In this presentation, Dr. Cady deconstructs the tensions and stressors on both patients and health care providers in today's system. This presentation reviews checklists foe liminating mistakes, the actual number of mistakes that are being made in medical practice, and what patients and their loved ones can do for self protection. This isn't a "bash the doctor" presentation. It's a thoughtful, careful exploration of stresses and ramifications to the current US healthcare system.

1. The Idea of “QUALITY” in
Medicine & Healthcare
presented to:
Louis B. Cady, MD
CEO, Founder – Cady Wellness Institute
Section 0915 – Evansville/Owensboro Section
November 13, 2023
Excellence Through Quality

2. H - 2
“There are two objects of medical education: to heal
the sick and to advance the science.”
- Dr. Charles H. Mayo, MD
“The glory of medicine is that it is always moving
forward, that there is always more to learn.”
- Dr. William J. Mayo

3. “Fair use” of image - per Wikipedia commons

4. Patients come to doctors to get
better.
“It’s not the
consumers’ job
to know what
they want.”
- Steve Jobs

5. The Delta in Doctoring…
• Old timey: actual physical exams,
auscultation, and taking a history.
• New-fangled: typically limited time
appointments, minimal physical exam, lots
of tests and imaging studies instead of
thoughtful history and physical.
• Also –broken down, disconsolate, grousing,
dissatisfied and depressed/burned out docs
and HCP’s.]

6. The concept of excellence and
personal congruence in your HCP
• How do they look?
• What’s their emotional state?
• Do they quote the peer reviewed literature
or just “somebody said”?
• Are they practicing with confirmation
bias(es)?

7. What is confirmation bias?

8. The current picture in the US

9. Keyes CL, Grzywacz JG. Complete health: prevalence and predictors among US
adults in 1995. Am J Health Promot. 2002 Nov-Dec;17(2):122-31.
19% of those
surveyed were
completely
healthy with
high levels of
both physical
and mental
health and a
low level of
illness.
18.8%
completely
unhealthy,
defined as
having low
levels of
illness. Two-thirds of the adults
reported some degree
of mental or
physical illness that
kept them from being
completely healthy.
“Incompletely healthy.”
HEALTH continuum
DEAD
OPTIMAL
66%
“Incompletely healthy”
81%!!!

10. Top Risk factors for chronic diseases–
from previous and multiple sources
• Physical inactivity
• BAD DIET
• Obesity & dysglycemia
• Cigarette smoking
• Excessive alcohol use

11. Everett Napier, an unemployed miner, said he pawned various items
while he has been looking for work, including rifles, tools, jewelry
and two guitars he used to play at church. 'I just swallowed my pride
and quit playing. That's all you can do.' David Stephenson for The
Wall Street Journal. November 26, 2013

12. Nutrition?!?!?

13. How do YOU Want to
Practice?

14. However, nothing
BEATS AGING and
Decay.

15. Do you really want to try 100,000
miles without changing the oil?
Las Vegas, NV © 2003

16. Age management medicine Conventional Western allopathic
practice
Fuel additives can keep our cars
burning cleaner and preserve
engines.
No fuel additives should be used.
They are unnatural. Gas is all that is
required.
We should use optimal quality of gas.
Cheap gas causes “pinging” which is
hard on the engine.
The quality of the gas is irrelevant
Anything that the motor will burn is
just fine. Pinging be damned.
Clean, fresh oil will keep your motor
going longer!
Dirty oil is normal. We should not
intervene.
Preventative maintenance (oil,
transmission fluid, coolant, brake,
transmission fluids; tire rotation)
should be done. Optimal function is
the goal.
“Periodic maintenance” with fresh
fluids, tires, and an occasional wash
and wax is stupid. We should wait
until the car breaks, and then have it
TOWED in.
Age management vs. conventional
medicine… for CARS.

