Sometimes it’s a look.

A line.

A moment that lands deeper than diagnosis.

This brief essay is a collection of those moments.

Brief.

Unexpected.

And always real.

“The Healing Power of Touch: A Patient’s Insight”

This week, a patient shared a poignant realization that emerged after years of emotional distance from his wife.

They had grown apart, but recently discovered a shared need: the simple, profound act of touch.

He reflected on how a gentle hug or a reassuring hand on the shoulder seemed to bridge the emotional gap between them.

“I think we’re wired for this,” he mused, referencing hormones like oxytocin that respond to physical affection.

His insight aligns with scientific findings.

Oxytocin, often referred to as the “love hormone,” plays a crucial role in social bonding and emotional connection.

Studies have shown that affectionate touch can increase oxytocin levels, reduce stress, and foster feelings of trust and closeness.

In fact, research indicates that even brief moments of affectionate touch can lead to measurable increases in oxytocin, a hormone that contributes to an improved mood and reduced anxiety.

This finding underscores the biological underpinnings of our need for physical connection.

My patient’s experience serves as a reminder that sometimes, healing in relationships doesn’t require grand gestures — just a touch of understanding, quite literally.

For more reflections on connection at the edge of life, read my essay: What Dying Men Confessed When No One Was Listening.

“The Prostitute’s Pasta”

In oncology, gratitude comes in many forms — thank-you notes, quiet nods, even tears.

But sometimes, it arrives as a steaming pan of pasta.

One of our patients, an older Italian gentleman with a twinkle in his eye and impeccable taste, has taken to feeding the staff.

Not metaphorically — literally.

Lasagna, tiramisu, and even delicate cannoli are dusted with sugar like freshly fallen snow.

Today, he arrived bearing a new dish. “Pasta Puttanesca!” he announced proudly. “You know — the prostitute’s pasta.”

A pause.

Then laughter. Nurses chuckled. My medical assistant nearly dropped her stethoscope.

He winked. “They say it was made quickly, between clients.”

I’ll leave the etymology to linguists.

But I can tell you this: the olives were briny, the sauce was bold, and the gratitude was unmistakable.

This event was something else entirely in a world often defined by scans and side effects.

A recipe for connection.

Served al dente.

Note: For patient privacy, I have modified some details.

Here are my previous Clinic Notes essays:

1. Clinic Notes 5/18/2025
2. Clinic Notes 6/26/2025

Want more stories like these — plus the science behind living longer and better? I’ve distilled the most powerful lessons from oncology, aging research, and patient wisdom into my new ebook: Extending Life and Healthspan.

Practical, evidence-based, and full of humanity.

The post Clinic Notes: What My Patients Said This Week appeared first on Medika Life.

In her first book, Fragmented: A Doctor’s Quest to Piece Together American Health Care, published by W. W. Norton, Dr. Yurkiewicz explores one of medicine’s daunting challenges – how patients, payers, policymakers, and providers must navigate the sea of medical record information that can be used to accelerate or become an obstacle in medicine’s primary mission – to heal.

Suppose we continue to avoid addressing the pitfalls of health-sector fragmentation. In that case, it will continue to increase costs, result in unnecessary hospital visits, negatively impact patient adherence and care disparities, and, even worse, lead to death.

Other bestselling books champion the concept of patient centricity – with information used to address medical needs swiftly.  But what information is available and how it is accessed remains a human function – a system-wide hurdle.  The desire to be healed and the readiness of healers to answer that call still faces a significant challenge – fragmentation.

“There’s an unspoken assumption when we go to see a doctor: the doctor knows our medical story and is making decisions based on that story. But reality frequently falls short. Medical records vanish when we switch doctors. Critical details of life-saving treatment plans get lost in muddled electronic charts. The doctors we see change according to specialty, hospital shifts, or an insurer’s whims. Physician Ilana Yurkiewicz calls this phenomenon fragmentation, and, she argues, it’s the central failure of health care today.” [W. W. Norton]

Medika Life offers readers this exclusive interview with Dr. Ilana Yurkiewicz, an award-winning author and dedicated physician with expertise in internal medicine, oncology and hematology, who unites the story of patients and physicians working to overcome one of the more significant challenges modern medicine faces. In her book, which outlines how information goes unshared, she highlights how “Critical details of life-saving treatment plans get lost in muddled electronic charts. The doctors we see change according to specialty, hospital shifts, or an insurer’s whims,” providing a much-needed perspective.

The Journey of a Physician-Author – To Illuminate and Heal

Gil Bashe: Congratulations on your work. Fragmented is a word I’ve used to describe the health ecosystem. You eloquently bring it all together in your book. You have been a journalist since your undergraduate years and now combine your love of medicine with writing. Could you give me some insight as a clinician, as a physician why you also wanted to be an author?

Ilana Yurkiewicz: I’ve always had those two careers going on in parallel. I knew from an early phase when I was in college that I wanted to become a doctor. I was always interested in both the sciences and the humanities. My interests were in combining them to make science and medicine accessible to everyday people.

I was a writer and an editor for the Yale Scientific Magazine, and since then, I’ve written in long and short form. I see the skill set I use in medicine and journalism as overlapping. When I counsel patients, I try to take complex ideas and break them down into information nuggets that people can understand. I do that when I’m in the exam room and when I write.

