Ever since the first novel and subsequent films, millions of people around the world have fallen in love with the magical world of the Harry Potter franchise. But did you know that the lessons we take away from this magical experience can be applied to our lives as we pursue health and fitness? Dr. Sonny Saggar and special guests Amanda Canete and Amanda McMichael visit KPLR 11 News at Noon to discuss lessons and tips as they apply in your quest for a healthier lifestyle.
CT scans diagnose serious medical problems and often save lives, but this tool is OFTEN OVERUSED resulting in big doses of radiation and big medical bills that could’ve been avoided.
Absolutely they are a great tool. I don’t think anyone can dispute the value they have brought to humanity.
And yes, I do order scans every day, but that doesn’t mean I should be ordering them on people who don’t need them.
I, or any other physician, shouldn’t be ordering a CT scan on people with weak reasons to do it.
Only because it’s definitely needed - it’s definitely indicated according to the medical evidence - and not because “it’s easy - I have a scanner available - let’s just do it”.
CT scanning has certainly aided diagnosis and helped many patients avoid exploratory surgery, but it has also spawned concerns about misuse.
X-rays have been used for almost 120 years, but the introduction of computed tomography, or CT scans, in the 1970s, was revolutionary. The new tests, which use multiple X-ray images, allowed doctors to see with unprecedented precision the inner workings of the human body, and earned the inventors of the device the 1979 Nobel Prize in medicine. Use of the tests grew quickly, rising from fewer than 3 million per year in 1980 to more than 80 million now.
2. Don’t you have clearly laid out and written criteria for ordering a CT scan? So what are the concerns about CT scans?
Yes, we have internationally accepted very clear criteria for ordering say a CT scan of the head, or the chest or the abdomen and pelvis, but unfortunately, that doesn’t mean your urgent care or emergency physician will follow those guidelines.
Remember, these are just guidelines. They’re not rules and they’re not the law.
The ballooning costs of healthcare, including from duplicate procedures, the potential harm from the tests themselves and the overtreatment of harmless conditions found during scans. These are effects of overdoing it with the CT scans.
There’s such a thing in Medicine that physicians call “incidentalomas” — so named because they are found unexpectedly — include benign lung and thyroid nodules and other common conditions that can lead to even more unnecessary and expensive workups as well as treatment that can cause complications.
3. How many scans are done unnecessarily? Anyone watching this will probably think that their CT scan was actually necessary won’t they?
And many of them would be right.
Unfortunately, many patients have fallen prey to a sophisticated sales pitch.
Researchers know that doctors today order millions of radiation-based imaging tests each year, that many of them are unnecessary, and that the more radiation people are exposed to, the greater their lifetime risk of cancer.
Recent research shows that about one-third of those scans serve little if any medical purpose. And even when CT scans or other radiology tests are necessary, doctors and technicians don’t always take steps to limit radiation exposure.
4. OK so let’s say that some scans probably shouldn’t have been done. What are consequences of getting these so-called ‘unnecessary scans’?
All of that exposure poses serious health threats. Researchers estimate that at least 2% of all future cancers in the U.S.—approximately 29,000 cases and 15,000 deaths per year—will stem from CT scans alone.
No one is saying that you should avoid a CT scan or other imaging test if you really need it, and the risk posed by any single scan is very small.
But the effect of radiation is cumulative, and the more you’re exposed, the greater your cancer risk. So it’s essential that you always ask your doctors why they are ordering an imaging test and whether your problem could be managed without it.
15,000 : That’s the number of people estimated to die each year because of cancers caused by their previous radiation exposure from CT scans alone.
5. Given those risks, why are we—and our doctors—so scan-happy?
For one thing, patients aren’t necessarily aware of the danger.
A new Consumer Reports survey of 1,019 U.S. adults found that people are seldom told by their doctors about the risks of CT scans and other radiology tests.
It’s no surprise, then, that only 2% of those who had a CT scan thought they might have received the tests unnecessarily.
And only 4% ever told their doctor they did not want a CT scan.
