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Justin Moore, MD, has thoughts.

Links for Thursday, October 18, 2018: the Tooz, menu hacking, and patient antibiotic satisfaction

October 18, 2018

John Matuszak, the former overall #1 NFL draft pick who played Sloth in The Goonies, died of a narcotic overdose at age 38

He was tragically ahead of his time.

There is a secret world of secret restaurant menus, visible only to those brave enough to order the “McLand, Air, and Sea”

I have a friend from college who is notorious—notorious—for ordering things from restaurants that are not on the menu. Nothing crazy. He doesn’t order shrimp cocktail at a hot-dog stand or anything. But asking for melted cheese to be spread on his burrito? Oh yeah. That’s the stuff. Turns out he’s not alone:

“That menu hacks are generally customer imposed, not instigated by the restaurants, shows in the character of the items themselves. They tend to be things that only those who don’t work in the kitchen would come up with. Such are composites of menu ingredients or entire items. At Taco Bell, one secret-menu item, known as the Incredible Hulk, consists of a five-layer burrito with guacamole instead of nacho cheese. That’s nothing but an ingredient swap.

Some well-known McDonald’s mash-ups are especially clunky. Secret-menu items such as The Pie McFlurry, a pie blended into a McFlurry shake; the McCrepe, a pancake filled with McDonald’s fruit-and-yogurt Parfait; and the McLand, Air, and Sea Burger—the innards of a burger, a chicken sandwich, and the Filet-O-Fish between the buns of one—are Frankensteinian.”

One of my co-fellows at UNC was fond of ordering pickle-less hamburgers from a McDonald’s on the West Virginia turnpike. His reasoning was that anything he special ordered would be guaranteed to be made on the spot. He didn’t like the texture of burgers that had been under the heat lamp. This seems reasonable and relatively kind to the workers at the restaurant, at least in comparison to some other tactics:

“Amid the din, once in a while, I heard a different voice. On social media, a restaurant worker would chime in, usually to counter a myth or plead for patience with or politeness to the restaurant staff. Here’s ‘Kathryn Erwin’ setting customers straight in the comments section of the ‘Nachos’ listing for Chipotle at HackTheMenu.com on December 2, 2015:

‘I work at a Chipotle and if you ask any of our crew members we will tell you that we do not have nachos. Nachos normally mean that the cheese is melted and we cannot melt the cheese for you. We can however put chips at the bottom of your bowl and then build a normal bowl for you. They are not called nachos though.’

It’s really her final line, however, that drives home the annoyance that menu hacking can bring for restaurant workers: ‘And please,’ Kathryn implores, ‘do not be rude to an employee if they refuse to call a bowl with chips nachos.’ In the conversations of menu hackers, I seldom heard such a distinctly labor point of view.”

Patients heart doctors who’ll prescribe them antibiotics for non-bacterial problems.

And they punish the docs who won’t:

“Few physicians achieved even the 50th percentile of satisfaction while maintaining low rates of antibiotic prescribing. To reach the top quartile, a physician had to prescribe antibiotics at least half the time; almost all physicians above the 90th percentile had a rate of antibiotic prescribing greater than 75%.”

In links to health Tags mcdonalds, chipotle, menu hacking, food swamps, john matuszak
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Not much food in this swamp.

Not much food in this swamp.

Links for Friday, December 29, 2017: food swamps, happiness from QI, and the persistence of ineffective treatments

December 29, 2017

So long, food deserts. Helloooo, food swamps

...food swamps had about four unhealthy options for each healthy one. Food swamps were a strong predictor of obesity rates—even stronger than food deserts were. The relationship between food swamps and obesity was especially strong in areas where people lacked both their own cars and access to public transportation.

See primary paper here.

Bob Badgett has thoughts on happiness and quality improvement

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The Dunning-Kruger effect (which applies to docs) is the phenomenon in which difficulty in recognizing one's own incompetence leads to Inflated self-assessment. That is, the worse you are at your job, to some extent, the higher you rate your ability to do that job. Uplifting stuff when we think about management. 

Why do doctors keep recommending treatments that don’t work?

Tough question that Eric Patashnik does a good job of summarizing in a manageable length. We're all victims of our own status quo bias:

In the US, even modest reforms to use taxpayer money to fund research to learn what treatments work best, for which patients, have engendered controversy. Republicans famously charged that the establishment of the Patient-Centered Outcomes Research Institute (PCORI) through the Affordable Care Act, would lead to the creation of “death panels.” The politicians made that argument even though the agency only funds studies and was given no authority to make policy decisions or payment recommendations. PCORI has yet to have a significant impact on clinical practice. It faces a sunset date of 2019, and its future remains unclear.

In medical literature, links to health, practice management Tags food swamps, food deserts, happiness, quality improvement, Dunning-Kruger effect, heart disease, status quo bias, medical rituals, efficacy
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