(This post introduces my latest column on TheHeart.org | Medscape Cardiology. It’s about stroke in young people.)Â *** We define stroke as the death of brain cells. The typical cause is a blocked blood vessel in the brain. Stroke usually occurs in older people who have established blood vessel disease. Stroke is bad; it may […]
Category: Doctoring
I was furiously tapping on the computer when he asked: “Doc, what happens if I don’t have the procedure you are recommending?” Glee spread through my body. I grinned and nearly jumped up from the stool to hug him. I enthusiastically answered. Few patients ask this vital question. I tweeted about the encounter: An older […]
I remain concerned about the irrational exuberance among some of my colleagues toward left atrial appendage occlusion devices for the prevention of stroke in patients with atrial fibrillation. In short, these devices are plugs that doctors place into the left atrial appendage. The idea is to stop clots from forming or escaping from the left […]
A study presented at the recent Heart Rhythm Society meeting in Chicago has added more uncertainty about the significance of short-duration AF episodes. Before I tell you about the study, I need to clarify what I mean by short-duration AF episodes, sometimes called subclinical AF (SCAF). SCAF is AF on a monitor that is often […]
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Medicine at its best is a team sport
Patient safety, quality, and value are new buzzwords in healthcare. No doubt, these are all laudable goals. The problem is that true quality care cannot be put on a spreadsheet and publicly reported. It just can’t. Never. Why? My friend Dr. Wes Fisher explains in this beautiful post called “Wingman:” There is talk of quality […]
Our brains can easily fool us. No experienced doctor would deny the power of the placebo effect. Today I want to discuss the nocebo effect, which occurs when negative expectations of something causes it to have a more negative effect than it otherwise would. Drugs can exert a strong nocebo effect. If your brain thinks […]
We have to talk about drugs. No, not illicit drugs, but medications used by doctors and patients. Plaintiff attorneys run ads on TV that fool people into thinking certain meds are bad. The current one I deal with is the clot-blocking drug rivaroxaban (Xarelto.) Before that, it was dabigatran (Pradaxa). If, or when, the makers […]
I like thinking and learning. Birthdays surely make one slower on the bike, but birthdays, it seems, do not have the same drag on the brain. For me, birthdays have increased my appreciation of liberty. In the Constitution of Liberty, Hayek defines it as the absence of coercion. Such is a beautiful definition. Don’t coerce […]
Concerned citizens will march this weekend to defend science. Standing up for science is a worthy cause. Look at what medical science has accomplished in recent times: serious diseases, HIV, heart attack, many forms of cancer, have been tamed by the advance of science. We need more not less science. It’s nuts to cut funding […]
Yesterday I posted the four most important questions to ask your doctor. Let’s apply those questions to a typical scenario: Whether or not to take an anticoagulant drug for prevention of stroke in the presence of AF. We need a typical patient. For this example we will pick a typical CHADS-VASC 2 patient. 65 year-old […]
I am seeing an increasing number of patients who did not know they had a choice about taking a medicine or having a procedure. Why did you have that heart cath? A: My doctor said I should. Why are you on that medicine? A: My doctor prescribed it. It’s time we re-review the basic four […]