That’s a bit worrying. Patients need to take the lead on this because their doctor may not.
Other studies show that doctors themselves often underestimate the dangers CT scans pose. Moreover, and this is a very worrisome situation, some doctors and clinics may actually have a financial incentive to order the tests.
“Health care professionals shouldn’t have the right to image children or adults unless they first show that they can do it safely and appropriately, and most of the time in this country, that’s not happening,” says Stephen J. Swensen, M.D., medical director at the Mayo Clinic in Rochester, Minn. “If the scan isn’t necessary or emits the wrong dose of radiation, the risks far outweigh the benefits.”
6. How much radiation can you get from a CT scan, and what are the risks of that?
CT scans can expose you to as much radiation as 200 chest X-rays.
CT emits a powerful dose of radiation, in some cases equivalent to about 200 chest X-rays, or the amount most people would be exposed to from natural sources over seven years. That dose can alter the makeup of human tissue and create free radicals, molecules that can wreak havoc on human cells. Your body can often repair that damage—but not always. And when it doesn’t, the damage can lead to cancer.
Cancers from medical radiation can take anywhere from five to 60 years to develop, and risk also depends on age and lifestyle. That’s why scientists struggled in early attempts to quantify the danger of medical radiation. Until recently, researchers often relied on evidence from the atomic bomb attacks on Hiroshima and Nagasaki. But now research shows that today’s medical patients are being harmed, too.
New evidence comes from a 2013 Australian study that looked at more than 680,000 people who had CT scans as children and compared them with some 10 million children who did not have a CT scan. Overall, people scanned once had a 24% increased cancer risk, and each additional scan boosted risk an additional 16%. Children who had one before the age of 5 faced a 35% spike in cancer risk, reflecting the fact that young bodies are more vulnerable to radiation.
Other researchers estimate that for every 1,000 children who have an abdominal CT scan, one will develop cancer as a result. And a 2012 study that looked at almost 180,000 British children linked CT scans to higher rates of leukemia and brain cancer.
All too often children are receiving adult-sized doses of radiation, which is many times the amount they need.
The dose directly increases the risk of leukemia or a solid tumor. And that’s not regulated today, especially outside the hospital setting. At least in the hospital, you will often have the academic input that prevents super-high radiation dosing, especially in kids.
7. And if you get one scan, does it increase the chances you’ll get another one?
That’s correct: one scan leads to another…
One of the insidious ways that unnecessary CT scans increase risk is that a single CT test often leads to another, then another. A disturbing example of that dangerous cascade was featured in an article in the September 2014 issue of the Journal of Patient Safety, co-authored by John Santa, M.D., medical director of the Consumer Reports Health Ratings Center.
An 11-year-old girl received a CT scan because of possible appendicitis. That was the first mistake: An ultrasound, which does not emit radiation, is the best initial test in such situations. The second error occurred when her CT showed a normal appendix but her doctors noted a spot on one lung and decided that it warranted a follow-up CT. Such incidental findings are so common doctors have a name for them: incidentalomas.
Expert advice is to ignore the vast majority of those results because slight abnormalities seen on scans are very common but rarely harmful. Yet many doctors find the urge to order follow-up tests irresistible. For the 11-year-old girl, the CT didn’t reveal a tumor or any other problem, but over the next two years her doctors recommended repeat scans of her lungs, all of which would further increase her cancer risk.
“Stories like this occur every day in the United States,” Santa and his co-authors wrote. “This unfortunate sequence of patient harm, waste, and needless anxiety could have been completely avoided with an ultrasound. None of this had to happen. None of this has to happen.”
8. So let me ask you again, why is there so much overuse of CT scanning?
The main reasons for excessive scanning are:
Some states allow almost anyone to work the equipment. The government relies on three outside accrediting organizations—the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission—to ensure the safety of advanced imaging facilities. But each group has different quality and safety standards.
