I’ve got a good one for you. Who is the better doctor? Is it the caregiver who–by whatever means–gets her patient on the best treatment, or, is it the doc who communicates the options most clearly? I ask because the Institute of Medicine has made shared-decision making (or patient-centered care) a major focus of quality […]
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The thing is: I am a real fan of ICDs. I could fill this blog with ‘good’ ICD stories. These would be vignettes that describe real people who have gained beautiful years of life because of an automatically delivered shock from a device that a former paper boy implanted. Like all things therapeutic, there are […]
Nearly six months have passed since “emergency†meetings were called. Gosh, if I had a dollar for every emergency meeting. It’s amazing how looking back at these crises makes our angst seem silly. Like many things medical, time and deep breaths have a way of sorting things out. The latest heart-rhythm crisis centered on the […]
Heart rhythm doctoring made news again. This time it was a WSJ report on CRT—cardiac resynchronization therapy. What is CRT? (Briefly) CRT devices, formerly known as bi-ventricular devices, involve placing an extra lead in a vein branch of the left ventricle at the time of pacemaker or ICD implantation. The extra lead allows the right […]
There are few other medical specialties that boast more guidelines than Cardiology. We don’t say a specific treatment plan was good or bad; we say it was “I, IIa, IIb, or III” Today, a well publicized health story (WSJ, and NY Times) from the Archives of Internal Medicine reported that more than 50 percent of […]
As posted yesterday by my colleague, Dr Wes, the folks at the incredibly useful site, Medgadget are hosting the best of 2010 medical blogs. As in bike racing, there are many categories in which to nominate a blog: Best Medical Weblog Best New Medical Weblog (established in 2010) Best Literary Medical Weblog Best Clinical Sciences […]
The implantable defibrillator (ICD) is an amazing life-saving device. Â When used in the appropriate patient, the scientific data supporting its benefit is rock solid. The sudden death-averting appropriate ICD shock in the middle of the night, allows the patient to enjoy breakfast with his spouse, rather than admission to the morgue. ICD function seems simple: […]
Malpractice and heart catheterization are in the news today. A spicy concoction for sure. An epidemiological study published in an obscure online (and overpriced) subsidiary of Circulation addresses the role of three major medical issues facing cardiologists today: malpractice, heart catheterization, and medical costs. The summary details of the study have already been published in many […]
Once again, the Nobel prize for economics–not science and medicine–has immense influence on the practice of medicine. Every day, in fact. This year, Richard Thaler, a behavioral economist at the University of Chicago, won for his work on human biases and temptations. The famous writer Michael Lewis (Moneyball) has a nice essay on Thaler’s work […]
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 […]
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 […]