Physician satisfaction: Seeing both sides of the debate
Students of the obvious might consider the topic of physician satisfaction one of mere folly. The “rich doctor” label is an easy one, and the recent Medicare data dump, which revealed hordes of physicians who were doing quite well, thank you, only strengthened it. Yet, when one moves past intuition, into analytical thinking, the contentment of doctors gains importance.
Rare is the person who goes from being perfectly healthy to peacefully dead in seconds. Rather, almost all of us will meet and depend on caregivers along the way. The mindset of doctors, therefore, is indeed far from folly.
That’s why I’d point you t...
Source: Dr John M - April 21, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
A whimsical update on things buzzing in my head…
Hey all,
I’ve hit a little tough patch in the area of writing. Simply said, it’s been difficult finding the time in recent weeks. That’s the funny thing about writing, the more I do it, the harder it gets. It takes longer now.
So…In an effort to just feel better, and, because this is a blog, which are, by definition, decidedly whimsical, I thought I’d jot a few paragraphs on things buzzing in my head.
Let’s start with the college tour in California during Spring break. California is something, isn’t it? You can see why so many people live there. Everything about that state is remarkable. Our hotel...
Source: Dr John M - April 18, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Cardiology and stewardship — New post up at Medscape|Cardiology
One of the definitions of the noun steward is a person whose responsibility it is to take care of something. Wikipedia calls stewardship an “ethic that embodies the responsible planning and management of resources.”
These apply well to cardiologists–who use powerful (and expensive) tools in the care of fellow humankind. The internal cardiac defibrillator, or ICD, is one such “big hammer.” The $30,000 device automatically terminates sudden cardiac death via internally delivered 750-volt internal shocks. These shocks usually prevent the patient from dying of that arrhythmia at that moment.
The c...
Source: Dr John M - April 15, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Six initial impressions of the Medicare payment disclosure story
What a day it was for medical news. After much legal wrangling, specifically by the Wall Street Journal, the Centers for Medicare and Medicaid Services (CMS) released detailed data on payments to 825,000 US physicians in 2012. It was called a “data dump.”
Wow. Was it ever.
The story was front page news in US newspapers. Social media amplified the conversation. The WSJ featured an interactive tool that allows anyone to look up a doctor, and see exactly what Medicare payments he or she received in 2012.
I don’t like using the modifier “granular” (it sounds so academic) but this is indeed granula...
Source: Dr John M - April 9, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
New post on Medscape/Cardiology: My take of the 2014 Atrial Fibrillation treatment guidelines
Atrial fibrillation affects millions of patients, and its incidence and prevalence are on the rise. It’s a peculiar disease in that it affects people so differently. When populations are studied, AF associates with higher rates of stroke, heart failure and death. But patients aren’t populations.
In recent years, the treatment options for this pesky disease have expanded. This is both good news and bad news. The good news is that when these treatments are applied wisely, with an engaged patient, outcomes can be improved. As an AF caregiver, it is gratifying to use these tools to help people. The bad news is that...
Source: Dr John M - April 1, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Vacation Time
Hey all,
The Mandrola family Spring break this year coincided with the American College of Cardiology 2014 Scientific Sessions.
It doesn’t look like a long swim from this lens
We are on a college tour in California.
The cardiology community is in Washington DC.
If you are interested in following ACC news, I’d recommend my colleagues and friends over at theHeart.org | Medscape/Cardiology.
The ACC hastag on Twitter is #ACC14
See you all in a while.
JMM
Related posts:
Vacation…
Finding normal–after summer vacation.
Summer Vacation (Source: Dr John M)
Source: Dr John M - March 30, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
New post up on Medscape/Cardiology: Ablation versus medicine as an intitial strategy for treating AF
Earlier this month I promised to put together teaching points from the Rich Peverley story. His was an interesting case of sudden collapse that likely occurred as a result of atrial fibrillation therapy rather than atrial fibrillation itself.
This was my original report: Important lessons from the collapse of NHL player Rich Peverley (BTW: It set a blog record for pageviews on a single day.)
This was the follow-up post in which I discuss the fact that atrial fibrillation featured prominently in the mishap: Atrial fibrillation features prominently in Rich Peverley collapse
Mr Peverley and his doctors announced a great dea...
Source: Dr John M - March 25, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
How successful is AF ablation?
Let’s talk about success.
At first glance, knowing whether a medical or surgical intervention achieves success seems quite simple. An antibiotic clears an infection–or it does not. A surgery removes a tumor with clean margins–or it does not. An angioplasty and stent open an artery during a heart attack–or it does not.
