health
Opinion: BMI should not be used to gatekeep orthopedic surgery
Here's a scenario that's all too familiar to endocrinologist Jody Dushay: a patient with high body weight and BMI needs a new knee. The surgeon says the patient has to lose 50 pounds first. But! Because the patient has a bad knee, and therefore suffers from chronic pain and immobility, it's impossibly hard to lose weight — even when taking the new weight-loss drugs everyone is raving about (if the patient can get them).
"Why is there a knee-jerk response by many orthopedists to deny joint replacement surgery to people above a certain BMI (usually 35)?" Dushay asks in a new First Opinion. When she looks at the research, it's unwarranted. "I wish the orthopedic and medical communities could be on a joint mission to see people as entire individuals, not a number on a scale, when deciding who gets what treatment and when," she writes. Read more from Jody on why refusing surgery based on BMI is not the right strategy.
health care
Vacations are necessary medicine for burned-out doctors
Few professions allow for as much vacation time as, say, an international pop star. But for doctors, a lack of vacation time — and then having to work anyway when they do take time off — is associated with higher rates of burnout, according to a new study published Friday in JAMA Network Open.
Researchers performed a cross-sectional survey of doctors in the U.S. between 2020 and 2021. Among over 3,000 respondents, about 60% had taken fewer than 15 vacation days in the year prior. While on vacation, 70% found themselves working at least 30 minutes per day. Taking more vacation was, perhaps predictably, associated with less burnout among doctors. More specifically, so was getting a complete break from the electronic health record inbox — part of the job that many doctors have lamented.
More institutional effort is needed to provide clinical coverage for doctors while on vacation, the researchers wrote. Burnout is a major problem in health care — in a First Opinion from 2020, Sudhakar Nuti wrote that she felt fundamentally changed by burnout: "I feel like I've gone from doctor to debris."
health
Chronic inflammation plus poverty makes for "double whammy" of mortality risk
A 40-year-old who suffers from chronic inflammation has a higher mortality risk than one who doesn't. A 40-year old who lives in poverty has a similarly higher mortality risk than those who don't. But a person who experiences both? They have more than double the risk of dying within 15 years from heart disease and almost triple the risk of dying from cancer within that period compared to people who experience neither, according to a new study published in Frontiers in Medicine. The two factors operate "synergistically," creating a "double whammy," lead author Arch Mainous III said in a press release.
Mainous and his team analyzed nationally representative survey data of adults ages 40 and over, representing about 95 million people. Further research is needed to better understand the clinical relationship between the two factors, they wrote, especially in order to consider potential future screening practices and research.
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