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 […]
Category: Doctoring
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 […]
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 […]
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 […]
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 […]
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 […]
(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 […]
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 […]
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 […]
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 […]
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 […]