Hypothyroidism Complicated by Vitamin C and Thiamin Deficiency in Surgical Patients.

Multiple vitamin deficiencies together with endocrinopathy may be encountered in individuals presenting with critical illness. Following the surprise postmortem diagnosis of concomitant scurvy, Wernicke, and hypothyroidism in an elderly woman presenting with a mix of atypical symptoms, patients considered at risk were tested for TSH, vitamin C, and thiamin levels. Between September 1, 2018, and December 31, 2022, 801 vitamin C levels in 679 patients were measured in our rural hospital and 309 (39%) were found <0.4 mg/dL. In this population, 39% of 626 thiamin levels were found to be low. Twenty-two patients with vitamin C and/or thiamin deficiency and elevated TSH levels were identified. Two patients died from scurvy; one also had myxedema. The incidence of vitamin C and thiamin deficiency in our patient population was higher than expected. Further studies should determine if this is unique to our rural setting or part of a bigger trend associated with poor dietary choices.

The Doctor Will See You After Your Workout.

Novel approaches to deliver lifestyle medicine that are convenient and accessible to patients are needed. Patients generally seek medical care when they are not well, reinforcing the notion of a "sick" care health system. Conversely, health clubs represent beacons of wellness amid the mire of chronic disease. Many individuals visit health clubs with the goal of becoming or remaining healthy. Expanding health care access to these health club populations creates opportunities to engage those who do not typically seek medical care, and may also attract those who are highly motivated to make lifestyle changes to prevent, treat, and reverse chronic disease. Health club clinics could be expanded with in-person or virtual offerings that go beyond traditional models. Such offerings would stand to improve health and be mutually beneficial for the provider and health club. By decreasing the barrier to access such care and meeting highly motivated patients where they are, providers may be more successful in their efforts to deliver lifestyle medicine to patients who are ready, willing, and able to make lifestyle behaviors changes.

Big Data Just Got Bigger: Implications of Real-World Evidence and Patient-Entered Data on Health Care and Health Care Policy.

Advancing care delivery in lifestyle medicine and primary care has increasingly benefited from unique data sources and points. To remain competitive and relevant in modern practice, physicians and health systems must tackle and engage the implementation of big data and advanced applications for increasingly complex care. In many cases, information is being aggregated, though barriers exist in terms of accessing, interpreting, and making it actionable. New mobile device applications have eased some barriers, yet present challenges of their own. These new applications, designed to gather patient-entered data outside of traditional clinical settings, will require new policies, systems, and workflows. From a business perspective, collecting such data has potential value to patient care and patient engagement as well as financial incentives. If handled correctly, these additional data sources, including those not previously accessible, have the potential to vastly improve patient health.

Developing physicians as catalysts for change.

Failures in care coordination are a reflection of larger systemic shortcomings in communication and in physician engagement in shared team leadership. Traditional medical care and medical education neither focus on nor inspire responses to the challenges of coordinating care across episodes and sites. The authors suggest that the absence of attention to gaps in the continuum of care has led physicians to attempt to function as the glue that holds the health care system together. Further, medical students and residents have little opportunity to provide feedback on care processes and rarely receive the training and support they need to assess and suggest possible improvements.The authors argue that this absence of opportunity has driven cynicism, apathy, and burnout among physicians. They support a shift in culture and medical education such that students and residents are trained and inspired to act as catalysts who initiate and expedite positive changes. To become catalyst physicians, trainees require tools to partner with patients, staff, and faculty; training in implementing change; and the perception of this work as inherent to the role of the physician.The authors recommend that medical schools consider interprofessional training to be a necessary component of medical education and that future physicians be encouraged to grow in areas outside the "purely clinical" realm. They conclude that both physician catalysts and teamwork are essential for improving care coordination, reducing apathy and burnout, and supporting optimal patient outcomes.