to recognize and celebrate the social and economic achievements of American workers and the labor movement, which fought for improved working conditions, fair pay, and safety during the Industrial Revolution. While it is a national holiday granting a day off, it also serves as a reminder of the sacrifices made for workers' rights and the ongoing importance of labor in building the nation's strength and prosperity

RESPECT OUR FLAG

 

A folded American flag represents reverence, remembrance, and respect for the nation's history, values, and those who have served it, with each of the 13 folds carrying specific symbolic meanings related to life, eternal life, veterans, faith, the country, and its people.

The triangular shape of the folded flag is also symbolic, reminiscent of the cocked hats worn by soldiers during the Revolutionary War, representing the sacrifices made to preserve the freedoms Americans enjoy today.

HELPING OTHERS

When you put others before yourself, it's called being selfless, which means you show unselfish concern for others.

 

SOCIAL MEDIA FALSEHOODS

 

Please folks, stop believing everything you read online. You can easily check for reputable source material via a Google search before getting suckered in.

Social media platforms are notoriously loaded with false information, driven by algorithms that reward engagement over accuracy and human psychology that makes misinformation more compelling. The viral nature of these platforms allows falsehoods to spread rapidly, with serious consequences for public health, democracy, and social cohesion

The data on the chart in the pic is from research conducted by Reuters Institute-Digital News Report 

AI

 

Yep, just let that sink in then ponder the pros and cons of advanced computer systems and AI and the impact on humanity

I sure hope this type of research helps to generate new mindsets in our schools that results in teaching writing and even math . Technology has a place in our schools but first teach our kids how to actually do and think on their own.

I had many students who would complain about having to learn how to calculate dosages or IV drip rates or take vital signs the "old fashioned" way or how to even write their notes (the computer auto fills, blah, blah, blah). My reply was always the same--Imagine you have a power outage and you are in a situation with no backup generator or your equipment is malfunctioning. Now ask yourself, how will you provide care to your patients 

BLACK FRIDAY

 

 

Okay, I know many of you think me crazy but I still look forward to our Black Friday tradition. I have been getting up around 4am to hit the stores since I was a teenager. Once Samantha was old enough to enjoy it with me we made it our mommy-daughter tradition and have been doing it for nearly 30 years and I hope I can still do it when her girls are old enough to join in.

Over the past few years retailers have slowly chipped away at the one day phenomenon known as Black Friday and now they have week long Black Friday deals or even month long. I understand the rationale, I just prefer the old Black Friday

My sneakers are ready--Come on Black Friday LOL

PARTICIPATION TROPHIES

 If you lost, you shook hands.

If you failed, you tried again.
If you came up short, you heard,
“Life’s tough… but so are you. Try harder next time.”
It didn’t break us.
It didn’t crush our spirit.

If anything, it built something inside us — grit, respect, accountability, and the understanding that effort matters.
And maybe that’s why so many of us appreciate hard work, discipline, and earning things the right way.

GROWING UP IN THE 60S--LIFE LESSONS

Psychology says people who grew up in the 1960s learned 8 life lessons that are rarely taught today

1. Boredom became the birthplace for creativity--
My parents’ response to complaints of boredom was consistent: “Go find something to do.”
Many at the time felt like this was a form of neglect. Now psychologists recognize it as something valuable. Research from the Child Mind Institute shows that boredom helps children develop planning strategies, problem-solving skills, and flexibility. When kids must figure out how to entertain themselves, they exercise cognitive muscles that constant stimulation never builds.

2. Failures were allowed to sting
Kids weren't handed participation trophies back then parents acknowledged losses and disappointments, but they didn’t treat it like a crisis.
The message was clear: this is how life works sometimes.
“Life isn’t fair” wasn’t a cruel dismissal. It was preparation.

Experiencing failure without excessive cushioning taught my generation that setbacks aren’t permanent catastrophes. Research confirms that when children are given opportunities to struggle and sometimes fail, they develop critical coping and resilience skills. Children who never encounter manageable failure often lack the confidence that comes from knowing they can recover.

3. Waiting was a normal part of life aka patience is a virtue
Nearly everything in our day required patience. Want that new bike? Save your allowance. Excited about the next episode of your favorite show? Wait until next week. Need to look something up? Get yourself to the library

But the famous marshmallow experiments conducted by Walter Mischel in the 1960s and 1970s at Stanford demonstrated that the ability to delay gratification predicts better outcomes in academic performance, health, and life satisfaction decades later.

We couldn’t stream anything. We couldn’t order anything with next-day delivery. We couldn’t get answers to questions without effort. This wired our brains differently, building what psychologists call stronger executive function, the ability to control impulses and work toward long-term goals.

4. Unsupervised play was normal
From the time I could walk, my world expanded in concentric circles. First the backyard. Then the front yard. Then across the street and finally the block. Eventually the entire neighborhood became our territory, governed by kid-made rules and kid-enforced justice.

There were no adults rushing in to mediate conflicts or supervise our adventures. We climbed trees that could have killed us. We built forts with questionable structural integrity. We navigated social dynamics without parental interference. We worked out our differences and were able to navigate issues among ourselves

Research published in Scientific American confirms that this kind of free play is critical for developing social skills, stress management, and problem-solving abilities. Without constant adult supervision, children develop risk tolerance, independence, and the confidence that comes from figuring things out themselves.

5. Adults were not always available
When I came home from school, I let myself in, I made my own snack, I started my homework without being asked, did whatever chores I needed to do, I figured things out.

6. We witnessed and experienced real life
Experiencing grief and loss was a normal part of life. Pets just didn't disappear, loved ones didn't go off to some exotic place. We witnessed and experienced loss and grief. Allowing children to be a part of the process helps them to cope later in life

7. We learned by doing not by being told
Parents didn’t lecture about the value of hard work. They showed by example, leaving before dawn and returning after dark, never complaining. Kids watched as their legal immigrant grandparents built a life from nothing, their actions speaking louder than any advice they might have offered.

Values were transmitted through observation rather than instruction. We watched adults navigate difficulties, make decisions, treat others with respect or disrespect, and we absorbed those lessons unconsciously.

Psychologists call this modeling, and it remains one of the most powerful forms of learning. The lessons that shaped our character weren’t taught in formal settings. They were caught through countless small moments of watching adults live their lives.

8. Community was our safety net
Every adult in the neighborhood had implicit permission to correct any child’s behavior. The lady next door would scold us for cutting through her garden. The man across the street would tell our parents if he caught us doing something dangerous.

We grew up understanding that we were part of something larger than our individual families. There were shared expectations, shared responsibilities, shared investment in how the next generation turned out.

That sense of interconnection has largely evaporated. But those of us who experienced it understand something about human flourishing that isolation can never provide. We’re social creatures who thrive when embedded in webs of mutual obligation and support.

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