Important lessons from the collapse of NHL player Rich Peverly
Last night my Twitter stream lit up with the news that NHL player Rich Peverly 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 diffe...
Source: Dr John M - March 11, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
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 and impairing his quality of life.
As I was discussing stopping many of the meds, the patient said (with a quite sincere tone):
“You doctors these days just want us old people to go off and die.”
That was a zinger, a real punch in the gut. I was trying to do the opposite–allow him to live a longer and better lif...
Source: Dr John M - March 7, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
My Social Media Talk at the 2014 Western AF (atrial fibrillation) symposium
How can social media improve AF patient and provider interaction?
It was an honor to speak at the seventh annual Western AF symposium this past weekend in Park City Utah. Once in the shadow of the Boston AF symposium, Dr. Nassir Marrouche (@nmarrouche) and his colleagues at the University of Utah have elevated Western AF to elite status. It’s a special meeting because it brings the world’s leading experts in atrial fibrillation to a cozy and welcoming place. The “vibe” if you will is informal and warm–serious, yes, but conducive to interaction. Perfect, if you ask me.
My task was to explain...
Source: Dr John M - March 5, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Doctors and Social Media — It’s time to embrace change.
I recently took on a position of medical journal editor. It is with the Journal of Kentucky Medical Association.
It’s been a good learning experience. Part of the job of editorial board members is to write an opinion column. (Check, I’ve done that before.) What follows below was published in this month’s journal.
The editorial board put no restrictions on me. So I decided to write about social media and why it is time that doctors make the leap from analog to digital. (It breaks the less than 500 words rule.)
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The Greek philosopher Heraclitus gets credit for the idea that change is central to th...
Source: Dr John M - February 28, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
13 things to know about Atrial Fibrillation
Here are 13 things I tell AF patients.
I am sorry that you have AF. Welcome to the club, there are many members. (Three million Americans and counting.)
I know how it feels.
Your fatigue, shortness of breath and uneasiness in the chest are most likely related to your AF.
AF may pass without treatment. Really.
Important new work suggests AF is modifiable with lifestyle measures. As in you can help yourself.
AF isn’t immediately life-threatening, though it feels so.
Worrying about AF is like worrying about getting gray hair and wrinkles. Plus, excessive worry makes AF more likely to occur.
Emergency rooms treat all AF...
Source: Dr John M - February 27, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
The simple reason the medical-home study failed…
This week, the Journal of the American Medical Association (JAMA) published a comprehensive study that has major health implications. Major because the negative findings should change how Americans think about health and healthcare. Plus, the findings validate a belief this doctor holds as truth.
First my belief, then the study.
One blog is enough for any practicing doctor, but if I were to start another, its name would be: “Health cometh not from healthcare.”
Nary a day goes by that I don’t see an example of how good-intentioned active management of a patient causes problems. (BTW: My son, a gramma...
Source: Dr John M - February 26, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Blaming Obamacare is the wrong diagnosis
The Wall Street Journal began the week by publishing a provocative essay in which a young man suggested Obamacare kept his mother from getting appropriate medicine for her cancer. The writer crafted a poignant story about his mother, who sounds like a good person with a bad disease.
Mainstream media buzzes with these types of stories. The Obamacare-is-the-problem narrative fits quite well on conservative news outlets.
The problem, as it so often is, is in the details.
The story here begins with a familiar first chapter: the writer’s mother had good insurance coverage but then it was cancelled. Next came her struggle...
Source: Dr John M - February 25, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Dronedarone (Multaq), clinical guidelines and patient safety
(What follows is a brief introduction for a post I wrote over at Medscape/Cardiology. The link is at the bottom of the page.)
It is appropriate to worry about medical errors and patient safety. Here the low-hanging fruit is plentiful: antibiotic stewardship, automated notification of drug interactions and attention to hand washing all join a long list of easy problems to address. I’m going to tell you about a more pressing and difficult-to-fix safety issue, one that flies below the radar, virtually unnoticed.
It is the metastasis of the expert clinical guideline.
I am very concerned about clinical guidelines. You...
