…the quality of having experience, knowledge, and good judgment. I read today a collection of words that exude wisdom. I share it with you because the purpose of this blog is to do create value through education. Peggy Girshman was an award-winning health journalist. When ill with a life-limiting illness, she wrote her own eulogy. […]
Category: Health Care Reform
Stanford economist Raj Chetty and coworkers published an important paper in the Journal of the American Medical Association this week. It’s free. They looked at the association between income and longevity in the US. The results will disrupt a lot of what you might have thought about healthcare. The first finding was not surprising: higher […]
I head to Chicago this weekend for the 4th Annual Lown Institute Conference. The Lown Institute seeks to catalyze grassroots movements for transforming healthcare systems and improving the health of communities. For those of you who want to be on the right side of the street of history, Dr. Bernard Lown, a cardiologist, activist, and […]
Bernie Sanders has intensified the debate about US healthcare. Specifically, he has people talking about a single-payer government-controlled system. Critics, uninformed as they are, point to the VA system as an example of inferior care. A well-conducted study refutes such misthink. Yale researchers performed a massive cross-sectional study to compare outcomes among older men in […]
The purpose of this post is to introduce my latest column on Medscape, which is linked at the end. You might wonder why an electrophysiologist is interested in cancer screening. I am interested because it may be one of Medicine’s largest reversals. A reversal happens when something (testing or treatment) doctors did, and patients accepted, […]
A frail elderly women has a leaky heart valve. It caused her legs to swell and increased her work of breathing when she pushed her walker around the house. One doctor wanted to relieve her suffering. She suggested palliative care; she wanted to make her disease less severe but without removing the cause. Other doctors […]
Last night I talked with one of my partners about a few terrible cases of medical harm from unnecessary procedures. He said, “John, people get this stuff done to them because they fear not being healthy. People are scared.” My answer was that people should fear healthcare more than they do disease. That sounds like […]
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: […]
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 […]