Bashe: In your book, you demonstrate a unique superpower to hone in on the patient you’re with. Is the real challenge about lack of access to information uniformly, not giving the clinical staff sufficient time to absorb patient information or a combination?

EMRs are Not a Book – They Remain a Puzzle

Yurkiewicz: It’s a very insightful question with a very long answer, but the short answer is that it is a combination. The electronic medical record (EMR) is not currently written in a format that is readable and meaningful to most providers. We first have the issue of interoperability, which addresses sharing records between different facilities. Sometimes I work in my clinic or the hospital, and I don’t have access to records from a doctor’s office down the street. So one issue is that records go unshared.

The second issue, though, is that even when all of the data is technically there – even if it’s all in the EMR – the EMR, as it stands, could be more organized. It’s little bits of discrete data put in different tabs that providers have to click, click, click, click through, trying to find a meaningful narrative themselves. I often tell my patients that the EMR is not written like a book. There’s no beginning, middle, and end. There are a ton of redundancies. A recent study showed that about 60% of doctors’ notes are identical to their previous notes.

To understand a patient’s full story, you are doing a lot of digging and clicking. You are trying to put pieces together manually to create a useful narrative about a patient that can help you make decisions. That process is labor-intensive and error prone.

Thirty percent of primary care doctors report missing findings even if all the information is in the EMR, because they’re clicking through so many tabs and need to know where something will be stored. So that’s problems one and two: how the EMRs are shared and organized. Issue number three, then, is time. You can imagine clicking through, say, 30 tabs to find one piece of data you’re looking for and then clicking into outside records and trying to collate them takes time.

When I meet a new patient in the clinic, if I’m doing it right, it takes about 30 minutes to do the preparation part of collating all the data into a narrative where I can think about next steps. And I’m only given 30 minutes per appointment.

So all this work starts accumulating for doctors, and we’ve gotten to a place where it’s unsustainable. We don’t have the time even if all the data is in one place. We need more time to sort through it in a meaningful way. I’ll add that one more study recently said that if primary care doctors did everything they’re supposed to do in a day, they would be working 26 to 27-hour days.

The Challenge of Navigating the Fragmented Health Ecosystem

Bashe: In the book, you discuss your interactions with patients across institutions like Cleveland. I wanted to get your read on the bigger fragmentation of the health system. When you think of information fragmentation, you say, ‘How does a patient navigate all this?’ How do you navigate the fragmentation as a clinician? You’re an expert in knowing the system and a visitor to the system. What do you think about that? I’m not asking you for the prescription to resolve fragmentation, but I think the readers would value your perspective on how patients must navigate the system.

Yurkiewicz: How do people do it? With incredible difficulty. Doctors do it with great difficulty, and patients do it with even more difficulty.

All sides need to communicate in a way that can help patients make the best decisions for themselves. At the same time, the cruel twist of irony is that patients are the ones who are currently expected to do all of the work of navigating the healthcare system, and inequalities fester. Some patients have become experts at navigating insurance and their different clinics and teams of doctors. They have learned to advocate for themselves by sending just the right message with phrasing that will push their doctors to communicate well. But not everybody can do that. And nor should they have to.

Recently one of my patients in her late 60s was diagnosed with mild cognitive impairment, which is a precursor to dementia. She lives by herself. She has no family to help her with day-to-day tasks, including navigating the medical system. She came to see me for a first appointment. I started running through a list of medical issues we had to address, and by the end, I gave her a to-do list. I wrote instructions down and said, ‘You call this number; you go to the lab in this location. Then you have to print out this data and bring it to the next place.’

I went through all these steps, and then she asked me them again. By the third ask, my heart was breaking as I knew she could not follow these steps; I could see the gulf of fragmentation enveloping her. I knew she would fall through the cracks if we didn’t change the approach. I simplified the list and put the highest-priority items on it. I said, ‘This time, do one and two, then come back to see me in a month, and we can try to address three and four.’

Tragically, our system is set up to let people like her fall through the cracks. The people who don’t have family members – patient advocates – are often unable to navigate this complicated system.

The Vulnerable Patient – Struggling to Understand and Be Understood

Bashe: Perhaps the most vulnerable and costly patients suffer because of the fragmentation. Now we have systems being created on systems that are being created on systems. What are your thoughts on how that addresses the spiraling fragmentation? Or are we just really adding to or splintering the fractured system? Is it getting further and further away from being pieced together, and are we seeing the rise of information anxiety or any hope of a cure for this fragmentation?

Yurkiewicz: We are seeing an explosion of fragmentation. We now have diagnoses and treatments for things that, 50 years ago, we never thought we could diagnose and treat. But the devil is in the details, and a patient’s ability to do well through a disease depends so much on what is often ignored – logistical hurdles.

The focus in the mainstream is often on treatment innovation rather than the details of whether the medication regimen is appropriately transferred from one doctor to another. Suppose the details of that life-saving treatment plan are written in a way in the EMR that everybody can see and access. Of course, it’s wonderful that we can treat illness better. But without an equal investment in connecting these logistical pieces, we are getting an explosion of information fragmentation, and patients can’t get the most out of these treatments.