17. What could hormonal optimization do?
Condition Solution hormones
Heart disease, stroke,
arthritis, DM, Alzheimer’s
More exercise
(must have MORE
ENERGY, & improved
lipids, BETTER DIET,
better mental clarity
E2, Testosterone, DHEA,
IGF1, thyroid
Mental diseases and
downstream
repercussions (alcohol)
More energy
More exercise
Better diet
E2, Testosterone,
Progesterone (women),
pregnenolone, DHEA,
IGF1, thyroid

18. How much are we spending?

19. 2021 National Healthcare (US) expenditures
https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-
expenditure-data/historical
• Data from NHEA (National Health
Expenditure Accounts) – the official
estimates of total health care spending
in the US
• US Health care spending increased
2.7% in 2021
– Reached 4.3 trillion dollars or $12,914 per
person.
– Accounted for 18.3% of the Gross Domestic
Product

20. Chronic Disease Overview
• In 2012, half of all adult – 117 million have chronic
health conditions.
• COSTS (per year):
– Heart dz/stroke $315.4 billion
– Smoking $289 billion
– Excess alcohol $223.5 billion
– Cancer care $157 billion
– Diabetes total csot $245 billion
– Arthritis $128 billion
– Obesity medical costs $147 billion
Total annual cost (estimated) $1,504.9 billion, or….
www.cdc.gov/chronicdisease/overview/ - accessed 8/6/2015
$1,504,900,000,000/year

22. “As many as 98,000 people die in hospitals each year as a result
of medical errors that could have been prevented.”

23. https://www.fiercehealthcare.com/digital-health/predictions-for-healthcare-2022
Labor shortages will double the medication error
rate among providers.
Forrester’s analysis: “Rapid clinician turnover and
burnout will contribute to ‘irreversible patients
impacts’ such as adverse drug reactions due to
medication errors & administrative flaws.”

24. In 2023 53% of over 9100 docs are dealing with
burnout. MDLinx survey 8/22/2023
Most burned out
• ER (65%)
• Internal medicine
(60%)
• Pediatrics (59%)
• Ob-gyn (58%)
• Inf. Dz (58%)
LEAST burned out
• Public health/preventive
med (37%)
• Pathology (39%)
• Cardiology (43%)
• Nephrology (44%)
• Orthopedics (45%)
(In comparison to 2018, when only 38% of men
and 48% of women felt burned out)
https://bit.ly/3QT2G3m

26. ECONOMIC/ETHICAL TAUTOMERISM
NEEDS OF the PATIENT
• Adequate time for data
base and to establish
rapport
• Adequate time for
PHYSICAL EXAM
• Being current with the
literature
• Resolve Harvey Specter-
Marcus Welby conflict
• Time for open-ended
questions
NEEDS OF THE HCP
• Time to handle practice
burden (PA’s, insurance
co’s, etc.)
• Need to generate income.
• “Quality” vs.
“Satisfaction” squeeze
• Time to self & family) and
resting and restoring your
therapeutic instrument –
YOU.
• Time to exercise and eat
right
A
delicate
balance
Add to this:
Cuts in “FTE’s”
Dec. support
staff
Administrative
burden/charting.
“PA’s”

27. What are we getting?

28. The stats:
• 1 in 4 Americans on Medicare harmed during
hospital stays
– 12% had “adverse events”
– 13% had temporary complications
– US Sept of Health & Human Services office of Inspector General
May 9, 2022.
• 795,000 American die or are permanently disabled
due to medical misdiagnosis.
– US New & World Report July 20, 2023

29. Interesting findings
US Dept of Health & Human Services office of Inspector General May 9, 2022
• Harm events
– 43% of harm events were preventable, and due
to substandard or inadequate care.
– 56% were not preventable.
• Categories of harm events:
– Medication errors (43%)
– Patient care and pressure injuries (bed sores)
(22%)
– Hospital acquired infections (13%)

