Carte Clinics

Lower limb edema, or swelling of the legs, can come from many causes, some harmless and some dangerous. Our doctors wanted to help our clients with stubborn edema manage it better, and to know when to call for medical help. We dug into both the medical literature AND the stuff on social media, with the goal of separating the helpful from the not helpful. Some lessons: ✅ Massage: HELPFUL. This can be super effective at resolving cases when nothing else works, especially for a specific subtype of edema called lymphedema. For these cases, it's worth connecting with the specially trained practitioners who could give you dramatically better outcomes ✅ Compression: HELPFUL. This is a mainstay in both wound clinics and million milers. They really improve venous return. You can get them in a range of pressures and lengths, including all the way up to the thigh. Quality and size matters, so don’t give up on this approach until you’ve made sure you’ve optimized for both 🛑 Drinking more water: NOT HELPFUL. Lots of websites (and as a result, AI chatbots) will tell you that drinking more water will encourage your body to flush more out, concluding you can use it to decrease edema. While it’s true that the kidney regulates water it conserves in response to how much it’s getting, this goes both ways: you pee more when you drink more but also pee less when you drink less (not retain more water when you drink less). If anything, over-drinking water without matching electrolytes can cause edema in people who otherwise don't have edema (and can worsen edema in people with edema due to kidney disease) See the full report here: https://lnkd.in/eSb8rJYU. And share with us what has worked for your edema!   (As always, do not substitute general reports like this for tailored medical advice. Ask a doctor or health expert you trust for how general advice applies to your unique scenario.)

Sometime while I was interviewing all these incredible ER doctor candidates for our company it hit me: the system is selecting out the best. Driven, results-oriented, deeply empathic doctors who are disturbed by not getting to the bottom of things are uniquely hurt by the ER today. They stay late, make extra calls, and hold hands at bedsides. They do this with no support from the hospital --reprimanding, in fact. Their bosses punish them for liability they take on doing a patient-centered discharged, or for telling patients about mistakes made in their care. They get publicly shamed and lose their bonuses for "inefficiency". Fast decision-making and keeping capacity open in the ER is a critical part of our work, and the work of any doctor in a system with limited resources. But working faster by taking shortcuts and putting patients in danger (when good medicine is simply not possible with the time given) is not the answer. Interviewing these best-of-the-best doctors for our company, so desperately looking for an alternative way to practice, made me so sad. Sad realization, that when your or my loved ones go to an ER in America, THE TYPE OF DOCTOR WE'D WANT IS EXACTLY WHO IS LESS AND LESS LIKELY TO BE THERE. That's what happens when ERs discourage doing the right thing. (Image Credit: EMdocs)

💢 Creativity in the treatment approach for rehabilitation units 💢 Inspired by gamification to improve residents' lifestyles, mobility and mental health. 🚀 ✨ Gamification of learning is an educational approach that seeks to motivate using game elements in educational environments. The goal is to maximize enjoyment and engagement by engaging learners and inspiring them to continue learning. Credit: Joël Kruisselbrink #elderlycare #health #ergonomics