I think in our public and political discourse, we need to emphasize equal investment in making sense of the information we already have and connecting it between doctors’ offices, between hospitals, and between one doctor to another within the same hospital.

The Power of Generalists and Specialists in Collaboration

Bashe: You’re focused on the human experience in medicine and oncology. You see medicine as the journey of a person – a patient – from their diagnosis, treatment, and then ideally post-treatment and dealing with the survivor experience. You’re also seeing your clinical journey through the eyes of the patient experience. How does that help you pinpoint fragmentation and help patients?

Yurkiewicz: Internal medicine is designed to look at the big picture.  I trained first in internal medicine and afterward in oncology and hematology. When I was done with all that training, which was 14 years, including undergrad, med school, residency, and fellowship, I decided to open a primary care practice focusing on cancer patients and survivors.

My job is to take care of the whole patient. I’m privileged to take care of their cancer and everything resulting from their illness and treatment even years later.

In my training, I learned to look at a fragment of a patient’s narrative from the specialist lens. So when I was in internal medicine, my vantage point was very different from when I was in oncology. When I became an oncology fellow, I felt like I had crossed this invisible line where my training told me to look for clues suggesting cancer or a blood problem.

And so I learned how to look for those clues and hone in on a patient’s needs using my specialist lens. I’ve had to retrain myself to take a step back and look at the big picture. I try to see the whole patient and embrace how their concerns fit together.

Neither Hope nor Hype – Cautious Optimism

Bashe: You were already a great writer of magazine articles and op-eds. You were published in Scientific American a few times. The book is coming out, and certainly, people in the health system will read the book very carefully realizing how significantly fragmentation impacts care and cost. Try to project that people will read your book a year from now.  What do you hope will be achieved through their experience of reading your words?

Yurkiewicz: There is a one-year goal and a longer-term goal. In one year, I want the book to help empower patients and family members to navigate the system better. I am an optimist, but unfortunately, I don’t think fragmentation in health care will be solved in one year. There are many factors and many incentives that make it very complex.

I’m hoping that in 20 years, my book will be closer to obsolete. Over the years, we can start to tackle each one of the factors of fragmentation toward a more sustainable healthcare system.

Bashe: Medicine is becoming increasingly specialized. Once upon a time, of course, gastroenterologists were gastroenterologists. Now you have clinicians at Stanford who only deal with the upper GI; others deal with the lower GI. You have cardiologists who are interventionalists. Others deal with lipids and so forth. Specialties pushed them to be experts. Are we getting to that level in medicine where doctors are becoming skilled in a tiny piece of the human body and patient experience?

Yurkiewicz: I once heard from a colleague in the sciences that we’re learning more and more about less and less until we know everything about nothing. And I wish that did not apply to medicine, but we’re heading in that direction because we promote specialization and sub-specialization.

For many reasons, it often leads to greater financial reward and respect within the medical hierarchy to become an expert in something narrow. And while specialization itself is not necessarily a problem, problems can arise when we have to reconcile different narratives that doctors tell themselves about a body part or an organ system.

Sometimes, no one person is looking at the whole patient, seeing if we can put the different narratives together into a unifying diagnosis or a unifying treatment plan.

I share in my book one story about a woman that I took care of in the hospital. She had leukemia and was very immunosuppressed due to chemotherapy, and she had an issue brewing in her lungs. She was gasping for air while I had to increase her oxygen support every day to the point that I had a frank conversation with her about whether she would want to go on a ventilator if her oxygen levels continued to worsen.

We had three teams of doctors on the case. There were infectious disease doctors, pulmonary (lung) doctors, and hematologists who specialized in her cancer. Each team came up with a perfectly reasonable assessment from their vantage point.

The infectious diseases team said, ’We’ve already treated her for most infections, so just throwing on an additional treatment is not going to help her. We’ve treated her with antibiotics and antifungals for a long time. We’ve treated the most highly likely things.’ And then the pulmonary doctors said, ‘Well, she already went to bronchoscopy. That didn’t reveal the diagnosis, so we shouldn’t do another one that’s going to be low yield, and it’s going to be risky because her platelets are low, and taking a biopsy could cause her to bleed.’

Meanwhile, the hematology team said, ‘She’s immunocompromised from chemotherapy. There’s no way to speed that up.’ Every single one of those analyses was perfectly sound. However, you put them all together, and we had a patient deteriorating before our eyes. Three narratives added up to say we should stay the course, which didn’t feel like a narrative that was the right one yet.

I share in the book what ended up happening to this patient, where I decided to treat empirically for the unlikely possibilities after each team ruled out the likeliest ones.

I don’t share this story to toot my own horn. But sometimes it takes somebody to take that step and say these reasonable assessments from each specialist’s point of view do not add up to a reasonable conclusion when taken together. An internist is trained to look for that big picture, but the empowering fact is that it can be a specialist who takes those proactive steps to look at what other specialists say about their patients and consider whether it adds up to a reasonable conclusion. It can even be patients and their family members at the bedside who advocate for their teams to come together and reconcile their assessments.

Again, it was not specialization itself that caused this problem. But we have to take that extra step to ensure that specialists reconcile their clinical narratives in a way that makes sense for the patient.

