Dr John M

cardiac electrophysiologist, cyclist, learner

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It’s all connected…

April 23, 2014 By Dr John

…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 other words, was the increase in episodes related to her other problems?

Yes. Yes.

This is what I’ve been trying to tell anyone who will listen.

In the human body, it’s all connected.

Some might say I spend my days treating heart rhythm disorders. That’s not accurate. I am treating people who have heart rhythm disorders. That person I am seeing may have kidney problems, cancer, arthritis, depression, sleep disorder, a recent surgery or any host of other issues. What’s more, that person has his or her own goals for care.

My job, therefore, isn’t just to suppress the rhythm problem. That’s an easy task. Rather, my job is to make the entire person better. That may mean not treating the rhythm. It may mean educating, empathizing, or helping the person manage other more pressing problems. It surely means seeing the effects our treatments will have on other aspects of human life.

Whenever we treat a disease, any disease, it’s vital that we see the person we are treating.

I repeatedly teach patients that my task is to help them without making them worse. AF is an easy example. The disease gets most scary when doctors get involved. We need to see that fact. We need to teach our patients that fact. There is no free treatment–it all comes with tradeoffs. Anticoagulants reduce stroke risk but increase bleeding risk. AF ablation reduces symptom burden but the procedure comes with a risk for serious complications. Statin drugs reduce the risk of a future heart attack but increase the risk for diabetes. You see the trend.

Cancer is another example. Why is the mammogram story so important? It’s because chemotherapy, surgery and radiation are so hard on the person. When I was in medical school the challenge of treating cancer was to kill just the cancer cells, not the normal cells. That remains the challenge. Surviving cancer often means surviving the treatments doctors prescribe. And that requires an entire person.

Treating disease in the elderly is perhaps the most important time to see the person rather than her diseases.

This precarious balance of connectedness is what makes doctoring so damn special.

JMM

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Related posts:

  1. The truth about early diagnosis — this is more than just a Mammogram story
  2. An important quality measure in hospitals
  3. In the Prime post up–Does work stress increase the risk of heart disease?
  4. An important message from the Heart Rhythm Society

Filed Under: Doctoring, Knowledge

John Mandrola, MD

Welcome, Enjoy, Interact. john-mandrola I am a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape

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Find me on theheart.org | Medscape Cardiology

  • Electrophysiology commentary on Medscape/Cardiology

Mandrola on Medscape

  • My Medscape column on general medical matters

For patients...Educational posts

  • 13 things to know about Atrial Fibrillation — 2014
  • A new cure of AF
  • Adding a new verb to doctoring: To deprescribe is to do a lot
  • AF ablation — 2015 A Cautionary Note
  • AF Ablation in 2012–An easier journey?
  • Atrial Flutter — 15 facts you may want to know.
  • Benign PVCs: A heart rhythm doctor’s approach.
  • Caution with early Cardioversion
  • Decisions of 2 low-risk cases of PAF
  • Defining success in AF ablation in 2014
  • Four commonly asked questions on AF ablation
  • Inflammation and AF — Get off the gas
  • Ten things to expect after AF ablation
  • The medical decsion as a gamble
  • The most important verb in our health crisis
  • Wellness Requires Ownership

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