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General Medicine Health Care Reflection

Is there anything we espouse now that will be this silly in 50 years?

My first cut and paste post… Tired.  Permanent AF is hard to ablate.  Plus, I did the evening bike ride with the real racer dudes.  Kept trying to tell them I was a blogger, not a crit racer.  Life force is nearing E. Enjoy. I think they were serious.  Have to wonder what the blogs […]

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Atrial fibrillation Health Care Health Care Reform

How does one treat Atrial Fibrillation in the unmotivated and uninsured?

Gosh, atrial fibrillation can be hard to treat. He lay in the ER bed with a light sweat, and an obvious discomfort from the rapid heart rate and high blood pressure.  He is my age.  The belly protrudes from a too small XL tee shirt, there is week old facial hair, and he looks up […]

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Doctoring Health Care Health Care Reform

Saving lives with a 25 dollar painless test…

In the era of expensive and technologically advanced tests like MRI, CT and PET scans, how could a 25 dollar ECG save many lives?  A recent study on the merits of adding a screening ECG to the routine screening of young athletes has created a stir, with many words written in the lay press. For […]

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Doctoring Health Care Health Care Reform

Why is paying a doctor so different?

Doctors going to a cash only system of payment is steadily increasing, and these changes are garnering much attention. Practicing medicine is a skill honed over many years of training and education.  Like any good or service, “doctoring,” has a value.  What this value is, has become a matter of much debate.   The payment […]

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General Medicine Health Care

In today’s medical world, is it possible to die of old age?

He is 93 and has numerous medical problems, most of which involved aging blood vessels, as well as multiple orthopedic issues, including compression fractures and diffuse arthritis. The bony issues have resulted in a severely compromised mobility of late. Despite ongoing treatment with both aspirin and clopidogrel, he presents after numerous hours of focal neurologic […]

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Doctoring Health Care Health Care Reform

Measuring quality of medical care. How can a consumer know?

While typing words, the advertisement for yet another hospital is overheard from the TV.  “Ignore it John,” I think to myself, but, it is impossible to not look up and see.  The head shakes with a smirk, like my grandfather did and without words displeasure was easily conveyed. Do people really think the graphical professionalism […]

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General Cardiology Health Care Health Care Reform Healthy Living

Coronary CT scans for the evaluation of chest pain illustrates the health care expenditure debate…

During residency, there was always a case of mis-diagnosed chest pain to discuss in conference.  Incorrectly sending a patient home and missing the diagnosis of cardiac chest pain was an infrequent but repetitively observed phenomenon. So as to tread carefully with words, it is sufficient to say that even now, chest pain triage remains a […]

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General Medicine Health Care Health Care Reform

Snow days…

These days of uncharacteristic winter have created much angst for the many who dwell in a southern state and have southern feelings about snow.   For the busy electrophysiologist who lives 5k from the hospital and grew up in New England, the snow provides an intermission from the race -a time out. All in the […]

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General Ablation Health Care Health Care Reform

Thirty nine thousand dollars for a lifelong cure…

On the way out of the exam room, after proclaiming her happiness on being cured of a lifelong arrhythmia by a single 4mm radio-frequency ablation lesion, the patient shows me the hospital bill and asks why it costs 39,000 dollars? Of course, the answer requires a few words. We are young doctors in training, learning […]

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Doctoring Health Care ICD/Pacemaker

A note to the professors, from the “real” world, on the use of ICDs in a fee for service community…

The practice of medicine is glorious, and I love it, but cynicism must be overcome. What cynicism?   A far more established and connected blogger, Dr Wes, writes of the way technology strains the doctor-patient relationship.  It involves a piece in the Chicago Tribune in which a study published in a major journal outlined doctors […]

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Health Care Health Care Reform

The conflict of declining reimbursement…

Conflicted am I on reading of the strategy of a group of South Miami cardiologists who have written their patients complaining of the cuts to reimbursement, primarily cuts in imaging procedures.  A tension emerges from within upon reading the following quote from a “healthcare expert.” “I’m not at all sympathetic with the cardiologists,” said Robert […]