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Cycling Stuff Cycling Wed Cyclocross General Medicine Reflection

Observations from being “the family.”

It’s been a trying week for our family. You learn things when your people need healthcare. It’s an entirely different perspective. I am doctor; I’ve been a patient, but this was the first time being “the family.” Without going into details, (see her guest post), my wife Staci came to need the best that American […]

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Doctoring General Medicine Hospice/Palliative Care Knowledge

Death-denial is something doctors can change

I’m not sure why so many doctors don’t get it. Death, that is. Where in medical school, or residency, or even in non-medical life, did this many smart people get the idea that death is optional? Theresa Brown is an oncology nurse and a writer. This weekend, her regular column in the New York Times […]

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AF ablation Atrial fibrillation Doctoring General Cardiology General Medicine Healthy Living Nutrition

Is this the most important cardiology study of the last decade?

In recent years, progress in the field of cardiology has been painfully incremental. We have enjoyed small gains–a better ablation catheter and mapping system, a couple of new anti-platelet drugs, maybe better stents, and even the highly touted anticoagulant drugs are within 99% in efficacy and safety of warfarin. Major breakthroughs, though, are non-existent. (And […]

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Doctoring General Cardiology General Medicine Health Care Healthy Living

Five lessons from the Niacin failure

This week the New England Journal of Medicine published two studies on the role of niacin in preventing future cardiac events. The short story is that niacin was ineffective and associated with significant harm. A number of excellent summary pieces have been written, and I will reference them at the end. The purpose of writing […]

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Doctoring General Cardiology General Medicine Healthy Living

Growing doubt on statin drugs — the problem of drug-lifestyle interaction

My mind is changing about statins. I’m growing increasingly worried about the irrational exuberance over these drugs, especially when used for prevention of heart disease that is yet to happen. An elderly patient called my office last week to tell me thank you…not for a successful procedure or surgery, but rather, for helping with a […]

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Doctoring General Medicine Health Care Reform

The danger of digital medicine

Sometimes I worry about where technology is leading the healthcare profession. It is not just the distraction of white screens and electronic health records. These are bad, terrible, in fact. The concern I have runs deeper than just monopolistic EHRs. We, and I mean we as in the caregivers, are losing touch with the basics. […]

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Doctoring General Medicine Health Care Reflection

Struggling with the (relative) value of humanistic medical care —

I just arrived in San Francisco. I am here for the 2014 Heart Rhythm Society sessions. The meeting begins today. A poster session this evening is overflowing with notable studies. Stay tuned. I’ll be working hard for theheart.org to bring you the best stories. First, though, here’s a little appetizer. On the eve of the […]

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AF ablation Athletic heart Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban General Cardiology General Medicine

New post on Medscape/Cardiology: My take of the 2014 Atrial Fibrillation treatment guidelines

Atrial fibrillation affects millions of patients, and its incidence and prevalence are on the rise. It’s a peculiar disease in that it affects people so differently. When populations are studied, AF associates with higher rates of stroke, heart failure and death. But patients aren’t populations. In recent years, the treatment options for this pesky disease […]

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Doctoring General Cardiology General Medicine Health Care

A follow-up on the LifeVest…and decision quality

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 […]

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Doctoring General Medicine Healthy Living Knowledge

A clear-eyed look at treating the elderly with medicine

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 […]

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General Medicine Health Care Reform

Blaming Obamacare is the wrong diagnosis

The Wall Street Journal began the week by publishing a provocative essay in which a young man suggested Obamacare kept his mother from getting appropriate medicine for her cancer. The writer crafted a poignant story about his mother, who sounds like a good person with a bad disease. Mainstream media buzzes with these types of stories. […]