How to Obtain Fragmented

The public health urgency in the shadow of the pandemic continues to reveal serious vulnerabilities. We see inequitable access to care and lopsided disease and mortality burden among diverse communities as another tragic manifestation of racial injustice. We read about an increasingly fragmented care-delivery system splintering even further as new technologies such as AI and ChatGPT create expectations that physicians should see more patients daily – not dedicate more time to each patient.

Dr. Yurkiewicz’s book is a welcome, first-hand objective look at this struggling health system dedicated to helping patients while awash in information.  Her candid expression of the patient and provider journey is vital in helping unite the disparate pieces.

Dr. Ilana Yurkiewicz’s book Fragmented: A Doctor’s Quest to Piece Together American Health Care, published by W. W. Norton, is available via the publisher, Amazon, and where all major books are sold.  Follow Dr. Yurkiewicz on Twitter and LinkedIn.

[Special thanks to Carolyn Neugarten, editorial assistant, Medika Life, for her keen eyes and comments. Coming from a healthcare household, her interest in journalism and social action accelerated the publication of this interview.]

The post The Book Fragmented is a Key Step Toward Navigating America’s Ailing Health System appeared first on Medika Life.

In the classic rat sleep deprivation trials, total sleep deprivation ended up killing the rats in 11-32 days. When the researchers deprived the rats of REM sleep, or commonly known as “dreaming sleep,” the rats also died, although they did survive for a longer time period, 16-54 days. Nevertheless, sleep deprivation is very detrimental, and when I was training as a sleep specialist, I learned about myriad health problems when people become sleep deprived.

So, when patients are admitted to the hospital, why do we wake them up in the early morning to draw blood tests? Yale University researchers studied this, and they found that nearly 40% of laboratory studies occurred between 4:00 AM and 6:59 AM:

The traditional thinking behind this is that, by the time the physicians and APPs come in to see their patients in the morning, usually at 7:00 AM, the blood tests are ready for them, and they can act on the findings of those blood tests to help care for the patients.

Yet, this begs the question: do we really need to get blood tests that early in the morning? Would care suffer significantly if those blood tests were drawn at, say, 8:00 AM? There should be enough time to act on any abnormal test results in the morning and before morning rounds. At my hospital, we round at 10:00 AM, and so if blood tests were drawn at 8:00 AM, they should be back by the time I round with the rest of the team.

As far as I can remember – and into today – “AM Labs” are usually drawn at 4:00 or 5:00 AM by default or even tradition. Unless the patient is comatose in the ICU, getting a blood test at 4:00 or 5:00 AM can disrupt the sleep of our patients, which can be very detrimental and can hinder their recovery from illness.

It can also precipitate delirium in our patients due to the sleep deprivation, the effects of which can also be very detrimental to the recovery of our patients. Moreover, it can also disrupt the sleep of the clinicians caring for those patients at night, who have to be awakened also at 4:30 or 5:00 AM to receive notification of critical results and act on them. This sleep disruption can also affect clinician well-being and burnout.

Good sleep is often the elusive treasure of a hospital stay. Many clinicians chuckle when they hear this, but it really is no laughing matter. It may be time to rethink the necessity of getting blood tests so early in the morning, so that our patients can actually get a good night’s sleep and be well on their way to a good recovery from illness.

The post Are Early Morning Laboratory Studies Really Necessary in Hospitalized Patients? appeared first on Medika Life.

That said, there is a general principle when it comes to treating patients – anywhere, actually – but especially the ICU: treat the patient and not necessarily just the number.

The heart rate may be fast at 125 beats per minutes. How does the patient look? Is she anxious? Does he have pain? Is there a fever? Is this an arrhythmia (abnormal heart rhythm) that needs treatment? Or, is there something else that is behind the abnormal heart rate?

The same can go for blood pressure. The number is low. But, once again, how does the patient look? Are they awake, alert, pink, and warm? Is the blood pressure reading truly accurate? What is their blood pressure normally? All of these factors need to be considered before prescribing potentially toxic medications to correct the low blood pressure.

The point is this: we need to take a holistic look at each of our patients and assess how the patient’s clinical appearance relates to whatever abnormal vital sign or laboratory value is present at that current time.

Now, of course, there are caveats to this general principle. There are some numbers, regardless of how the patient looks, that need immediate treatment. A serum potassium level of 7 – which is dangerously high – needs to be immediately treated no matter how the patient looks clinically.

The same goes with an abnormally low oxygen level: even if the patient looks “fine,” we need to give oxygen to someone who has a dangerously low oxygen level. Covid patients, in fact, routinely presented with oxygen levels previously thought to be incompatible with life but looked completely comfortable. I had never seen that before in my career. We still gave them oxygen, no matter how comfortable they appeared.

Still, in general, we need to treat the patient and not necessarily just a number. Yes, the numbers mean something, and we need to look at the entire clinical picture to figure out what is really wrong with the patient and fix that underlying problem.

In the ICU, I can make the abnormal numbers go away. I can give medications to “fix the number.” But that does not mean that I have treated the patient. Sometimes, “fixing the number” may make the patient worse.

The post ICU Rule #8: Treat The Patient appeared first on Medika Life.

Other colleagues called Poison Control, worried that she maybe ingested a toxic alcohol. I was incensed: “What are you talking about? She has sepsis! Get the antibiotics! Get the fluids!” I was on a tear in the Emergency Department.

