The medical decision is sick but not hopeless…

What follows is my latest post on | Medscape Cardiology. It’s weird; the post is one of my favorites, but it’s not made the most read list–at all, not even fifth place. There are thoughtful comments but it’s simply not popular among doctors. **** Imagine this scenario: A learned professor comes to your office […]

Medical decisions — tradeoffs, emotions, preferences and experts

Maybe you wonder why a cardiologist writes about vaccines and mammography. It is because I have grown intensely interested in the medical decision. As a doctor in a preference-sensitive field, electrophysiology, how do I help patients understand and choose the best path–of which there are many. This seems like a simple task, but with humans, […]

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 […]

New post up at Practice variation in cardiology signals problems

There’s a problem in the world of cardiology. We used to be leaders in the medical world. Now, I am not so sure. We may be at an inflection point. What would you think if cardiac procedures, like diagnostic catheterization and PCI (stents usually), varied widely depending on a patient’s geography or payment system? Your […]

Four Components of Making Medical Decisions

How do doctors decide on treatments? How do you decide? And yes, you should decide! What inputs go into making this important decision? Let me make it simple. Basically, there are only four. (As they say in the Hamburg EP lab…”It’s easy.”) First, since I am an older doctor, I’ll start with… Risks: In deciding […]

A new ICD, without a wire in the heart…Less can be better…

“Hey John, I hear there is a new ICD out…without any wires,” came the question in the doctor’s lounge. That’s cool, they are reading the NEJM, I thought. It is true that a very preliminary report on a subcutaneous-only ICD was published in the print version of the NEJM this week.  The print version of anything […]

Impending ICD oversight may not be a bad thing…

At the risk of exposing my naivete, or being too much like the geeky student who sits in the front of the classroom, I can’t help but welcome the upcoming policing of cardiac device implants.   As recently written by Dr Wes, government policing agencies, the DOJ and RAC folks, are planning to focus on […]

Five “real” world issues with the complex decision to recommend heart catheterization…

Malpractice and heart catheterization are in the news today.  A spicy concoction for sure.   An epidemiological study published in an obscure online (and overpriced) subsidiary of Circulation addresses the role of three major medical issues facing cardiologists today: malpractice, heart catheterization, and medical costs.  The summary details of the study have already been published in many […]