When my favorite podcaster, the economist Tyler Cowan, asked Dr. Ezekiel Emanuel what nonobvious advice he would give to medical students today, the answer surprised me. The famous bioethicist said: I do think that this is probably the most exciting time in American medicine in a century, since really about 1910, 1920. And it causes a […]
Questioning Your Doctor is Ok
I received a good question(s) from a reader: In your “Changing the culture” posting there is the comment: “Patients seeking medical treatment should not assume a prescribed therapy is beneficial just because a doctor says it is.”… How then does a patient evaluate a proposed treatment in a way that they aren’t thwarting a doctor from performing what may […]
Grander Lessons from a Failure of Robotic Surgery
This week on my podcast, I deviated briefly from cardiology to discuss a shocking and sad study highlighting the vital nature of doing randomized controlled trials in the practice of medicine. The reason I mentioned a trial comparing 2 types of hysterectomy (removal of the uterus) in women with early stage cervical cancer was not to […]
Thoughts on the Apple Watch
Apple products are cool. I love them. But (even) Apple will struggle delivering health. Making healthy people healthier is fraught with problems. At the core of this issue are the many snags of screening people for disease. Here are 600 words I wrote for Medium: I’m a Heart Doctor. Here’s Why I’m Wary of the New […]
On Our Words
During a recent office visit an older women recited to me what I had said to her over a decade ago on the day she came to the hospital. The detail of her memory gave me pause. I could not remember the scenario but she said that my words had become part of her family’s […]
How dangerous are NSAIDs in patients with AF?
One of the most commonly asked questions in the office is the treatment of arthritis pain. This comes up because of the concern over taking NSAIDs (non steroidal anti-inflammatory drugs) in patients who are on anticoagulants (such as warfarin, or dabigatran, rivaroxaban, apixaban). My views on this matter have changed. But first, I want to […]
Cardiology Podcast Every Friday
My editors at Medscape warned me years ago that many people, especially younger ones, read a lot less. This saddened me because I’ve spent a great deal of time learning to write. One of America’s most accomplished writers, Malcolm Gladwell, began his podcast because he worried about not reaching younger people. Each week, I spend a […]
Finding Truth: How Much Do We Need Experts?
I am planning a column on the role of experts in translating medical evidence. Evidence is important because it’s how doctors know they are helping not harming people. It’s hardly news that the new (digital) democracy of information has changed the rules of influence in Medicine. In the days of old, academic doctors generated, analyzed […]
Forgotten Concepts in Medical Practice
A reader asked an excellent question on my last post. Roy wondered if further research in elderly patients would identify a subset of patients that would benefit more from anti-coagulation. My answer is… not likely. The reasons involve three oft-forgotten concepts. See below. To Roy, I say it is unlikely that further research will address […]
How Hubris Impairs the Care of the Elderly
An elderly man with atrial fibrillation (AF) asks whether to continue taking a clot-blocking drug to prevent stroke. This is the gist of a case my colleague Dr Anish Koka recently posted on Twitter. It’s a great thread. Click here to get to the discussion. The first question Anish raised was whether you would keep […]
Flat-of-the-Curve Cardiology Practices
If you think about it, you can’t get much done. So you don’t think about it. You just shake your head and keep tapping on the computer; the next patient awaits. To avoid moral distress, to remain employed as a doctor, you don’t think about the high cost and waste of cardiac care. Dr. Andrew […]
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