I spoke to the Poison Control colleague (likely a physician in training), and he recommended I make sure she didn’t have any toxic alcohol ingestion (like wood alcohol or antifreeze) given how acidic her blood was. I rolled my eyes. “She has sepsis. I am absolutely positive.” He replied politely and said, “That is our recommendation. You can do what you want.”

I ordered a CT scan of her abdomen, fully expecting to see multiple abscesses like they were before. I was shocked: her abdomen was completely clean. I couldn’t believe my eyes. And while I was totally convinced it would be negative, a little voice deep down inside me said, “Maybe just check for an antifreeze level…just in case.” So, I ordered one.

The ethylene glycol (i.e., antifreeze) level came back very high. It turns out that my patient tried to commit suicide by drinking antifreeze, and she had dangerously high acid levels as a result. I, therefore, came back into the hospital from home to put in a special tube so she can get emergency dialysis. She did well after that and was discharged to an inpatient psychiatry facility.

I frequently share this story to highlight my ICU Rule #6: “Your Ego Can Be Dangerous.”

We can never let our ego get in the way of patient care. We need to always keep a sense of humility when dealing with the patients for whom we care. In this case, the Poison Control trainee was absolutely right. My patient did not have sepsis, but indeed had ethylene glycol (antifreeze) toxicity. I was wrong, and he was right.

In other cases, the bedside nurse may make a suggestion that turns out to be right on; or, the medical student may do so. We cannot be full of our own self and ego to not take suggestions from everyone in the care team. Different clinicians bring different perspectives, and as leaders, we need to welcome those perspectives.

We are all on the same team with the same objective: to help heal our patients. If we ignore salient facts or suggestions because a nurse or tech or student or therapist suggested it, we are liable to place the patient in great danger. We have to resist this with every fiber of our being.

I shudder to think about what could have happened if I ignored that little voice inside me which said, “Dumb resident can’t tell me what to do!” and NOT ordered the antifreeze level. I shudder to think about what could have happened if I continued to feed my ego in this case. It is a lesson I have never forgotten, and I pray that I never, ever forget it in the future.

Along the same vein, I can’t tell you how many times I have said, “Call a Code!!!” while working in the ICU. When I say that, it means that a “CODE BLUE” needs to be called overhead in the hospital. When this is called, as many people who can respond come to where I am with my patient. It is a call for help.

Now, I have been practicing in the ICU for more than 16 years. I have been blessed with a lot of clinical experience. I am confident in the clinical abilities with which I have been blessed. But that does not mean that I am “too cool” to call for help, which is my ICU Rule #7: You Are Never “Too Cool” To Ask For Help.

Sometimes, I will call for help before even trying. For example, if I see that a patient needs to be placed on a ventilator and they have a challenging airway, I will call my Anesthesia colleagues from the very beginning. Yes, I have placed hundreds and hundreds of breathing tubes in the throats of patient. That doesn’t mean that I am the world expert at it. I want what’s best for my patient, and if that means have an Anesthesiologist rather than me place the airway, then so be it.

Now, does my ego get bruised a bit if my colleague easily does what I couldn’t do? Maybe. But, who cares about my ego? We are dealing with life and death in the ICU, and I am not going to stick a patient’s vein or artery multiple times – for example – so I can save face. If that was my family member, I would want the same for them.

Our egos can be dangerous. We are never too cool to ask for help. Yes, we have the experience. Yes, we are confident we can do the job right. But asking for help is not a sign of failure. We are all one team, and we have the same goal: healing our patient. And if that requires asking for help, then that is what we should do.

The post ICU Rules #6 and #7: Your Ego Can Be Dangerous appeared first on Medika Life.

But is moderate alcohol consumption okay, or does the drinking pattern matter? Can you be a weekend consumer of alcohol, drinking four drinks on Saturday and three on Sunday, and still call yourself a light or moderate drinker?

“I began to think vodka was my drink at last. It didn’t taste like anything, but it went straight down into my stomach like a sword swallowers’ sword and made me feel powerful and godlike.”
― Sylvia Plath, The Bell Jar

Alcohol problems among moderate drinkers

In their provocative recent report, researchers observe that “a significant amount of binge drinking among adults escapes public health scrutiny” because it occurs among people who drink at a moderate average level.

A new observational study looks at a binge drinking pattern in predicting alcohol problems among moderate drinkers in the United States.

Is moderate alcohol consumption safe, regardless of the drinking pattern? Researchers examined over 1,200 current drinkers enrolled in the study of Midlife Development in the United States.

Here are the study results:

Independent of the average amount of alcohol consumption, binge drinking appeared to be associated with an almost 3-fold increase in the number of alcohol-related problems and a 40 percent increase in the number of alcohol problems nine years later.

Interestingly, moderate average drinkers accounted for most cases of binge drinking and multiple alcohol problems. Among this group, binge drinking appeared to be linked to a nearly five-times increase in concurrent multiple alcohol problems.

The National Institute on Alcohol Abuse and Alcoholism defined moderate drinking as an average of no more than one drink daily for women and two for me. High drinking is an average of more than one drink for women and more than two for men.