30. • Update and broaden the lists of hospital acquired
conditions to capture common, preventable, and
high-cost harm events
• Explore more use of patient safety metrics in pilot
programs.
• Develop and release interpretive guidance to
surveys for assessing hospital compliance with
requirements to track and monitor patient harm.
https://oig.hhs.gov/oei/reports/OEI-06-18-00400.asp
Interesting findings
US Dept of Health & Human Services office of Inspector General May 9, 2022

31. The concept of excellence and personal
congruence in your HCP
[”Harvey Specter vs. Marcus Welby”]
• How do they look?
• What’s their emotional state?
• Do they quote the peer reviewed literature
or just “somebody said” or “the literature
says”? Can they CITE “THE STUDY/(IES)”?
• Are they practicing with confirmation
bias(es)?
– (Do they have a shark on their leg?)

32. The Great Crossover – what is stressing us,
impoverishing us, and lobotomizing us?
• Four crossovers in human history
– The development of speech
– The development of writing.
– The development of moveable type (printing
press).
– The development of the microchip.
– Dan Sullivan. The Great Crossover: Second Edition). The
Strategic Coach.
• The FIFTH crossover – TECH & Generative
AI (Cady)… Where EMR’s lurk.

33. Who can afford care?

34. The US spends 17.8% of GDP on health care.
Percent of GDP spent on health care, 1980-2021

37. Pharma vs. Peer reviewed literature,
and why I like lawyers……

40. Multiple pathways for Alzheimer’s
Disease…

41. Gawande, Atul. Metropolitan Books, Dec. 22, 2009
Will going into the hospital or
doctor’s office be fatal?

44. WHAT TO DO
Uh-oh. I’m sick.

45. Consumer Protection tips
• Be NICE with hospital and/or medical staff.
• Make sure they wash their hands.
• Make sure the surgery area is MARKED.
• Ask about every medication you (or your loved
one) are about to get administered. Write it down
in a journal.
• Pay particular attention to night staff.
• You are entitled to ask for a second opinion.
• You are entitled to ask for a reference from the
peer-reviewed medical literature documenting the
rationale of an advised course of treatment.

46. While considering treatment…
• In non-urgent care, consider if you are
getting an unthinking “by the book” and not-
up-to-date treatment recommended.
• Do your own research on “PubMed.”
• Also use www.scholar.google.com 
• If your doctor or HCP is curt or dismissive,
or doesn’t listen to your questions and
answer them, RUN!

48. Subclinical Hypothyroidism Is an
Independent Risk Factor for Atherosclerosis
and Myocardial Infarction in Elderly Women:
The Rotterdam Study
• Conclusion: Subclinical hypothyroidism
is a strong indicator of risk for
atherosclerosis and myocardial
infarction in elderly women.
Hak EA, Pols H, Visser TJ, et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis
and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med. 2000;132:270-278.

49. Example: testosterone & women
• “Testosterone women heart disease” (479)
• “Testosterone women cognition” (468)
• “Testosterone women mood”(1,174)
• “Testosterone women libido” (498)
• “testosterone women menopause” (2,873)
https://www.ncbi.nlm.nih.gov/ - accessed 11/7/2023

50. ??? Q & A ???

51. The medium and far
future…
• Climate change (two different
interpretations)
• Rise of intelligent robots
• Minerals/chemicals farmed from the
sea.
• Moonbase(s) from CAVES.
• Terrafarming of Mars (2015 -2080).
Genetically engineered plants (2080-
2115). Ice melts at ice caps (2115-
30
– Fianl stage: Towns multiply with farming
and high-tech industry. (2130-70)
• Need to avoid asteroids.
• Mining asteroids for precious metals.
• Interstellar travel using anti-matter
drives. (!!)
But where are we going in
medicine?
- Optimal maintenance and
support?
- Enligtened practice per
peer-reviewed literature?
- Dealing with lifestyle
diseases?
- Or just better surgery
techniques and heroic end-
of-life measures?

52. Personal collection
Louis B. Cady, M.D.