After the multiple problems and flipflops we have seen this year with recommendations and guidances in COVID, the public must be aware that medical recommendations are only of value if they come from real experts.
Here are some thoughts on how to evaluate medical expertise.
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First, recommendations should always list names of the experts on the panel so that we can evaluate whether or not guidelines or determinations are made by people with genuine expertise. Anonymous posts are not helpful & lack accountability. If names are not listed, I move on.
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Second, do not fall for fancy leadership titles. While some titles reflect true expertise and academic leadership, some people with glowing titles may be far removed from research or patient care for a long time. Things change fast in medicine. Look past administrative titles.
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Third, assess actual academic and research output on pubmed.gov — paying attention to papers written as first or last author, & whether they are recent. Alternatively for clinical medical judgment calls, determine whether or not they actually see & treat patients.
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Fourth, try to find video or audio of experts speaking or giving a lecture. Usually you can tell people who know their stuff from those who don’t, once you hear them speak. For Eg., When Dr. Fauci speaks we know he is on top of things, and that he is well informed & wise.
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Fifth, assess the composition of the panel for depth, but also breadth of knowledge. Some people with great depth lack the ability to see the big picture.
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Finally, assess whether there are conflicts of interest. This is not easy. But sometimes it obvious. In recent months, a little too obvious.
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To my followers who wonder what MOC is, and why many doctors are tweeting about it. Thread.
1) Maintenance of Certification (MOC) is a redundant requirement thrust on US physicians by a private organization. We resent it.
2) MOC is causing frustration and burnout. Over the years, ABIM certification and MOC have become entrenched and institutions and insurers require it and will not accept any other alternative.
I am advocating on behalf of my colleagues in the US for change. To end MOC.
3) MOC requires us to pay fees imposed on us by a private organization and take multiple choice question tests irrelevant to our practice.
10 suggested action items for physician colleagues suffering under the burden of @ABIMcert MOC. #MedTwitter
1. If your institution allows it, stop participating in MOC. Personally, MOC has no value to me.
2. If your institution requires ABIM certification, advocate for @InfoNbpas as alternative option.
3. Do not participate in more than one ABIM MOC specialty, the one that’s required by your institution. Save your money. Don’t spend a penny more than you have to.
I see a lot of wrong analysis on accelerated approval and surrogate endpoints.
It’s always easy to criticize from the outside. The criticisms raised are well known to the FDA and investigators. They are considered. We go in eyes fully open. We try to do what’s best for patients
Without accelerated approval using surrogate endpoint of overall response rate in single arm trials, for 2-3 years lives would have been lost waiting for drugs like Velcade, Revlimid, pomalidomide, Daratumumab, carfilzomib and more.
1) @costplusdrugs — where you can get >2000 prescription meds at lower price than almost any other pharmacy in America. Has revolutionized the generic prescription drug market. @mcuban costplusdrugs.com
2) @PayorDieFilm — the story of lives lost due to the high price of insulin in America. Likely contributed to why all 3 big insulin manufacturers have now cut the price of insulin by >70-80%. @scottaruderman @NSmithholt12
Watch on @paramountplus @mtvdocs
3) Inflation Reduction Act provisions to cap Medicare Part D copays.
For 2024, the out of pocket max for Part D drugs that a patient pays in copays is capped to a max of ~$3250. A huge relief to many.
Two days ago I did 60 ABIM MOC questions in Heme and Onc (against my will).
Almost all were esoteric/ irrelevant questions. Rare things that doctors rarely see. #MedTwitter
What’s my opinion?
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I spend a lot of time in medical teaching and writing. I write for UpToDate for 20 years, and all of the major Hem Onc textbooks.
In my opinion, the MOC questions are useless for routine Hem Onc clinical practice. Useless to assess “walking/ essential knowledge”.
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What’s worse: Every 3 or 4 questions that I spent time and answered, I would get a note that it was a “test question”. No answer was given at the end, making it a complete waste of time and making me an unwilling partner to test questions for the ABIM. @DavidSteensma
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