Morning MEDtalks with Dr KK Aggarwal 14^th November 2018

Proper delegation can help avoid litigation: In the complicated maze of medical referrals and authorizations, a physicians reliance on a competent staff to work with benefit providers to complete any necessary paperwork is eminently reasonable. In the end, though, the patient will look to the physician as the one ultimately responsible for completing the task. Even if you think paperwork has been completed, its best to check to avoid errors in patient care. Ensure that everyone in the practice understands their duties and responsibilities up front, and review procedures regularly to solidify understanding of all necessary tasks… (Medscape)

The US National Rifle Association (NRA) may have picked the wrong fight when it took on the physicians. After reading an American College of Physicians (ACP) position paper on how to reduce firearm deaths that was published online in the Annals of Internal Medicine, the gun rights organization on November 2 published a takedown of the paper, concluding, "The ACP is apparently only interested in pseudo-science evidence that supports their preferred anti-gun policies."

The NRA then posted a tweet on November 7 that was as sure to get attention as it was to rankle many physicians: "Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves." This tweet from the NRA unleashed a tweetstorm from physicians who quickly grouped their responses under the hashtag #ThisIsOurLane.

Eric Toschlog, MD (@etoscho) tweeted, "I am a trauma surgeon and a gun owner. I took an oath. I own this lane."

Emergency department physician Elizabeth Meade, MD (@EMeadeMD), responded, "My lane is the ER when kids come in shot in the face. When we tell parents they wont walk or are going to die. Were not anti-gun, we are anti-preventable death. We want #safestorage, [lower] #suicide deaths. We want to talk about firearm safety. We want our patients to survive." (Medscape)

Adolescent obesity is associated with up to a four-fold increased risk of future pancreatic cancer. Overweight and even higher weight within the "normal" weight range in men may increase pancreatic cancer risk in a graded manner, according to a study published in the journal Cancer.

US Department of Health and Human Services (HHS) includes preschoolers for the first time in the 2^nd edition of its guideline on physical activity for Americans, which says that regular physical activity has health benefits for everyone, regardless of age, sex, race, ethnicity, or body size. The recommendations published Nov.12, 2018 in JAMA are:

1. Preschool-aged children (3 through 5 years) should be physically active throughout the day to enhance growth and development.
2. Children and adolescents aged 6 through 17 years should do 60 minutes or more of moderate-to-vigorous physical activity daily.
3. Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. They should also do muscle-strengthening activities on 2 or more days a week.
4. Older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities.
5. Pregnant and postpartum women should do at least 150 minutes of moderate-intensity aerobic activity a week.
6. Adults with chronic conditions or disabilities, who are able, should follow the key guidelines for adults and do both aerobic and muscle-strengthening activities. 

Of all human diseases, 60% originate in animals; “One Health” is the only way to keep antibiotics working, says WHO. “Human, animal and environment health are all equally responsible for the correct use of antimicrobials and to avert the threat of antimicrobial resistance,” said Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “As we strive to ensure that antibiotics are rightly used in the community and in health-care settings, one sector alone will not solve the problem. A ‘One Health’ approach brings together professionals in human, animal, food and environment health as one force, and as such is the only way to keep antibiotics working. I call on all European countries to secure the highest commitment to this approach from the whole of society and the whole of government.” (WHO Europe)

Polypharmacy and legacy prescribing raise risks for drug interactions as well as adverse reactions to individual medications. Such effects include falling, poor nutrition, and altered cognition. With more prescriptions to manage daily, patients may face adherence challenges and risk skipping or taking extra doses. "Legacy prescribing" is the prescribing of drugs for a longer period than is typically needed to treat a condition. The primary care setting is a source of legacy prescribing because it is the coordinating center and gatekeeper for managing patients with multiple morbidities, Dee Mangin, MBChB, DPH, FRNZCG, from McMaster University in Ontario and the University of Otago in Christchurch, New Zealand, and colleagues write in the Annals of Family Medicine… (Medscape)

Cancer appears to be overtaking heart disease as the leading cause of death in the US, especially in higher-income populations, according to an observational study of 12 years of county mortality records published in the Annals of Internal Medicine.

Video to watch: TEDx Video: Doctor-patient relationship www.youtube(dot)com/ watch?v=i9ml1vKK2DQ

Dr KK Aggarwal

Padma Shri Awardee

President Elect CMAAO

President Heart Care Foundation of India