The power of the specialist physician — and stewardship

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My latest column over at theHeart.org discusses the disordered balance of power in the doctor-patient relationship. As most of you know, I harbor strong biases about the quality of medical decisions, especially in the elderly. Attached. Yes, I am attached to the issue of decision quality. Nearly all of electrophysiology, and much of cardiology, involves […]

Antibiotics and the heart — Think hard

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My colleague and friend Dr. Melissa Walton-Shirley wrote a nice review article on antibiotics and cardiac issues over at theHeart.org. It is worth a look. MWS is a heck of writer. Although she is writing to doctors, the issues she raises about antibiotics are relevant to everyone. I recently reviewed a case in which a serious […]

Is healthcare careful? Is it kind?

Research now indicates 50% of middle–aged people live with one chronic disease. Translation: half of middle-aged people are not healthy. (You don’t need a reference there. Just walk out into the world and look around.) This new normal creates a challenge for caregivers. How will we care for the onslaught of chronic disease? Surely not […]

Dr. Bernard Lown and the first rule of doctoring

I knock, then enter the exam room. “Hi. My name is John Mandrola.” (Maybe it is my age but I am moving away from calling myself Doctor Mandrola.) “I am a heart rhythm specialist. I have looked at your chart so I know a little about your medical history.” “Can you tell me how you […]

Medicine, lifestyle disease and the pool-safety post

What follows is an introduction to my most recent post on theHeart.org | Medscape Cardiology. It was published yesterday. Many of the comments are excellent. The link is at the end of this post. You might wonder what pool-safety has to do with lifestyle disease. Here is how they relate: I am currently reading an […]

The year in Cardiology 2014 — a top-10 list

When the editors at Medscape asked me to put together an essay on the Top 10 stories in cardiology in 2014, I thought it would be an easy project. I was wrong. It turns out there was a lot to say about the happenings in cardiology this year.  In the end, the final essay had 37 references–a […]

Opposition to ABIM — A tipping point for physicians?

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I know physicians. They are smart, hard-working and prideful. They do a lot of good in this world. But one thing we have been utterly incapable of doing is organizing together and speaking as one voice. The American Board of Internal Medicine may have changed that. The hubris, overreach, and tone-deafness of ABIM may have […]

Undisclosed conflict of interest in the FDA review process

A report from the WSJ this week detailed the fact that FDA reviewers had significant and undisclosed financial ties to industry. I found this discovery remarkable, especially the undisclosed part. But perhaps more remarkable was the lack of reaction it created. The article has only 39 comments, paltry numbers of Tweets and FB shares and […]

Viva La Evidence

Hi All, It’s been a while. The hospital is abuzz with electrophysiology problems. I’ve been unleashing some serious medical fury in the past weeks. It has been fun, though it gets in the way of writing and training. James McCormack (@medmyths) is a “Pharmacist, Professor, Medication Mythbuster, and Healthy Skeptic at the Faculty of Pharmaceutical […]

Where is Cardiology in 2014? An AHA Review

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Last week, I attended the American Heart Association (AHA) 2014 Scientific Sessions in Chicago. I was there as both a learner and physician-writer for theHeart.org. Here are a few paragraphs on the meeting. The main purpose of this post is to introduce the five editorials I wrote. The links to the posts are at the […]

Sudden death and a common antibiotic

The longer I practice medicine, the more nervous I get about medications, especially when patients are already on other drugs for chronic diseases. I much prefer deprescribing. A recent study on the common antibiotic cotrimoxazole, which is a combination of sulfamethoxazole and trimethoprim, and often referred to by its brand name, Bactrim or Septra, lends […]