9. So what can the public do to prevent unnecessary radiation from CT overtesting?
Here’s my advice on what to do before you get any radiation-based imaging test:
ST. LOUIS, MO (KPLR) – With the new year right around the corner, Dr. Sonny Saggar hopes you will set realistic goals for 2017. If you haven’t managed to get some quality time with family and friends this holiday season, he recommends making that your number one goal starting January 1.
Reconnecting and rediscovering one another, as well as ourselves, is good for your health, even better than exercise or quitting smoking.
Fitbit reports that it has almost 10 million paid active users, but there seems to be no evidence these devices raise activity levels enough to improve health.
There have been many marketing promises for wearable activity monitors, telling us how much we are moving and how many calories we have burned during the day, might help some people to drop pounds. Those promises were based on studies that were small scale and short term, so it was still unclear how much activity monitors actually did help with weight loss.
People seemed to abandon the devices because they didn’t glean any new information. If you’re inactive, you know it. And so the last thing you want is to see it announced on a screen.
Although the research studies seem to conclude that devices that monitor and provide feedback on physical activity may not offer an advantage over standard behavioral weight loss approaches, Dr. Saggar doesn’t think that means we should stop using them.
You don’t get more fit by just owning a treadmill or pair of running shoes, or by signing up for gym membership; you have to actually use these things.
It’s Dr. Saggar’s suspicion that the Fitbit is actually a very good idea, because it focuses our minds on the goals we want to achieve, but if we don’t use the device, or if we just quit, then it might actually be worse than not having one at all, and that’s what this research is demonstrating.
Bodyweight exercises are gaining ground in the fitness world due to the practicality and simplicity of getting in shape using your own body weight.
Planks are one form of bodyweight exercises that will probably never go out of fashion.
KPLR’s ‘Doctor Is In’, Dr. Sonny Saggar, is here to talk about this simple exercise that’s quick, free and simple, if not always easy.
2. What’s the main benefit of doing planks?
Your abdominal muscles provide support for your trunk and upper body, just like your back and spinal column do.
I like to think of the abdominal muscles like a ‘front spine’ which, unlike your real spine (made of bone and already strong and tough), needs to be constantly hardened and tempered!
So the stronger your abdominal wall muscles, in your core, the less likely you’ll experience back pain and back injuries, because you’re SHARING THE LOAD between the abdominal muscles and the back.
Doing plank exercises every day is a great way to strengthen your core, and in doing so, help support your spine.
1. Specifically which muscles are helped by doing planks, and what do these muscles do?Planks engage all major core muscle groups including the transverse abdominus, the rectus abdominus, the external oblique muscle, and the glutes.
All of these groups serve their own purpose.
If you strengthen these muscle groups you will notice:
2. Is it safe to do planks?Yes they’re safe. Planks allow you to build muscle while making sure that you are not putting too much pressure on your spine or hips.
According to the American Council on Exercise, doing planks regularly not only significantly reduces and prevents back pain but it also strengthens your muscles and ensures a strong support for your entire back, especially in the areas around your upper back.
3. Doing planks aren’t exactly cardio, are they?Actually, planks will burn more calories than other traditional abdominal exercises, such as crunches or sit-ups!
The muscles you strengthen by doing this exercise on a daily basis will ensure that you burn more energy even when you’re not doing anything!
This is especially important if you are spending the majority of your day sitting in front of a computer.
Also, making it a daily 10- to 1 minute home exercise before or after work will not only provide an enhanced metabolic rate but it will also ensure that that metabolic rate remains high all day long, (yes, even while you’re asleep).
4. Do planks improve your posture?Doing planks greatly improves your ability to stand with straight and stable posture. Through strengthening your core you will be able to maintain proper posture at all times because muscles in the abdomen have a profound effect on the overall condition of your neck, shoulders, chest and back.
5. What about balance?If you can’t stand on one leg for more than a couple of seconds, it’s because your abdominal muscles aren’t strong enough to give you the balance you need.
Side planks and planks with extensions will boost your balancing skill.
6. And flexibility?
Flexibility is a key benefit of doing planks regularly, for this form of exercise expands and stretches all your posterior muscle groups – shoulders, shoulder blades, and collarbone – while also stretching your hamstrings, arches of your feet, and toes.
