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 in San Francisco was in the Nob Hill area. The running there was more like hiking. It took a week for my calves to feel normal again. We spent the second part of the week in Los Angeles. My brother lives out near Pasadena—a wholly different experience than my prior LA visits when I stayed in either Manhattan Beach or Laguna Beach. The Pasadena area reminds me of the song about paving paradise and putting up parking lots.

Then there was the return to practice after holiday, which, any doctor will attest, is no small thing. The onslaught of ‘tasks’ was okay for me, though. January and February had been slow so I was glad to be busy. Practicing electrophysiology still gives me immense pleasure. I’ve been doing some great cases lately. It’s striking how much helping people eases the awfulness of the seemingly endless farcical nonsense hoisted on doctors these days. (Yes, that was hyperbole–but I’m leaving it. It’s a blog.)

This week was a special one too. University of Colorado professor Dr. Dan Matlock was in town for two lectures. As many of you know, Dan has become a friend, and, in ways that our interconnected world now allows, a mentor as well. We recently co-authored an editorial in JAMA-Internal Medicine. He was in Louisville to give Grand Rounds at my hospital on Tuesday and then at the University of Louisville yesterday. Both talks centered on decision quality; both were superb. Look for more from me on that topic. I recorded both lectures, and I have his slides.

I’ve also tipped my toes into doing some research. Last night, I took part in a conference call with a group of nationally recognized researchers. We are planning a patient-centered study of athletes with atrial fibrillation. I’ll tell you more about that in the coming weeks. I was asked to participate as a researcher because of my interest in athletics, atrial fibrillation and social media.

I am also in the process of reading an amazing book. Thinking, Fast and Slow, by Nobel Prize winner Dr. Daniel Kahneman, delves into the way the human mind makes decisions. Kahneman won the Nobel for economics but he is not an economist; he is a psychologist. He, and his now deceased colleague Amos Tversky, studied the two systems of human thought. System 1 thinking is intuitive fast thinking while system 2, or slow thinking, analyzes, assesses and monitors System 1. This work pertains directly to medical decision-making. The Twitter-length summary is that good medical decisions result from engaging system 2, or slow thinking. The problem is that it takes effort to engage system 2, and humans prefer quick intuitive fast thinking. (e.g. FoxNews.) This book has me fired up about learning. Our collective misread of basic statistics explains so many of our past medical mistakes, like mammography for instance.

I’ve reluctantly decided to weigh in one of the newest controversies in healthcare—the assessment of physician quality. Currently the American Board of Internal Medicine (ABIM) holds a monopoly on the testing of doctors. The process of “board” certification used to entail taking a test every ten years. That has changed. ABIM has now upped the ante, requiring onerous, expensive and unproven testing every two years. The overreach and hubris is incredible. In the past, I’ve been a strong proponent of testing, and no one can be against physicians keeping up, but this lucrative cottage industry has overstepped its bounds. Here is a link to my take on the matter: Call Time-out for the ABIM MOC Mandate. My colleague Dr Wes Fisher has led the charge on this topic.

As for athletics, I’ve gone back to mixing running in with cycling. I’m going to try to crack off a fast 5k later this year. I figure I can do that without inflaming myself back into AF.

Now I feel better. I wrote something.

JMM