Source: Dr John M - February 22, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
The problem with testing students and doctors is what gets truncated
For me, maybe you too, the best part about science is how it disrupts the status quo. A belief, a way of doing something, a paradigm if you will, becomes entrenched. Humans love patterns. We get attached. I call this the way-it’s-always-been-done philosophy. It’s endemic in medicine, and, from what I can see, in education as well.
Take the notion that SAT and ACT scores are all that. Maybe they are…and maybe they are not. Surely the 2 billion dollar testing industry says their tests are important. Testers even say their tests open doors for the under-privileged. The idea appeals to our intuition. The meri...
Source: Dr John M - February 20, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
AF ablation and the hard truths about AF
Atrial fibrillation is a mysterious disease. We know a lot but surely not enough. We look at AF but are we really seeing it?
I believe there are hard truths to this disease. Hard in a way that neither patients nor doctors like. More on that later. First to some news on a major AF ablation trial.
AF ablation news:
One of the fundamental questions in electrophysiology today centers on the outcomes of AF ablation. Though most experts agree that AF ablation, when compared with medical therapy, reduces AF symptoms and improves quality of life (important metrics for sure), we don’t know whether ablation reduces the chance ...
Source: Dr John M - February 18, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
New post up at Medscape/Cardiology — Heart Rhythm Society’s Choosing Wisely List is tentative and cursory
The Choosing Wisely campaign began in 2009 when the American Board of Internal Medicine (ABIM) Foundation invited medical societies to own their role as “stewards of finite healthcare resources.” The movement aims to promote care that is supported by evidence, not duplicative, free from harm and truly necessary. That sounds delightful, and I wrote enthusiastically about Choosing Wisely back in 2012.
It appeals to me because it addresses core problems in US Healthcare–inefficiency, excessive action and paternalism. While Choosing wisely informs patients, it targets doctors to do their part in stoppin...
Source: Dr John M - February 14, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
The truth about early diagnosis — this is more than just a Mammogram story
The British Medical Journal published a monumental study on screening mammography this week. It’s garnered a ton of media coverage because the findings provocatively question the sacrosanct idea that early detection of breast cancer saves lives. Imagine that…Imagine if the entire pink machine was misguided. Of course, for people who have been willing to squint hard and look through the haze of hype, this news does not surprise.
In two sentences, this is the story: Detecting disease earlier prolongs survival from that disease (you have it longer), but it may not improve the death rate. That’s because many ...
Source: Dr John M - February 13, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
NSAIDs — Yet another dubious “health” product at CVS
Now that the ‘healthiness’ of products sold at CVS stores is a matter of public discourse, it seems a perfect time to mention the common pain relievers known as Non-Steroidal Anti-inflammatory Drugs (NSAIDs).
It just so happens that two FDA advisory committees are meeting today and tomorrow to discuss the cardiovascular risks of NSAIDs. The Arthritis Advisory Committee and Drug Safety and Risk Management Advisory Committee will hash out details on labeling, and will likely offer comment on whether naproxen (Aleve) may be the least risky NSAID from a cardiovascular standpoint.
I’ve written a lot about the ...
Source: Dr John M - February 10, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Learning what not to do…
Ali Almossawi is a young metrics engineer at Mozilla. He collaborates with the MIT media lab. He has done something quite remarkable, uplifting and useful. (And isn’t that a good thing these days.)
He wrote a book called An Illustrated Book of Bad Arguments. More than 500,000 people read the online version. Now there is a print version.
From Amazon
Here is the best part: he has published it online with open access. As in, you can look at without paying. Of course there is a donate button.
The reason I share this book is that it is a beautiful collection of bad arguments. It teaches. It entertains.
Mr Almossawi took h...
Source: Dr John M - February 10, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
When professors make less than janitors…
…one could be pessimistic.
PBS NewsHour did this story last night. Adjunct professors, many of them with doctorates, are struggling to make a living. A French literature professor uses food stamps. An English professor just up and quit.
This video got me thinking about the word “value.” The MacBook delivered this as the first definition:
the regard that something is held to deserve; the importance, worth, or usefulness of something.
I don’t know about you but I owe a lot of my success to teachers. So many of them, tenured or not, helped me–and at every level, from elementary school through el...
Source: Dr John M - February 7, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
