Doctoring Health Care Health Care Reform Reflection

Exhibit A on how hubris in medicine can be deadly…Let’s take a time out for skepticism

Thanks for all the support on my last post. It’s striking how sometimes pointing out the obvious gets a lot of attention. I have a quick follow-up post. The purpose is to show you a real-life and current example of how medical hubris might have killed thousands of patients. My friend and colleague, Dr. Wes […]


How much Medicine is enough?

I’m going to tell you a secret about my office practice. (Yes, procedural-based doctors spend long hard days toiling in the office.) On office days, I often play a little game with my imaginary friend. He challenges me to leave the prescription pad in the drawer for the entire day. The idea being that patients […]

AF ablation Atrial fibrillation

More notes from the first day of the Boston AF symposium

 The second half of the day was fast paced and full of information. Folks, these are rough notes. Hope they help…Again my random thoughts are in italics.  Dr Eric Prystowsky led off the with the best clinical papers of 2011: He is a great speaker and hit upon a bunch of important topics.  The good […]

Atrial fibrillation Doctoring Reflection

Can experience make it tougher for doctors?

You have probably read that experience makes for better doctors. And of course this would be true–in the obvious ways, like with the hand-eye coordination required to do complex procedures, or more importantly, with the judgment of when to do them. There’s no news here: everyone knows you want a doctor that’s been out of […]

AF ablation Atrial fibrillation Knowledge

AF Update: Flecainide misinformation

I have said that the best tool for treating atrial fibrillation (AF) is education. I still strongly believe this, perhaps more then ever. AF presents itself to people in so many different ways–from no symptoms to incapacitation. Likewise, the treatments for AF range from simple reassurance and lifestyle changes, to taking a medicine, and on […]

AF ablation Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban

An update on Atrial Fibrillation: Notes from HRS 2011

Earlier this month, heart rhythm professionals from all over the world met in San Francisco. I found the 2011 version of the Heart Rhythm Society meeting an incredible learning experience–a buffet of knowledge on all matters electric. Here’s a book report of sorts on a few atrial fibrillation (AF) related issues: From above the trees, […]

Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban General Cardiology

The first four months of a new era.

My iPhone vibrated with an urgent message that read: Please call…The INR on your atrial fibrillation patient scheduled for cardioversion is too low.  He is on that new blood thinner, Pradaxa.  What do you want to do?” I responded, sounding like an expert:  “It’s Ok.  Pradaxa thins the blood adequately, it just doesn’t change the […]

Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban Health Care

Dabigatran is approved

There can only be one cardiology story to report today. Earlier today, the FDA approved Dabigatran (Pradaxa), an oral anticoagulant for the prevention of stroke in atrial fibrillation. Previously, the only drug approved to prevent stroke in patients’ with AF was warfarin. Despite the well known sound scientific data in support of warfarin for the […]

Atrial fibrillation Health Care Health Care Reform

Big pharma knows your private health matters

He was here for routine follow-up. He has atrial fibrillation. He is, and has been well controlled on generic, well-tolerated anti-arrhythmic medicine for years.  “I feel great, Doc” He is happy, as am I. But he was confused.  Why hadn’t he been switched to the “new” AF medicine. Hmm. Uh-oh.  Here we go again. He […]

Atrial fibrillation General Cardiology General Medicine Knowledge

See everything…

Do you see anything wrong with this picture? (Hint: right column) It is certainly true that atrial fibrillation management guidelines needed an update; the last comprehensive update was in 2006.  Much has changed in AF therapy, including the expanded role of catheter ablation and the soon-to-be warfarin substitutes. I guess the European electrophysiologists couldn’t wait […]

Atrial fibrillation

Alas, a single success…

I have waited a long time to see even one dronedarone (Multaq) success story.  In the interest of having a fair and balanced blog, I report my first witnessed favorable therapeutic response to the controversial new Sanofi AF drug, dronedarone. Four months ago, I saw him in consultation for an inappropriate ICD shock due to […]