A separate question separated a regular versus binge drinking pattern on one occasion. Researchers asked the subjects: Considering all alcoholic beverage types, how many times during the past month did you have five or more drinks on the same occasion? The scientists defined binge drinking as five or more drinks on the same occasion.

Alcohol problems and moderate drinkers: My take

Moderate average-level drinkers accounted for the majority of cases of binge drinking and multiple alcohol problems. Note that the findings represent correlation and do not establish causality. As the study participants self-reported data, there may have been recall bias.

The surveys defined binge drinking as five or more drinks on occasion for both men and women. Today, binge drinking in women is more commonly defined as four or more drinks on a single occasion; thus, the study findings may have underreported binge drinking in women.

Moderate drinkers need to be aware that they can cross into binge drinking. Everything in moderation, as we have all heard. Thank you.

The post Interesting Findings Of Weekend Only Drinking appeared first on Medika Life.

We are unwittingly aiding and abetting our greatest common enemy: disease.

Our advancement as a species has been driven by our ability to cooperate at a global level. In our best moments, this quality has allowed us to build societies and economies, preserve world order and improve life for billions of people, especially children. Strong public health programs and scientific achievement lie at the heart of our capacity to meet our most pressing health challenges, providing us with the policy guidance and coordination to overcome disease outbreaks with increasingly sophisticated tools.

Yet, the best public health plan paired with the most innovative medical discoveries cannot overcome our human tendency to complicate how we fight disease threats. Instead of banding together and fostering collaboration, we inadvertently fuel outbreaks. Among the barriers that we put in place to confront disease threats effectively, four issues routinely arise.

First, we blame and stigmatize the source of an outbreak. Viral diseases can happen anywhere, at any time. Spillover events — when viruses transfer from animals to humans — are as likely to occur among species in Asia or Africa as they are in the Americas. But in our efforts to provide an explanation for natural phenomena, it is far easier to assign blame on the failures of a foreign government or community, which dramatically hinders a global, coordinated response.

Few Americans supporting restrictions against China for serving as the source of the coronavirus are aware that the tables were turned a century ago: evidence suggests that the deadliest pandemic in modern history, which infected half a billion people and killed 50 million worldwide, may have originated from a pig farm in southwestern Kansas. The 1918 Influenza Pandemic, as it’s now known, was not linked to the United States because of strict news embargo during World War I; it was called the Spanish Flu only because neutral Spain did not follow the news blackout practiced by countries fighting in the war. With nationalism on the rise again, spurred on by social media, partisan politics and 24/7 news cycles, the impact of isolating and penalizing countries for naturally occurring disease outbreaks can cost lives and economic stability.

Second, we apply inconsistent standards for monitoring, reporting and countering disease threats. When countries know that they will be penalized for reporting outbreaks, what is their incentive to be transparent? And even when governments play by the rules and apply the best practices for reporting disease outbreaks — as South Africa did with the detection of the Omicron variant in November — they are subject to unfair and counterproductive penalties.

The development and application of a disease surveillance and reporting protocol that is used effectively by all countries can speed response to outbreaks before they have a chance to reach pandemic proportions. This is not to say there’s been an absence of such protocols; the WHO and national health agencies have coordinated through the decades to address novel disease strains, frequently blunting the potential for a virus to reach its worst-case impact. However, as the conditions for novel pathogens to emerge, it’s time for new approaches to be considered.

We are witnessing the loss of wildlife habitats, increased proximity of humans and animal disease hosts, accelerated global travel and climate change, each of which play a role in disease transmission. Covid-19’s lessons should produce a universal system that prioritizes timely, accurate disease surveillance and rewards reporting transparency.

Third, when we prioritize vaccines and treatments for wealthy countries and place greater value on profits instead of a collective response to a pandemic, it is an expression of 21st century Apartheid. Both the Sars-Cov-2 and Influenza viruses have a powerful ability to mutate, developing new variants that take advantage of weaknesses in our global immunity levels. Just as Martin Luther King Jr. famously noted that injustice anywhere is a threat to justice everywhere, the same applies to epidemiology in our world today: a novel viral threat in a remote corner of the world is a danger everywhere.

Our inability to provide equitable protection for communities beyond our national borders is another form of injustice, plain and simple.

Human advancement is reliant upon our ability to overcome our inherent tribalism. This runs counter to millions of years of evolution. We’re hard-wired to focus on our community’s interests first. The problem is that Covid-19 may likely be a dress rehearsal for worse pandemics in the near future and our failure to overcome tendencies to prioritize vaccination in some regions over others could foreshadow harsher outcomes ahead.

Despite some initial shortcomings, the COVAX facility and initiatives taken by individual vaccine manufacturers could provide a blueprint for rapidly scaling vaccine production and distribution to reach rich and poor countries alike. These are important steps in the right direction.

Fourth, pandemics thrive on chaos. And for the past 24 months, we have inadvertently fostered a haphazard response at the local, national and global levels through a pattern of fumbled communications on public health guidance. All too frequently, the U.S. and other nations have undermined confidence in vaccines and medical science, health agencies and government policy by failing to deliver clear messaging that communities, businesses and everyday people can understand.