After the pandemic I noticed something strange. My colleagues in the ER were telling me the same things as my patients. "I’m so anxious and trapped. I have no idea what I’m doing. I want to quit." From the outside, wealthy physicians have little in common with someone with uncontrolled migraines, or a bad work injury, or cancer that keeps coming back. But the fundamentals are the same: it hurts to not be living the life you want to be living. If you’re trapped, it’s time to get the hell out.  What traps people? The knee-jerk response to this question is external factors: an abuser, a diagnosis, a new global respiratory virus. Sometimes we are taken hostage by forces external to us, sure. But more often we’re hostaging ourselves. We feel trapped when there is a mismatch between our stated priorities and what we’re doing. My doctor colleagues saw themselves as doers and givers, yet in the hospital they increasingly were behaving like powerless, bitter complainers. My patients envisioned a life free of limitations, active, attractive, and respected. Instead their self-agency trickled away with every doctor-dictated clinic appointment, every passing day getting sicker and weaker and less motivated to look after themselves. The point of healthcare should be freedom to do what matters most to you. And freedom means different things to different people. That’s why the first job with a patient is to learn what health enabling an unencumbered life would look like. It may have less to do with preventing every conceivable cancer or wrinkle and more to do with energy, or willpower, or a sense of calm through any storm, or not needing pain meds. That foundation of understanding is missing from much of modern medicine, and it’s the principle I knew I needed to start from with Carte Clinics.  I spent several months visiting my patients after they went home from the ER. My ER colleagues who were burnt out of the hospital came too. We’re finding new ways to practice medicine in a more tech-savvy, less-hospital-centered world. Once you have it, freedom can’t be unlearned. “When you think about it, mostly, a cage is air — ” Time to think for myself is worth more than anyone can pay me. I love being a doctor, but I knew I dreamed of inventing a better clinic model in medicine, and if I didn’t take a bet on big ideas, I would resent any day-to-day work I did instead. So I work fewer shifts. I spend time finding the best doctors and clinics in the country, meeting with problem solvers, and researching. I prioritize time outside with my son. When I work in the ER, now I come with gratitude and energy, ready to go the extra mile for patients. Not all ER doctors can work fewer shifts and forego the income, I understand. But plenty who can, don’t, and complain instead of changing their circumstances. I’m excited to share the vision of Carte Clinics with our clients. I hope we untrap lots of patients and doctors in the days and years to come.

Thank you Lesley Jane Seymour for inviting me on the pod! You shared a story more people need to hear about breast cancer and getting help navigating along the way. Women need to speak up when the health plan they got doesn't feel right. Excited for our session with CoveyClub.com coming soon! https://lnkd.in/ea7DSePP MD Anderson Cancer Center #breastcancer

When giving informed consent for surgery, almost 40% of people didn't get information about treatment alternatives (Agozzino et al BMC Med Ethics. 2019) When giving informed consent for chemotherapy, 43% of patients said their doctor didn't discuss alternative therapies. 18% said the goal of treatment was not clear. 7% said they didn't understand the goal of treatment at all. (Schwaegermann et al J Cancer Res Clin Oncol. 2021) Of the information that is provided, studies show that patients are able to recall only 20-40% afterwards. (Herath et al EClinicalMedicine 2023) This is the state of affairs of information transfer in a rushed, emotionally fraught setting for incredibly high stakes health care decisions. Please go into discussions about your health with eyes wide open about how much data is missed or forgotten under the status quo doctor-patient conversation. If you want better results, change the game. Record, do research, and have backup advocating for you.

Today I want to talk about how my grandfather died. On a pretty fall morning, my grandpa fell and broke his neck. When the ambulance got him to the ER where I saw him, he was awake, lucid, and pleasant. He didn’t complain of pain. His spinal cord was so precariously snagged up against his misaligned bones that he wasn’t allowed to sit up. He didn’t want major surgery. The ICU doctors attending to him looked at how frail he was and agreed. He died peacefully, the same way he lived, a few days later. I think about his decline at the end of his life a lot. I think about the meds he was on and how for the last several months of his life he felt his stomach was always upset, and wonder how much better his appetite would have been off a few more prescriptions. I think about the tens of thousands of dollars outlayed when people fall and go to the hospital, but the total lack of insurance coverage to help people when they are stuck in a rut with their health. We know so much now about nutrition, movement, sleep, motivation, rehab, fall prevention, social support. We know an ounce of prevention is worth a pound of cure. And we can usually sense when the conventional medical system is just kicking the can. But most of us just follow along until it’s too late. My grandfather’s death taught me lessons about how not to settle. There is a growing community of doctors, coaches, and health professionals who see our system’s complicity in attending to sickness but not promoting life. I’m going to post over the next couple of days on how you can focus on quality of life for yourself and your loved ones. 

