Medical decisions – the illusion of control
This is a very short story about a baby bird, a yoga mom and a hawk. I tell it because it made me think about the disordered way we think of healthcare decisions.
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The neighborhood is one of old brick houses, cracked cement sidewalks and tall trees. What was once a suburb is now a city neighborhood. What was once a community of older folks is now one of young couples and children. There is money here. There is education here. This is not the 1% but maybe the 2.4%.
The fit young mother dressed in yoga pants and a bright-colored top was pushing a jogging stroller with two children. A typical image in the land of the educ...
Source: Dr John M - June 15, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
We depend on each other…
What is the greatest possible thing that could happen to you today?
Is it winning a million dollars? Seeing your children smile? Going to a job you love? Perhaps it is waking up next to a spouse whom you love and is also your best friend?
These are all winners, for sure.
But what if you actually saved another person’s life? No, not figuratively, but really. Imagine: another person just up and dies in front of you, and you take decisive action to save her. And she lives.
I can testify that truly saving a life is indeed a life-changer. You never forget.
The scenario of out of hospital cardiac arrest is not an uncommon one....
Source: Dr John M - June 13, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
The danger of digital medicine
Sometimes I worry about where technology is leading the healthcare profession.
It is not just the distraction of white screens and electronic health records. These are bad, terrible, in fact. The concern I have runs deeper than just monopolistic EHRs.
We, and I mean we as in the caregivers, are losing touch with the basics. I see it everyday, especially, but not exclusively, in the younger generation of nurse and doctor. The collective loss of fundamentals is happening so slowly and steadily that no one seems to notice. Indolent is what we say in medical-speak.
Here is what I mean.
What makes the practice of medicine work ...
Source: Dr John M - June 8, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Be courageous: help stop the pill madness
Medicine people give it a sterile-sounding name. Polypharmacy means giving too many drugs, usually to an elderly person.
But this practice is worthy of clearer words: dumb, dreadful or doctoring at its worst.
The idea to mention the growing problem of giving too many pills in combination came to me after reading this Medscape coverage of a trial of statin removal in patients nearing end of life. The randomized clinical trial was presented at the 2014 Annual Meeting of the American Society of Clinical Oncology. One group of patients had their statin stopped and the other group continued the drug as is the normal practi...
Source: Dr John M - June 6, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Another VA lesson — Healthcare needs to stop being like flying business class
The VA healthcare story has me thinking about the good aspects of delays in medical therapy.
Typical American intuitive thinking holds that healthcare waiting lists are a bad thing. The two central tenets of this mindset are that healthcare brings health, and most of medicine is as time sensitive as cardiac arrest or heart attack.
Yet, when we engage our slow thinking minds it’s easy to see the flaws in such an early-intervention shortcut (heuristic). The business about healthcare not bringing health has been addressed here many times over. The short story is that in general we do best when treating the very sick, not so...
Source: Dr John M - June 3, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
The VA healthcare system — Can we handle the truth?
Memorial Day weekend is an apt time to consider the recent accusations of wrongdoing in the VA healthcare system. It’s an opportunity to face the truth.
As a free American, I am connected to veterans. It has always been remarkable that young people give their life or health for their country, but now, in this me-centric era, it is stunning that they do. It is truth to say that veterans deserve our respect and our care. Consider also that recent wars have been fought on the backs of the underprivileged, a fact that strengthens this calling to care.
I am also connected to veterans’ healthcare. For it is in the VA sys...
Source: Dr John M - May 25, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Exercise, over-indulgence and atrial fibrillation — seeing the obvious
If you like thinking and writing, few topics are better than the excess exercise and heart disease story. Indeed it is a matter for the curious.
Two studies published last week in the British journal Heart addressed the relationship of exercise and heart disease. (See references below.) Although these studies garnered mainstream media attention they added little to what is already known. Namely, that moderate exercise is protective and excessive exercise is detrimental. This has been dubbed the J-curve of exercise. You could also call it…obvious.
I’ve been to this place so many times, I was going to leave it al...
Source: Dr John M - May 18, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
2014 Heart Rhythm Society Sessions — My massive recap:
Hey Everyone,
I recently returned from the Heart Rhythm Society meeting in San Francisco. I attended the meeting as both a physician-journalist-columnist for theHeart.org and as a practicing electrophysiologist. As it so often is with international meetings, I returned energized and rejuvenated about the practice of medicine. Medical meetings are great this way.