Miscommunication has plagued pandemic responses throughout the past 100 years, but the inability for national government health agencies — most particularly the U.S. Centers for Disease Control and Prevention (CDC) — to anticipate messaging issues may prove to be a principal driver for the erosion of trust that citizens have in their leaders.

There is no shortage of excuses for why miscommunication during the pandemic has been so rampant. Nonetheless, global health leaders and the communications advisors supporting them must take a hard look at how to improve communications practices moving forward.

We need to see consistent application of a simple standard for health communications: ensure guidance is grounded in science; make sure it is so simple that school children understand it; and think about how guidance can be followed in the real world, outside of policymaker echo chambers. Then, run every possible scenario past a merciless band of reviewers whose job is to think about how health guidance could be misunderstood or ignored and fix issues before anything is publicly communicated.

These four issues are nothing new. Like so many other problems coming to a boiling point during Covid-19, they have been recurring challenges in past efforts to respond to pandemic threats. Yet global public health leaders, policymakers and communicators have an opportunity and an obligation to minimize the impact of stigma, haphazard disease mitigation standards, nationalism and miscommunication on pandemic response. Covid-19 has been a horrific reminder of the importance of collaboration, transparency and clarity. Our generation may not be given the same latitude during the next pandemic. We need to show we can apply the lessons now.

The post Aiding and Abetting a Virus appeared first on Medika Life.

1. Understand the hospital’s visitation policy

In this current climate of the pandemic, visitation rules are constantly in flux and hard to predict. That being said, they usually have a rule where there is a primary visitor and a secondary or alternate visitor. This is a very important decision and needs to be take seriously, especially as it may be hard to quickly change the visitor assignment under short notice.

Having a good sense of who may be the most fitting to have these roles, depending on the type of relationship (parent, child, spouse, etc.), proximity to the hospital, availability to visit, and level of care involvement post-hospitalization, are all major factors to keep in mind when making this important decision.

2. Bring items that help you feel comfortable, relaxed, and that allow you to have some privacy

Patients can often be admitted to a hospital very far away from home if their local area doesn’t have the resources to support them. However, even if you live nearby the hospital, it can also feel as though you are very far away from home as well so any little comforts that you can bring in that is permitted can help make your stay that much more comfortable.

Ask your family or friends to bring in comfortable clothes, slippers (if this type of footwear is permitted) or perhaps cozy socks, your favourite sneakers, an extra blanket, a few photos of loved ones, personal toiletries, electronics (and earbuds to help you have more private conversations), a charger and extension cord for your devices, noise-cancelling headphones to help reduce distractions in the surrounding environment, books and other items connected with your hobbies and interests that can be stored at the bedside, and anything else you can think of that might help you feel at ease that is allowed by the hospital. You can check with the hospital administrator if you need more information about what you can and can’t have at the bedside. These are also just a few ideas to consider – choose items to have with you that suit your own unique needs.

3. Ask if there will be a discharge meeting with the doctor and if a family member can join in person or by phone

Depending on the length of your hospitalization, your medical team may decide to have a meeting with you to discuss your progress and next steps. You can ask if a family member can join this discussion in-person or by phone – especially if you are not fluent in English – or ask the hospital to provide an interpreter if that would be helpful. If a family member is allowed to join in-person or virtually, they can be that second person to either make notes or ask questions that you may forget or may not be comfortable raising on your own.

Some important topics to discuss in your meeting include: your physical and mental health, any new diagnoses and treatment plans, home care services, precautions to take or limitations to be aware of when you return home, when you should follow up with your family doctor, etc.

4. Make an appointment with your family doctor and record any hospital follow up appointments if relevant

Call your family doctor’s office to make either a virtual or in-person appointment to keep them updated regarding your current situation. They will continue to follow up regarding your medication refills and general medical needs and are your go-to health professional to assist you as you settle back into the community.

If the hospital has made any follow up appointments for you, make note of this in your calendar so that you get the follow up you need regarding any specialized health issues that require ongoing treatment. Similarly, if you need home care services for personal care needs, check in with your medical team or hospital coordinator regarding what services are recommended and when services are expected to begin after you return home.

5. Remember to take time for yourself – you need to rest as much as possible to improve your recovery process

In between all of your tests, scans, interdisciplinary team appointments, and other related tasks in your schedule, you need to prioritize your rest. Taking care of yourself is vital at this time. Sleep, hydration, nutrition, and exercise – even if it means engaging in some movement in your hospital room that is within your physical abilities – are all important domains that you need to focus on to get better.

Finding pockets of time to spend with your loved ones as well – whether virtually or in-person – is also good for your mind, heart, and soul. Keep up the good work and hopefully you will be on your way home soon!

The post Five Things to Consider When Being Admitted to Hospital appeared first on Medika Life.

The answer, at least the expectation of the commanding officer, was fairly simple, if not obvious. And a good ice-breaker to start the discussion. But the young pilot’s response caught his CO completely off guard. The pilot reacted, as pilots often do, with a simple and emphatic word: no.  At that moment, the tone of the conversation changed rather dramatically, and the officer looked quizzically at his inexperienced student and asked why. His answer was both factual and based on science versus speculation or military optimism. “With our current engine specifications of lift and drag, higher speeds would require the engines to be too big. And, at that size, the resulting aerodynamics would not allow a significant increase in airspeed.” Of course, the answer didn’t incorporate the jet engine which was the real game-changer and not yet available to either the military or commercial aviation.  But that innovation was just around the corner.