With a side plank added into the mix, you can also work on your oblique muscles. This will provide you with further benefits when it comes to hyper-extending your toes, a movement that is crucial for supporting your body’s weight.
7. Any other benefits of planking?Plank exercises have a particular effect on our minds, making them an excellent means of improving overall mood.
Well, they stretch out muscle groups that contribute to stress and tension in the body. Just think about it: you are sitting in your chair, at home or at work, all day long; your thigh muscles get tight, your legs get heavy due to being bent for several hours; and tension develops in your shoulders due to being forced to slump forward all day. These are all circumstances that put too stress on the muscles and nerves.
The good news is that planks not only calm your brain, but they can also treat anxiety and symptoms of depression– but only if you make it part of your daily routine.
Now, the last thing left to do is to give you a sample plank exercise you can do to achieve great results in only 5-10 minutes a day.
Here is a great infographic that shows some of the best plank exercises to evenly target all abdominal muscle groups:
Are you ready to devote 5-10 minutes of your day, every day, to stay fit, healthy and, most importantly, strong as a bull? Then jump in and make doing plank exercises a part of your life.
Here’s a 30 day ‘plank challenge’ for my family, friends and patients:
Complete a front & side plank (both sides) every day for the time specified on the calendar.
1. Start in a pushup position and then slowly lower your forearms to the ground
2. Ensure that your elbows are lined up under your shoulders.
3. Keep your abs & glutes tight and lifted.
4. Do NOT let your hips sag. Do NOT arch your back.
5. Keep a neutral neck and spine
“Dr. Saggar is an emergency and urgent care physician, and he’s also an internist.
You can reach him at STLHealthWorks.com or STLPrimaryCare.COM, or
Twitter @DoctorIsInSTL | Facebook: DoctorIsInSTL | Blog: DoctorIsInSTL.com”
Hospital based Urgent Care Facility Fees – How to be an educated healthcare consumer, especially if you have a high deductible.
Urgent Care Facility Fees & Overtesting – how to be an educated healthcare consumerAll urgent cares do not charge the same, especially those that are affiliated with hospitals. While STLHealthworks.com does not charge expensive facility fees, most other centers, especially hospital-owned urgent care centers, do. Hospitals run about 26 percent of urgent care centers nationwide. Patients of some of these hospital-owned centers are often surprised when they get their bill and see that they were billed as an ER visit or charged a facility fee.
Overtesting & Overtreatment
Worse, many urgent cares will try to use the expensive equipment and resources they own. If they own an ER, they'll try to transfer you there "because it's safer". If they own a CT scanner or ultrasound machine, they'll try to use it on you "just to be sure". Your headache, sore throat, bladder infection, laceration and abdominal pain will typically not require such expensive testing, according to evidence based medicine. What's the harm to the patient of overtesting? Three things: 1. Higher Cost 2. Harmful Radiation 3. More worry.
What exactly is a “facility fee”?
A facility fee is a charged to the patient by the hospital in addition to the professional fee. For example, if you see a doctor at a hospital’s urgent care for bronchitis, you expect to pay the 'professional fee' bill, which is for the person who attended your case, such as the Doctor or Nurse Practitioner at a private urgent care center. However, hospitals will also charge another separate fee. This is known as a 'facility fee'. In urgent care medicine, these facility fees typically average -' additional $200. This fee is in addition to the professional fee part of your bill.
Patients are waking up to this, and have begun to fight facility fees, and some state legislators have proposed bans. Unfortunately, none have become law yet because of the powerful 'non-profit' hospital lobby. These fees routinely add hundreds of dollars to a patient’s bill. This adds out-of-pocket costs for those who have an increasingly common, high-deductible insurance plan, which may require a patient to pay $2,500 or more toward her medical bills before the coverage kicks in.
What can you do about it?
Determine if the urgent care center you are considering utilizing is owned by a hospital. Then, call and ask if they charge a facility fee in addition to the professional fee. Also, you should ask if they own a CT scanner onsite. You can check their website, but the information may not be there. If the receptionist is unsure, ask to be connected to their billing office.
