Doctoring General Medicine Healthy Living Knowledge

A clear-eyed look at treating the elderly with medicine

A recent case taught me a lot about how people perceive their medicines. I was trying to help a 92-year-old man get off some of his medicine. I can’t go into the details, but suffice to say, there was much opportunity to trim a long list of drugs, many of which were threatening his existence […]


New post up at Practice variation in cardiology signals problems

There’s a problem in the world of cardiology. We used to be leaders in the medical world. Now, I am not so sure. We may be at an inflection point. What would you think if cardiac procedures, like diagnostic catheterization and PCI (stents usually), varied widely depending on a patient’s geography or payment system? Your […]

Doctoring ICD/Pacemaker

New post up at — The ethics of ICD decision-making

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 […]


Standing up for a Harvard Doctor

There was a very important article written in the NY Times today. It highlighted a common medical scenario in my world—the defibrillator (ICD) world. I am going to talk about ICDs here, but the big picture inherent in this story illustrates the important issue of how best to apply invasive therapy to elderly and sicker […]