Seven out of eight patients in his clinic one afternoon had unnecessary care. This from Dr. Atul Gawande, who may be the most respected physician in the world. And he works at Harvard. Overuse wastes resources. Overuse causes harm. Overuse fosters underuse. We must make it visible. The public needs to know. Here you go: […]
Category: Doctoring
Right Care seeks to be smart care. In the first part of my career, I rarely looked critically at the evidence. I was too busy; and I was more trusting of the vertical hierarchy of medicine. Eminence-based medicine seemed normal. Listen to the experts, for they are experts, went my mindset. Then something happened. When […]
The current state of informed consent in the US is best described as un-informed consent. A study this May reported that only 3% of patients with coronary artery disease received full informed consent before having an invasive procedure. Findings like these, and there are many other similar studies, reflect the ill-health of the medical decision […]
I wrote yesterday about how a broken healthcare system favors overuse of procedures. Today I will discuss rational care. Remember the goals of the Lown Institute: We think healthcare should be affordable, effective, rational and available to all. Rational means in accordance with reason or logic. Hardly a day goes by that I don’t see […]
I am proud to be part of the Lown Institute. Founded by Bernard Lown, a cardiologist, mentor, activist, and winner of the Nobel Peace Prize, the Lown Institute is an organization committed to making things right in the US healthcare system. In case you wondered, yes, there is right and wrong in healthcare. At this […]
The next frontier in cardiology is the replacement of cardiac valves via catheters rather than open-chest surgery. This new branch of cardiology is called “structural” cardiology. Trainees do entire “structural” fellowships in which they learn to do things with catheters that surgeons once did with open chest techniques. You may have heard about TAVR–or transcatheter […]
Future generations of doctors will face different challenges than I did. When I started training, disease was easier to spot than it is now. Today, the line between sickness and wellness has blurred–and it gets blurrier all the time. The quantified self movement stands to make this worse. In a profit-driven healthcare climate, disease feeds […]
Hundreds of thousands of people have undergone surgery or stents to “fix” blockages in their carotid arteries. (The left and right carotids are the main arteries to the brain.) Most of the these people (about 90%) reported no complaints. We say they are asymptomatic. The blockages were discovered on exam or by ultrasound of the […]
One of the most common reasons people require medical care is their medical care. This is a distinctly modern problem. In times past, doctors treated disease. Patients saw their doctor when they were sick. They had a problem; doctors offered help. The doctor of today often improves health by removing healthcare. It’s one of my […]
It’s time to write an update on AF ablation. Things have changed. The major change is that I am doing many fewer ablations for AF. The reason is we have a better understanding of the disease, or should I say, condition? In the last 2-3 years, good science has changed the way specialists see AF. […]
What follows is my latest post on theHeart.org | Medscape Cardiology. It’s weird; the post is one of my favorites, but it’s not made the most read list–at all, not even fifth place. There are thoughtful comments but it’s simply not popular among doctors. **** Imagine this scenario: A learned professor comes to your office […]