What if you have a high deductible?
If you or your family has a high deductible (over $1,000) but are frequent visitors to the urgent care or primary care office, then you've probably noticed that your monthly premium is just the beginning, rather than the end of your medical bills.
That's why we recommend DirectYourCare.com to our high deductible patients. With this program, you proudly keep your highest deductible lowest premium (aka catastrophic) insurance policy, but you put a cap on other out-of-pocket costs, at around $59/month, no matter how complex the visit, but this is only for primary care and urgent care visits.
In summary, be informed about professional fees, facility fees, overtesting (such as with CT scans and ER transfers), and look at other solutions for your high deductible.
Do your Advanced Practice Providers choose the red pill or the blue pill?
In the current competitive business climate, aren't non-competes even more necessary?
That all depends on what kind of employees you want. Non-competes actually suppresses nurse practitioner and physician assistant motivation and creativity.
A non-compete tends to be counterproductive on different levels. Do you want to have APPs that would like to leave... but don't because of a non-compete? Do you want APPs who are immediately demotivated because they feel their human capital is not their own?
Which urgent care would you rather work for: the one that puts tremendous effort into placing legal and contractual stakes in the ground, or the clinic that puts tremendous effort into trying to be your employer of choice
Isn't it true that the APPs who don't want to sign non-competes tend to be the ones you want most? They're aggressive, motivated, have lots of ideas. The APPs who willingly sign are the people you don't want.
When a clinic or hospital demands non-competes, that employer create self-selection and a market for lemons: the people who unthinkingly sign a non-compete may feel they don't have the skills to get another job or take off on their own. Every employer wants employees who are self motivated, who have confidence, and who have aspirations.
Why put up artificial barriers that make it harder to attract great APPs, or indeed any other employees?
APPswant to develop their careers--maybe work for an urgent care system or hospital for a few years then become entrepreneurs, perhaps starting their own clinics.
Freedom creates more incentive to for APPs to connect, be visible, network, and develop themselves both within and outside the company--all of which benefits their employer.
Perhaps the only thing worse than forcing people to sign non-compete agreements is how hospitals and other big employers attempt to enforce that agreement when they leave.
If employees really want to leave, they'll leave. So then what do you do about it?
Some companies engage in irrational and counterproductive threats and even litigation. Say you can actually get a non-compete enforced; do you really want to develop the reputation as a clinic system that sues ex-employees? That sends the wrong message to current employees and to the talent you want to recruit.
So you just let your nurse practitioners go when some big hospital offers them a job, after all the time and training you gave them?
It's not like you have a choice. So rather than developing the reputation for being upset when employees leave, focus on the positives.
Really great people will leave your clinic all the time. It's fine. They need to find themselves. Instead of seeing this as someone who left to become a competitor, we see them as alumni, now working for a new customer of ours.
This mobility is a way to seed STLHealthWorks.com into other places. Even our competitors can quickly become collaborators and partners.
The Glass is ALWAYS Half Full
At STLHealthWorks.com, we run on multiple slogans:
Always treat every patient like you would your own family.
The patients don't come first - the employees do. Happy employees are the best way to get the best patient outcomes.
It will all turn out ok - just watch.
If you love somebody, set them free. When they return (and they will return), welcome them back with hugs!
Everybody wants to live a life of security, safety and perceived comfort. That's why, when one of our APPs leaves to go work for Mercy, BJC or SSM, we totally get it. They want to have the comfort of working for 'the big employer' which has billions of dollars. If that's what's important to the employee, then that's what they should do. No harm - no foul. If the employee wants the comfort and security of working for the big box, that's totally cool. They were meant to go. If however, the employee wants the excitement and adventure of working as part of the team of a growing company, then they stay. If they want autonomy, they stay. If they don't believe in non-competes or 25 cent annual raises, they stay. If they want the blue bill, and it's totally fine if they do, then they leave. If they want the red pill, with the authenticity of free will and being in control of their own lives, then they stay.