Kyle Warren MD

Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor? PURPOSE Much of the literature on team-based primary care has focused on physician productivity, workload, and burnout. Less is known about how team-based care influences patient satisfaction and perc...

www.annfammed.org/content/23/2...

Images and descriptions of what's available on NEJM.org this week

New in the March 27, 2025, issue of NEJM:

Blood-Pressure Control in Patients with Diabetes (BPROAD trial) nej.md/4eyDckd

Inebilizumab for Treatment of IgG4-Related Disease (MITIGATE phase 3 trial) nej.md/4euxr6Y

#MedSky

Of >105,000 participants with 30-year follow-up, only 9.3% achieved healthy aging (age 70, w/o any chronic diseases). Their diet was significantly associated with this outcome. @naturemedicine.bsky.social

🚨New episode !🚨 Ep #476: Medications for AUD 2.0 w/ Dr. Stephen Holt! 🍻💊

We go beyond naltrexone & acamprosate—diving into topiramate, disulfiram, and dosing strategies to optimize care. Don't miss it! 🎧

Executive Summary: State-of-the-Art Review: Recurrent Uncomplicated Urinary Tract Infections in Women Over 50% of adult women experience at least 1 urinary tract infection (UTI) in their lifetime, and almost a quarter of them will experience a recurrent UTI

Woot woot:

click.skem1.com/click/bbu3-2...

Table. Broker Financial Incentives and Possible Reforms

When they become eligible for Medicare, beneficiaries must choose to enroll in Medicare Advantage (MA) or traditional Medicare.

This Viewpoint discusses the differences between MA and traditional Medicare. https://ja.ma/3FzVLc0

@thecurbsiders.bsky.social
@paulnwilliams.bsky.social any insight here?

A legend died today.

In his memory, how about a heartwarming heme #skeetorial? #hemesky #nerdalert

Today the world lost the man with the "golden arm"
1/n

Just a reminder that the HPV vaccine literally PREVENTS CANCER and the series can be started as early as 9 years of age.

Excerpt from a public letter Roald Dahl wrote encouraging people to vaccinate their children. Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything. “Are you feeling all right?” I asked her. “I feel all sleepy,” she said. In an hour, she was unconscious. In twelve hours she was dead. The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her. On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunized against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.

The measles outbreak in Texas is reminding me of the public letter Roald Dahl wrote about losing his daughter to measles in 1962, just before the vaccine was publicly available.

Opinion | I Shudder to Imagine Kennedy Running Our Health Agencies. (Gift Article) We have to go toe-to-toe with this administration and resist its attacks on public health.

Grateful to @gregggonsalves.bsky.social for his inspiring work and words

When ‘Just Asking Questions’ About Science Turns Into 300,000 Dead

www.nytimes.com/2025/02/13/o...

I’m seeing a lot of toddlers coming to me with URI symptoms saying they were exposed to GAS at daycare and wanting testing. I’ve told them that GAS doesn’t cause URI symptoms, so we probably shouldn’t test. Sometimes I get pushback. Glad to hear I’m not completely out of line.

I’ve read that children under 3yo do not respond immunologically the same way as older children, and thus are not at risk for rheumatic fever (which in my understanding is the primary reason for treating older children). I’m sure nothing magical happens exactly at 3, so I try to be lenient 🤷‍♂️

KDIGO: Every CKD patient should be on a statin
KDIGO ADPKD Guidelines

Thanks for your response. To clarify, by symptomatic do you mean with a clinical syndrome of pharyngitis? or with any URI symptoms? From the little I’ve read, GAS can cause more of a severe URI syndrome in kids under 3. (Which only makes the conundrum of who to test more difficult to me)

Hey #MedSky, #IDSky, and #PedsSky, when is it appropriate, if ever, to test a child under 3 years old for GAS pharyngitis?

Statement from Leading Physician Groups on Removal of Data and Guidance from Federal Websites | ACP Online www.acponline.org/acp-newsroom...

When even the WSJ Editorial Board has this to say
www.wsj.com/opinion/rfk-...

The Pediatrician’s Lament | NEJM With U.S. politics threatening to erase the gains of science, reduce access to vaccines, and undermine their vast public health benefit, what is a conscientious pediatrician to do?

“But now is no time for silence. Politics now threatens to erase the gains of science, reduce access to vaccines, and undermine the vast public health benefit of the vaccines…Now is the time to lament loudly, to beat my chest, and to wail.”

www.nejm.org/doi/abs/10.1...

Supporting vaccinations in the name of public health - CHEST Physician CHEST supports the fundamental responsibility of a public health system to seek out and apply evidence-based medicine in the development of sound policies essential to preventing illness.

Nice to see @accpchest.bsky.social speak up on the importance of vaccines and evidence-based medicine in public health

Timely

www.chestphysician.org/supporting-v...

Hey #MedSky is anybody using buprenorphine for Kratom Use Disorder? #GIMSky

What a week

I’m going to bed so I’m rested and ready to take care of patients, myself, and my loved ones.

I can’t change the world but I can make a difference in our little world.

Goodnight yall.

Every health system in the country’s goal is to try to extract as much money as possible out of Medicare and insurers. With that incentive, how will we ever truly reduce healthcare cost? The system is fatally flawed.

This week's cover and editorial @thelancet.bsky.social on mis- and disinformation's impact on public health
www.thelancet.com/journals/lan...

YouTube video by carlsagandotcom Carl Sagan - Pale Blue Dot

Yep.

This perspective helps too. We are just a spec in the universe.
youtu.be/wupToqz1e2g?...

Want a specific example of the death by a thousand cuts that is #PriorAuthorization?

Here is an example from yesterday in clinic

A short 🧵

I get a note in my inbox that a patient of mine was denied inhaled budesonide for their asthma

1/

Figure 4. Results for 4 of 7 comparisons for secondary end point of time to influenza vaccination receipts.

Simple, scalable, and cost-efficient electronic letter strategies, used in this study to encourage flu vaccinations, may have substantial public health implications.

ja.ma/3ZKlKVF

Now how about #medpedssky? Haha #MP4L

Just a reminder:

All vaccines used in public health have been rigorously tested. Their benefits greatly outweigh their risks. While a few people have a medical reason for not taking vaccines, most people (and the population overall) will benefit. Doctors who claim otherwise are irresponsible.