Today I want to talk about how my grandfather died. On a pretty fall morning, my grandpa fell and broke his neck. When the ambulance got him to the ER where I saw him, he was awake, lucid, and pleasant. He didn’t complain of pain. His spinal cord was so precariously snagged up against his misaligned bones that he wasn’t allowed to sit up. He didn’t want major surgery. The ICU doctors attending to him looked at how frail he was and agreed. He died peacefully, the same way he lived, a few days later. I think about his decline at the end of his life a lot. I think about the meds he was on and how for the last several months of his life he felt his stomach was always upset, and wonder how much better his appetite would have been off a few more prescriptions. I think about the tens of thousands of dollars outlayed when people fall and go to the hospital, but the total lack of insurance coverage to help people when they are stuck in a rut with their health. We know so much now about nutrition, movement, sleep, motivation, rehab, fall prevention, social support. We know an ounce of prevention is worth a pound of cure. And we can usually sense when the conventional medical system is just kicking the can. But most of us just follow along until it’s too late. My grandfather’s death taught me lessons about how not to settle. There is a growing community of doctors, coaches, and health professionals who see our system’s complicity in attending to sickness but not promoting life. I’m going to post over the next couple of days on how you can focus on quality of life for yourself and your loved ones. 

My last ER shift at undisclosed hospital: A woman was sent to the ER from her OB office, where she was screamed at in the waiting room in front of other patients, that she had put herself in danger by waiting to take an abortion pill for her ectopic pregnancy. Between sobs, she explained that two days ago she was told her pregnancy was “in the wrong place” and “most likely but not completely certainly” wouldn’t be viable. She really wanted this baby. If it wasn’t certain the pregnancy wouldn’t work, could her doctors help her gather more information? The hedge-y read on her ultrasound two days ago was totally bewildering to her. Terminating the pregnancy was so incredibly consequential. Yet no one took the time to explain the likelihoods in detail, the options available to her, the impacts on her future fertility. This is the state she came to me in the ER in: terrified I was going to tell her we needed to surgically cut her tubes out, riddled with unjustified guilt, and confused without sufficient help from her doctors. And of course, grieving the loss of her pregnancy. ERs consider women with pregnancy complications the lowest priority if they’re not bleeding out: these are healthy young women who should be sent out for outpatient follow–up. Maybe they can be seen by an APP without even going to a room, they say. Luckily I got to take care of her, luckily I didn’t have to cave to pressures on my time this shift keeping me from holding her hand and giving her the time and answers she was long overdue for. Luckily the OB colleague I called was exceptional and undid the misinformation shouted upon her in the office earlier that day. But because she didn’t bleed out or have a complication or sue us, this case isn’t reviewed as a sign of a system failure. How wrong of our health system to tragically mismanage the care of this woman on so many levels. Women like this (and anyone going through life-impacting medical decisions) should get as much time as they need with experts to make the right choice and feel a sense of peace about it. They’re not wasting anyone’s time: getting sound explanations is part of health care, which is their fundamental right. 

A good doctor must have two things: a spine and time. When you go to a doctor for help, all they really need to do to help you is have a spine and have time. IF THEY KNOW WHAT YOU NEED-- and you think you need something else, they need to have the spine to tell you so and the time to hear you out and convince you. (An MRI will distract from the real problem here. You don’t need antibiotics and they could make you sicker.) IF THEY THINK THEY KNOW WHAT YOU NEED BUT THEY'RE WRONG-- because they didn’t listen to you enough the first time, they need to take the time to listen, review, read (ask ChatGPT), and try again. IF THEY HAVE NO CLUE WHAT YOU NEED-- they need to have the spine to tell you that instead of bullshitting you. If they have no clue, they also need to take the time to use their vast medical connections to find you who you do need, and refer you there. Doctors must HAVE A SPINE to stand for truths (even inconvenient ones) and TAKE TIME to hash things out with patients until all their questions are answered. So simple, yet so elusive. Both integrity and time are under assault by the minutes-per-appointment-whittling, prescription-peddling, over-standardizing, cost-cutting, lip-servicing, medical-industrial-complex. I don’t have a magic wand to make the whole health care honor patients’ right to as much time they need with doctors. But I can protect Carte Clinics which funds doctors to take as much time as clients need, and to watch out for the bad actors and steer clients the eff away from them.