Years later, a young medical student was called into his attending’s office.  This time, the discussion was regarding his application for a residency program at a prestigious medical center. The conversation followed a similar path as the young pilot, as they both chatted about the evolution and transformation of medicine today and into the future.  The discussion turned from the clinical to the philosophical, as the student spoke of his father’s dissatisfaction with his current job as a primary care physician. The future seemed a bit uncertain for both father and son.

Then the question from the attending came.  “Do you feel that the physician of today, you and me, will become obsolete?”

The medical student was on guard, as this was an important interview.  So, it’s no surprise that he heard zebra hoofbeats in the distance. But still his response was swift, resolute, and almost pilot-like—he said yes. But there was more to come. He spoke eloquently of his father and how the joy of medical practice had deteriorated into a system where pre-authorization became a misplaced journey of hope for both the clinician and patient. He explained how holding a hand was replaced by holding a mouse and peering at a keyboard and screen. And he opined on how his father would come home late at night, exhausted and burned out from a system that seemed to priortize dollars over heartbeats.

His point was clear.  That physician of today is obsolete.  The role is inconsistent with the human needs and desires expressed by patients, caregivers, clinicians and all those who provide that simple four-letter word: care. But he continued about his personal expectations for tomorrow. He clearly didn’t want to become that type of physician and suffer the consequences of an oppressive system. It had little place for him or his father. 

His voice became elevated and optimistic as he presented his generation’s future and reclaiming the joy of medicine.  His vision wasn’t a compromise, but a perspective on how technology can redefine roles, share the cognitive burden, and even enhance his human capabilities such as hearing, touch, and sight. 

Just like the jet engine, advances in technology that he grew up with, can help define his humanity and redefine medical practice.  He tempered his perspective with the reality that this is no simple task or path.  And in many instances, it’s already been declared DOA by those types who still flew in the old “prop jobs” of yesterday.  He concluded with the simple observation that change, and change for the better, is at hand.  And his job, as a new intern, would certainly be to hold the hand of his patient. But sometimes, he concluded, technology might be holding his other hand.

Author’s note:  The young pilot in this story is my father, John T. Nosta who was a Naval Aviator in World War II. He later went on to become a successful electrical engineer.  His vision was both practical and forward-thinking.  And sometimes, he liked to fly very fast.  The year 2022 is the 100^th anniversary of his birth.

The post The Parable Of The Pilot And The Medical Student appeared first on Medika Life.

There is no shortage of people who carry excess weight but have impeccable blood pressure and cholesterol levels and no known health problems. Consider the example of professional athletes whose livelihoods are dependent on being heavy, such as football linemen or sumo wrestlers.

At first glance, it is easy to notice their rotund shape, but they also possess greater physical endurance and strength than the average person. On the other hand, some maintain a thin figure but eat poorly, seldom exercise, and have a host of health issues.  Granted, most of us don’t train like professional athletes but it gets to the heart of the question: What matters more when it comes to health– weight or fitness?

Some studies do suggest that regular physical activity can mitigate some of the negative effects of being overweight, which does lend credibility to the idea of being both. Regardless of your weight, exercising regularly is sure to be a good thing. However, even when controlling for physical activity level, those who are overweight tend to be at higher risk of disease than their normal-weight peers.

Here are three reasons why being overweight does not always harmonize with being fit:

1. Fat is a hormonally and metabolically active tissue – Fat cells do more than just add inches. They can influence the balance of hormones and energy systems in our bodies. For example, fat cells can increase cortisol levels, which can further contribute to weight gain, and can promote insulin resistance, which can lead to diabetes.   It can also release substances that contribute to a steady level of chronic inflammation in the body – which increases risk of some cancers.
2. Excess weight, irrespective of fitness level, can be a risk factor for development of disease. While some people may be overweight but still maintain healthy blood pressure, cholesterol, and glucose levels, it is important to recognize that they are a snapshot of their present health status. The reality is that being chronically overweight carries the risk of developing other health problems in the future, although there is no way to predict exactly when that might occur.  Health is about the long-term strategy. Some of these health problems include diabetes, high blood pressure, heart disease, and stroke. Certainly, maintaining a regular physical activity regimen to keep fit may delay the development of these conditions, but losing body fat is another important way to reduce the risk of developing them.
3. Carrying extra fat can put undue stress on various body structures. Many discussions about fitness focus on cardiovascular health and reducing the risk of some cancers, but being overweight can also worsen back and joint pain. Chronic back and joint pains are significant causes of disability as we get older.  Extra fat around the neck can also contribute to the development of obstructive sleep apnea by causing the airway to collapse while sleeping.

The COVID pandemic has taught us important lessons about the importance of self-care. It’s not just about our lifespan, but also our health span.  That requires each of us to do our part in striving for a healthier lifestyle, whether that means eating more healthfully, exercising more consistently, or implementing better stress reduction techniques. While it’s possible to achieve good health despite being overweight, reducing excess body fat is yet another way to further optimize health and fitness and reduce the development of chronic disease.

The post How Many Pounds You Weigh vs How Fit You Are… appeared first on Medika Life.