…and this is the crux of the practice of medicine. I just had a Eureka moment while talking on the phone with a patient. We were discussing how to manage her increasingly frequent episodes of atrial fibrillation. She was also dealing with two other major health problems. She asked me: Are these things connected? In […]
Physician satisfaction: Seeing both sides of the debate
Students of the obvious might consider the topic of physician satisfaction one of mere folly. The “rich doctor” label is an easy one, and the recent Medicare data dump, which revealed hordes of physicians who were doing quite well, thank you, only strengthened it. Yet, when one moves past intuition, into analytical thinking, the contentment […]
A whimsical update on things buzzing in my head…
Hey all, I’ve hit a little tough patch in the area of writing. Simply said, it’s been difficult finding the time in recent weeks. That’s the funny thing about writing, the more I do it, the harder it gets. It takes longer now. So…In an effort to just feel better, and, because this is a […]
Cardiology and stewardship — New post up at Medscape|Cardiology
One of the definitions of the noun steward is a person whose responsibility it is to take care of something. Wikipedia calls stewardship an “ethic that embodies the responsible planning and management of resources.” These apply well to cardiologists–who use powerful (and expensive) tools in the care of fellow humankind. The internal cardiac defibrillator, or […]
Six initial impressions of the Medicare payment disclosure story
What a day it was for medical news. After much legal wrangling, specifically by the Wall Street Journal, the Centers for Medicare and Medicaid Services (CMS) released detailed data on payments to 825,000 US physicians in 2012. It was called a “data dump.” Wow. Was it ever. The story was front page news in US […]
New post up on Medscape/Cardiology: Ablation versus medicine as an intitial strategy for treating AF
Earlier this month I promised to put together teaching points from the Rich Peverley story. His was an interesting case of sudden collapse that likely occurred as a result of atrial fibrillation therapy rather than atrial fibrillation itself. This was my original report: Important lessons from the collapse of NHL player Rich Peverley (BTW: It […]
A follow-up on the LifeVest…and decision quality
One of the most controversial posts I have ever written concerned Zoll corporation’s wearable cardiac defibrillator, which they have smartly branded the LifeVest. Here is the link to the 2013 post: LifeVest: A Precarious and Unproven Bridge . . . to Somewhere The less-than-glowing assessment brought me a great deal of criticism, both publicly and […]
A clear-eyed look at treating the elderly with medicine
A recent case taught me a lot about how people perceive their medicines. I was trying to help a 92-year-old man get off some of his medicine. I can’t go into the details, but suffice to say, there was much opportunity to trim a long list of drugs, many of which were threatening his existence […]
Doctors and Social Media — It’s time to embrace change.
I recently took on a position of medical journal editor. It is with the Journal of Kentucky Medical Association. It’s been a good learning experience. Part of the job of editorial board members is to write an opinion column. (Check, I’ve done that before.) What follows below was published in this month’s journal. The editorial […]
Dronedarone (Multaq), clinical guidelines and patient safety
(What follows is a brief introduction for a post I wrote over at Medscape/Cardiology. The link is at the bottom of the page.) It is appropriate to worry about medical errors and patient safety. Here the low-hanging fruit is plentiful: antibiotic stewardship, automated notification of drug interactions and attention to hand washing all join a […]
The problem with testing students and doctors is what gets truncated
For me, maybe you too, the best part about science is how it disrupts the status quo. A belief, a way of doing something, a paradigm if you will, becomes entrenched. Humans love patterns. We get attached. I call this the way-it’s-always-been-done philosophy. It’s endemic in medicine, and, from what I can see, in education […]
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