AF ablation Atrial fibrillation Doctoring General Medicine Health Care ICD/Pacemaker Knowledge

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 […]

Atrial fibrillation Doctoring General Medicine Health Care Health Care Reform Knowledge

The trick of hope — and the medical decision

Last night, during the intro show for the PBS documentary, Cancer: The Emperor of All Maladies, a Ken Burns film based on the book by Siddhartha Mukherjee, Katie Couric interviews both Ken Burns and Dr. Mukherjee. The moment occurred about 10 minutes into the video. There is a poignant scene in which two young parents […]

Doctoring Health Care Knowledge

The medical decision as a gamble

The medical decision–to have a screening mammogram, to take warfarin, to undergo a catheter ablation–is, at its core, a gamble. We pit the treasure of the win (benefit) against the pain of the loss (harm). In times past, medical gambles were easier. You took the antibiotic or you lost your leg. Most medical decisions today […]

Doctoring Knowledge

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, […]

Doctoring Health Care Health Care Reform Knowledge Reflection

Medical decisions – the illusion of control

This is a very short story about a baby bird, a yoga mom and a hawk. I tell it because it made me think about the disordered way we frame healthcare decisions. **** The neighborhood is one of old brick houses, cracked cement sidewalks and tall trees. What was once a suburb is now a […]

Atrial fibrillation Doctoring Healthy Living ICD/Pacemaker

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 […]

Doctoring General Medicine Knowledge

COVID19 and Finding Effective Medical Therapies

This post introduces a column I wrote over at | Medscape Cardiology — The good news is that most people infected with coronavirus don’t need a hospital or doctor. But some do. Some get very ill. The maddening thing is that doctors don’t have an effective treatment for the virus. There are no cures. […]

Doctoring General Cardiology General Medicine Health Care Knowledge

More on the gambling decision to take statins

In my last post, I wrote my initial thoughts of an important new study on how the decision to take a medication or have a screening test in the name of prevention is similar to playing the lottery. I promised to think and write about the study more carefully. My latest thoughts are now published […]

Doctoring Knowledge Social Media/Writing/Blogging

Disruption in medical education — Teaching the teachers via social media?

Everyone agrees that doctors should be informed and up-to-date. Perpetual medical education has always been a vital component of doctoring. But now, as the rapid pace of healthcare innovation pushes against the limits of biology, and really, our humanity, medical education gains even more importance. Doctors (and patients) must know what can and cannot be […]

Doctoring General Cardiology ICD/Pacemaker Reflection Social Media/Writing/Blogging

First ever invited commentary in a medical journal — JAMA-IM

I’m going to be proud for a moment. Yesterday, the journal JAMA-Internal Medicine published an invited commentary that I co-wrote with Dr. Dan Matlock (@Dan_Matlock) from the University of Colorado. The title of the piece is The Antidote for Unprepared Patients — A Caring Clinician. It’s available for free. Invited editorials in medical journals are often […]

Doctoring Hospice/Palliative Care Reflection

Take fear and ignorance out of end-of-life decisions — A rebuttal to Dr Paul McHugh’s WSJ editorial

Perhaps it’s because I love the practice of medicine so much. Or maybe it’s because doctors (and teachers) have always been my heroes. I’m trying to sort out why I feel so offended by Dr. Paul McHugh’s editorial in the Wall Street Journal last weekend. His sensational and paternalistic view of physician-assisted suicide can be […]