It comes in a large white envelope each month. It’s marked confidential. When I hold it up to the light, I can see through the envelope. I can’t see the details, but the colored graphs give it away. It’s my monthly productivity report. Most employed doctors get these graphs. These “dashboards” of value include your […]
We get what we tolerate…
Richard Fries, a cycling-safety advocate in Boston, uses the phrase we get what we tolerate to describe the dire situation of drivers killing cyclists and pedestrians. Many humans die from these collisions because we tolerate it. An inattentive driver kills a person on a bike; then nothing changes. The phrase applies well to other dubious […]
Big lessons from my error
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 […]
Statins, Like All Medicines, Are Neither Good Nor Bad
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 […]
Trust and Medical Science
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 […]
Fight On Healthcare Reform Misses Core Problems
Politicians and policy makers are fighting over new health reform proposals. This debate misses the core problems in US healthcare. Look at this graph from the Our World In Data website: It shows that Americans pay too much for lousy health outcomes. Fixing the problem on that graph should be the focus of reform. I […]
Should AF ablation require approval from a heart team?
A patient presents with atrial fibrillation (AF) and a rapid rate. He doesn’t know he is in AF; all he knows is that he is short of breath and weak. The doctors do the normal stuff. He is treated with drugs to slow the rate and undergoes cardioversion. During the hospital stay, he receives a […]
Is AF ablation a big placebo?
Turkish authors boldly raised this question in a recent editorial. They likened AF ablation to renal denervation, a procedure in which RF ablation in the kidneys was felt to reduce BP. Many studies showed kidney ablation markedly lowered BP. Then a trial was done with a sham control (people got part of the procedure but […]
Wisdom…
…the quality of having experience, knowledge, and good judgment. I read today a collection of words that exude wisdom. I share it with you because the purpose of this blog is to do create value through education. Peggy Girshman was an award-winning health journalist. When ill with a life-limiting illness, she wrote her own eulogy. […]
Access to healthcare does not deliver health
Stanford economist Raj Chetty and coworkers published an important paper in the Journal of the American Medical Association this week. It’s free. They looked at the association between income and longevity in the US. The results will disrupt a lot of what you might have thought about healthcare. The first finding was not surprising: higher […]
Another thing to fear in healthcare: Getting an Xray
I head to Chicago this weekend for the 4th Annual Lown Institute Conference. The Lown Institute seeks to catalyze grassroots movements for transforming healthcare systems and improving the health of communities. For those of you who want to be on the right side of the street of history, Dr. Bernard Lown, a cardiologist, activist, and […]
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