It’s quite sad that fewer doctors are traveling to meetings. It’s a missed opportunity for learning, and shall I say, rekindling of the spirit of doctoring. Sure, social media allows a semblance of virtual attendance, and this is better than no attendance, but ...
Source: Dr John M - May 15, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Mother’s Day…2014
As I return home from the Heart Rhythm Society sessions in San Francisco this Mother’s Day, I got to thinking about my mom.
Here I am, a cardiac electrophysiologist, a doctor. I’m traveling to meetings, learning to write commentary, making friends with colleagues across the globe.
How did this happen?
Surely with great luck, but, I also know my total immersion in love and support as a child contributed. For this, I have my entire family to thank.
Mom’s, however, our special.
Mine was selfless. Her children, her family, my father, this was everything to her. Sadly, such selflessness likely shortened her li...
Source: Dr John M - May 11, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Struggling with the (relative) value of humanistic medical care –
I just arrived in San Francisco. I am here for the 2014 Heart Rhythm Society sessions.
The meeting begins today. A poster session this evening is overflowing with notable studies. Stay tuned. I’ll be working hard for theheart.org to bring you the best stories.
First, though, here’s a little appetizer.
On the eve of the biggest EP meeting of the year, my friend Wes Fisher, also an electrophysiologist and writer, posted this provocative piece, When We Reward Regulators More Than Doctors, on his blog. Wes did some investigating and learned that doctor-executives in the testing industry reap remarkable salaries. Ev...
Source: Dr John M - May 7, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Atrial fibrillation and philosophy…
Patterns. As a doctor, you learn to see patterns. Biologists call the patterns of organisms phenotype–as opposed to genotype, the genetic makeup.
For twenty years, I have observed phenotypes (patterns) of people afflicted with AF, and have come to believe, and data are beginning to confirm, that the disease doesn’t just happen. It’s not a fluke. AF happens to people because of something about them.
I’m not talking about the obvious AF associations, such as obesity, high blood pressure, sleep apnea, and structural heart problems (heart failure and valve disease, etc). These are all diseases that disr...
Source: Dr John M - May 4, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
The public voice of doctors
One of the selfish reasons I love being a physician is the honor of being included in such a respectable group. Doctors are good people, smart people, dedicated people. These are my colleagues, my mates, my fraternity.
This attachment to the honor of doctoring is why it pains me when we hurt ourselves with our words. When the public voice of doctors lacks grace or empathy or even a modicum of self-awareness, the profession, the group as a whole, is diminished. The digital age cuts both ways. On the one hand, its democracy gives regular doctors a voice, but on the other, it amplifies and makes permanent our missteps.
A rece...
Source: Dr John M - May 2, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
The why and how of public distrust of vaccines…Surely, questions worth asking
One of the biggest changes in healthcare in recent times is the emphasis on decision-making. Patients and doctors now work with big menus. It’s mostly a good thing, but a certainty with increased choice is increased conflict.
As a doctor who works in a field–electrophysiology–that is almost exclusively preference-sensitive, I’ve grown increasingly interested in why and how humans choose things. After twenty years of bearing witness to medicine’s wins and loses, I’ve come to realize how little I know about this central theme of doctoring.
The list of mysteries I think about is a long one:...
Source: Dr John M - April 28, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Disruption in medical education — Teaching the teachers via social media?
Everyone agrees that doctors should be informed and up-to-date. Perpetual medical education has always been a vital component of doctoring. But now, as the rapid pace of healthcare innovation pushes against the limits of biology, and really, our humanity, medical education gains even more importance. Doctors (and patients) must know what can and cannot be accomplished. We must know the evidence. And these days, evidence pours in.
Doctors are essentially teachers, and thus, a central question in medical education parallels that in regular education: What is the best means for teaching the teachers?
I’ve written before...
Source: Dr John M - April 26, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
It’s all connected…
…and this is the crux of the practice of medicine.
I just had a Eureka moment while talking on the phone with a patient. We were discussing how to manage her increasingly frequent episodes of atrial fibrillation. She was also dealing with two other major health problems.
She asked me:
Are these things connected?
In other words, was the increase in episodes related to her other problems?
Yes. Yes.
This is what I’ve been trying to tell anyone who will listen.
In the human body, it’s all connected.
Some might say I spend my days treating heart rhythm disorders. That’s not accurate. I am treating people...
Source: Dr John M - April 23, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