In the case of treating atrial fibrillation, however, it’s not like that. And this is especially true when one considers the use of catheter ablation–the biggest hammer in the toolbox of an electrophysiologist.
The doubters ask: why can’t it be simple? They say ablati...
Source: Dr John M - March 24, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
A follow-up on the LifeVest…and decision quality
One of the most controversial posts I have ever written concerned Zoll corporation’s wearable cardiac defibrillator, which they have smartly branded the LifeVest. Here is the link to the 2013 post:
LifeVest: A Precarious and Unproven Bridge . . . to Somewhere
The less-than-glowing assessment brought me a great deal of criticism, both publicly and privately. I was proud of theHeart.org, which is now Medscape/ Cardiology, for publishing the piece without editing.
I bring this topic up again because of an email I received this week. It came from a patient who had been prescribed a LifeVest. Here is the email, which I po...
Source: Dr John M - March 23, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Dear Girl Scouts: It’s time to cut out the cookies
It happened while I was leaving a grocery store in the southeastern United States. The young girl who asked me if I wanted to buy Girl Scout cookies was strikingly perfect. She was thin, happy, and well spoken. So were her colleagues. The moms, too, were of healthy weight and cheer. It was as if they were English-speaking transplants from the Netherlands. They did not appear to be regular consumers of their own product.
And this is a problem, isn’t it? Here is the Twitter bio of the Girl Scouts of America:
Ultimately the Girl Scouts aim to make the world a better place. Good. We need more groups like this.
The problem i...
Source: Dr John M - March 16, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Dear Motorist: We are you
The thing about people who ride bikes is…
…we are people. Human beings.
The life of a person on a bike depends on the humanity and compassion of motorists.
Here is a poignant 4:42 second video that I hope you will watch, and then share with others. (After the video is a post I wrote in 2010 on life, death and cycling.)
Here is my 2010 post:
Dear Motorist…We are you.
JMM
Related posts:
Dear America: Embrace the bike culture…It’s heart healthy
Cycling Wed: Dear Motorist…We are you.
Inspiration to doctor, from a dear friend passed… (Source: Dr John M)
Source: Dr John M - March 15, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Integrity of acid-bath stem cell paper questioned — possible retraction
Oh folks. I am sorry about this. Six weeks ago, I published this guest post from Michael Zhang, an MD-PhD candidate at the University of Louisville, on what I felt were two pioneering papers in biology. Michael did a great job reviewing and explaining the papers, which described a simple method of reprogramming mature mammalian cells.
I felt safe in writing about these remarkable studies because they were published in the prestigious journal Nature. I assumed the work survived a rigorous vetting and editorial process.
Now, a co-author of one of the papers, as well as other researchers have questioned the scientific integri...
Source: Dr John M - March 14, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Atrial fibrillation features prominently in Rich Peverley collapse
Professional hockey player Rich Peverley gave a news conference today in which he and his medical team announced surprising details about his heart condition.
We learned that atrial fibrillation and its treatment featured prominently in his collapse during a game earlier this week.
“A flare-up last week led Peverley to skip a road game, and he had upped his medicine.”
Here is an email I received from another journalist:
“They’re saying he was diagnosed with atrial fibrillation when he was traded in the offseason and went for a physical. The procedure was that they “shocked” his heart. Th...
Source: Dr John M - March 12, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Important lessons from the collapse of NHL player Rich Peverley
Last night my Twitter stream lit up with the news that NHL player Rich Peverley collapsed from a heart arrhythmia. Fortunately, he was successfully treated, and is reported to be in good condition.
Here is a link to the best story I could find. It sounds awfully significant.
[Dr.] Salazar said of the treatment, “We provided oxygen for him. We started an IV. We did chest compressions on him and defibrillated him, provided some electricity to bring a rhythm back to his heart, and that was successful with one attempt, which is very reassuring.”
A couple of things to clarify about this matter. First, cardiac arrest is diff...
Source: Dr John M - March 11, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Small things, big things
I ran up the hill. It seemed shorter, and less steep than I had remembered. I was barely winded at the top.
I looked into the front office windows as I ran by the old high school. I don’t run fast anymore, yet the image was gone in seconds. My memory had the building as vast. It was not. I had learned that both my assistant principals had died—Alzheimer’s and heart attack. Perhaps the years of inflammation exacted its toll? Where was the guidance counselor who had made it clear that medical school was a bridge too far? My math teacher, I learned, was still alive. Gosh that man helped me. (That remains large.)
I ran b...
Source: Dr John M - March 11, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
