Update: Social justice of AF care, NOAC monitoring, population health and two new podcasts

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Hi All, Here is a short update of the past week. The first thing to say is the Atrial Fibrillation Care: Put the Catheter (and Rx Pad) Down post has gotten a lot of attention. It stayed on the most popular list all week. It has over a 130 comments, and I have received many […]

I will host Hospice and Palliative Care Tweet Chat — #HPM

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This Wednesday Feb 11th, at 9 PM EST, one day after PBS Frontline features Dr. Atul Gawande and his new book Being Mortal, I will guest host the Hospice and Palliative Care (#HPM) Tweet Chat. Dr. Christian Sinclair is a physician leader in HPM and a co-editor of Pallimed. He recently commented on my stewardship piece […]

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 […]

Because there is nothing else to do

If you ever hear your doctor say we are going to do something because there is nothing else to do, be afraid. Be very afraid. First of all, it should be self-evident that if caring and empathy and relief of suffering count as doing something, there is always something to do for patients. A growing problem […]

To deprescribe…Adding a new verb to the language of doctoring

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What follows is my most recent editorial in the Journal of the Kentucky Medical Association. It is reposted with permission. **** One day every month, my wife Staci, a hospice and palliative care physician, goes to see an elderly woman in the nursing home. The routine has gone on for years, which is surprising because […]

New post up on theHeart.org — Dr Emanuel’s Death Wish Harms Rather Than Helps

You know the story on US healthcare and the elderly: Our current default is an American tragedy. It’s devoid of truth and candor; it’s inhumane and it’s wasteful. Recent gains in longevity have come by extending the period of disability right before death. Aggressive care treatment is often hoisted onto the frail because caregivers lack […]

Guest post — 10 observations from a 49 year-old falls risk.

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It finally happened. After years of sitting at John’s bedside through multiple serious bike crashes, I had one of my own. I’ve had plenty of time to build up a ridiculous amount of smugness about why he crashes and I don’t. “John is reckless; Staci is cautious. John rides like an airplane engine on a […]

Death-denial is something doctors can change

I’m not sure why so many doctors don’t get it. Death, that is. Where in medical school, or residency, or even in non-medical life, did this many smart people get the idea that death is optional? Theresa Brown is an oncology nurse and a writer. This weekend, her regular column in the New York Times […]

Be courageous: help stop the pill madness

Medicine people give it a sterile-sounding name. Polypharmacy means giving too many drugs, usually to an elderly person. But this practice is worthy of clearer words: dumb, dreadful or doctoring at its worst. The idea to mention the growing problem of giving too many pills in combination came to me after reading this Medscape coverage […]

ICD deactivation in the NY Times — with a quote from a blogger

The news came via a direct message on Twitter. “You got a plug in the NY times. Congrats.” (Thanks Dr. Jay Schloss.) Paula Span, author of the NY Times’ The New Old Age Blog, reported today on the issue of cardiac device deactivation in patients who are approaching end of life. The role I had […]

Two gifts and a consolation prize

President Obama has a few good ideas. He wants Americans to discuss healthcare this holiday season. That’s actually a really good idea. This blog aims to do some good in the area of medicine and health. What follows are two incredibly important essays. The consolation prize is an excerpt from my recent Top Ten post. […]