Weisman's World

Insightful and factual posts related to relevant medical and weight loss issues and topics to be discussed

Wherefore Art Thou Medically Supervised Weight Loss Management?

It appears that there are unlimited options available for anyone hoping to lose weight. Just turn on your TV, check your email, open your local newspaper or thumb through a glossy magazine and you will quickly be inundated with slick ads. These come-ons tout a wide variety of claims that you will enjoy amazing, never-before-achieved results in only 1 week! Lose up to 10 lbs in your first week!!!!

Of course, there are often before and after pictures inserted into these ads.  The before pictures too often seem to be a pic of a woman posing awkwardly,  wearing a somewhat sour look, dressed in something really unfashionable, and in the worst of the ads she has many, unseemly bulges, some pretty serious acne and for unclear reasons she forgot to brush her hair before the picture was taken. In the after pictures  we are often presented with a svelte profile of an ecstatic customer, flashing a wide, full toothed, ear-to-ear, grin, posing in a gorgeous bikini or she is holding her waistband way out in front. She looks radiantly healthy, well coiffed and inexplicably has beautiful skin…is is possible that she has managed to cure her acne outbreak with her diet program?

There are all kinds of fantastic claims made in these ads as well. I’ve seen some that allege you can lose 4 pounds for as little as $16, It’s as if you can simply buy the results you want! And they all seem to incorporate some kind of special “trick” into their program that is guaranteed to turn you into a runway fashion model. Among the most popular options I see promoted are an assortment of carefully selected vitamins, B12 shots, expensive beta-HCG intramuscular injections, food substitutes, metabolism enhancers and fat-burners.

And if you’ve tried any of these programs I’m sure you were eventually disappointed when you realized that the program didn’t work very well. Most customers do lose some weight of course, but much too often the weight loss is disappointingly small, short-lived and worst yet, you may end up heavier than when you started. You may already be aware that yo-yo dieting has been shown to be really bad for your health. It’s actually even worse than doing nothing and yet commercial weight loss programs remain extremely popular. You know all the names of these companies by heart so I won’t list them here – unfortunately their advertisements are everywhere!

What these programs seem to be lacking is a scientific method ! So many useless, unproven,  or potentially harmful things are being foisted on hopeful, overweight people who need effective and proven help the most.  The fact remains that the weight loss industry is still highly sought after, insanely profitable, and largely unregulated. According to data by Marketdata Enterprises, a market research firm that specializes in tracking niche industries, Americans spend north of $60 billion annually to try to lose pounds, on everything from paying for gym memberships and joining weight-loss programs to drinking diet soda.

In addition to the costs of dieting efforts, being obese or overweight itself is quite costly. Brace yourself, as these numbers are truly staggering. The medical care costs of obesity in the United States in 2008 dollars, according to an article in Health Affairs, were estimated to be $147 billion.  According to another article from Obesity Review, the annual, nationwide, productive costs of  obesity-related absenteeism range between $3.38 billion ($79 per obese individual) and $6.38 billion ($132 per obese individual)

These excessive costs continue to mount, in part because the approaches being used  are often wrong-headed and in part because obesity continues to increase at an alarming rate in America. These facts are less surprising when we consider the fact that there is still so much misinformation out there about food, nutrition and health. Unfortunately the government, dietitians, teachers and yes, even doctors, continue to teach us the wrong things about what we need to do to stay fit, healthy and maintain a normal weight. I find this completely inexcusable today, as we now have so much good information available. There is an ever-growing body of evidence-based, obesity medicine that will enable us to get the results that we deserve.  This information truly needs to get out to the public asap.

Approaching this formidable challenge with out-dated and unscientific methods is shameful. Now more than ever we need to utilize the tools and the wisdom we have at our disposal so we can reverse the obesity epidemic in America. Our lives and our quality of life depends on it!

Save the Forest, Plant a Tree for Me.

I practice medicine in the heart of Silicon Valley where everyday-people wear high-tech wearables, proudly display the latest handhelds, have smug, geek-party discussions about who’s more digitized and unapologetically immerse themselves in text chats throughout their dinner dates. I guess that has something to do with why I get defensive whenever I get asked why I still use paper charts. “Get with it Weisman”, they seem to say! “Don’t you know that you should modernize, stop killing trees and embrace the electronic medical record, or as it is know in modern parlance, the EMR? You’re a dinosaur!”


For the record, my practice is located in Mountain View, which is after all, ground zero for the technology revolution. And the seemingly ubiquitous technophiles who critique my practice, may be derisive of my outmoded ways because they believe I am old-fashioned, a Luddite, and incapable of changing with the times.  Yes, I still document my patient encounters with paper and pen. Ugh.


And worse yet, the detractors are convinced that I am guilty of providing suboptimal care to my patients by refusing to move from paper to a digital practice. Am I missing the boat? Needlessly hurting innocent people? OMG! LOL! Nothing could be further from the truth.


There’s no shortage of obsequious propaganda out there promoting digitalization of the medical world. So it’s hard to blame those who grouse about my ongoing use of paper charts for falling victim to all the hype and spin. Oh yes, I too have read all the endless, fawning fodder and heard all the sanguine soliloquies, touting the advantages of the digital chart.  


Pick up any medical journal and you will readily thumb through full-page ads, hailing the arrival of the EMR.  Beautiful people in crisp, white coats are commonly depicted holding sleek tablets, sitting comfortably at slick keyboards, flashing their subtle, smug smiles. I often open a newspaper and find yet another article filled with frenzied hype, about the oh-so-much progress that we have made in healthcare information technology. Poppycock! We are so surrounded by hysteria promoting the electronic chart that it has become harder and harder for me to defend my decision for failing to join the modern world.


So much has been made of the benefits of putting patient information on-line. In the face of all the propaganda it has been a challenge to hold the line and not “modernize” my office. Let’s face it, an EMR makes a lot of sense when you analyze all the potential benefits: Legibility. Efficiency. Saving forests. Easy data sharing.  Patient info 24/7. No messy charts. No file cabinets. Improved quality of care. Assisted decision-making.


Oh, and one more kind of a big thing: they threw a lot of money at me to “adopt” this Rube Goldberg scheme: a sweet, sizable bribe so to speak. Yes, I turned down a check from the U.S. government for $44,000! I mean who does that??? I must be a fool. Well, not to worry. I’m certain that turning down that tantalizing incentive saved me much, much more in valuable time and money. And I’m convinced that my patients benefited too. But that’s for a later rant. I promise to tell you all the details about this massive political boondoggle in a later blog.


Let’s face it.  Becoming a digital doctor just sounded too good to be true.  And it was.

“If it sounds too good to be true, it usually is” was a catchphrase used by the Better Business Bureau to alert the public to shady business practices since at least 1954. Well you know what? I’m here to tell you that the electronic medical record is in fact just another shady business practice. All the hype, all the touted benefits, all the fluff is unfortunately just too good to be true! It is just another beautiful dream that quickly becomes a false reality once you awaken.


The medical literature has been extremely critical of pretty much all of the commercially available medical record software for quite some time and almost from their inception. After all, these healthcare publications are actually written by end-users. And they ought to know. These are the providers of healthcare who get to use and try to make these systems work at the point of care. And until recently, I have noticed a real disparity between the glowing discussions about the EMR found in consumer publications and the studies reported in the medical journals that I read regularly.


Happily, and at long last, the truth about the electronic medical record is finally getting out there. No less than Bob Dylan said it best in one of his anthems: “The Times They Are A-Changing.”  So I’m sending a big shout out to Robert Zimmerman!! At the end of the day he was correct. Things are finally a-changing.  


There are two important reasons that motivated me to start writing this blog about the pitfalls of the EMR. First of all, I saw two patients this week who were grateful that I hadn’t gone digital. One simply thanked me for using paper charts.  “You’re old school” said a 76 year old woman with unexplained abdominal pain. “Thanks for doing things the old-fashioned way and not making me talk to your back while you type away at your computer.” The other was a 55 year old man in for routine cancer screening, who sat momentarily bewildered with his mouth agape when he saw me carry in the paper chart. “Good for you”, he mumbled. “I know that all the doctors I see hate having to type up their findings and you probably know that the patients hate it too. It takes so long to type it all in there. Probably many times longer than it takes to actually collect all the info.” He said it again for emphasis, “Really, I mean it, good for you!”


The second and equally compelling reason was the article I recently read on the Opinion Page in the Wall Street Journal.  The September 22, 2016 article was entitled. “Turn Off the Computer and Listen to the Patient” by Caleb Gardner, MD, a physician and resident at Cambridge Hospital in Massachusetts and John Levinson, MD, a cardiologist at Massachusetts General Hospital and Harvard Medical School. In their article, they argued that using a computer to document patient visits has damaged the doctor-patient relationship and ironically has interfered with the fundamental and important communication that is supposed to occur in that setting.  Bravo to you Dr. Gardner and to you Dr. Levinson.  You are both onto something big here. The patient must be the most important entity in the examining room and we should do everything in our power to make sure that nothing interferes with our patients’ preeminence.


Stuart Weisman, M.D


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