I remain concerned about the irrational exuberance among some of my colleagues toward left atrial appendage occlusion devices for the prevention of stroke in patients with atrial fibrillation. In short, these devices are plugs that doctors place into the left atrial appendage. The idea is to stop clots from forming or escaping from the left […]
I attended the European Heart Rhythm Association meeting last week in Vienna. Here is an update on the stories I found most interesting–the ones I wrote about on the heart.org | Medscape Cardiology. Brain Lesions after AF ablation: Electrophysiologists do not talk much about the small brain lesions that appear after procedures in the left […]
Good book alert: This holiday weekend I read The Rosie Project by Graeme Simsion. Simsion sets the story of a nutty genetics professor in Melbourne, Australia. The book is sweet, funny and uplifting. It’s a perfect escape from the mean-spiritedness of today’s news cycle. An Australian electrophysiologist who I had dinner with during the recent […]
A study presented at the recent Heart Rhythm Society meeting in Chicago has added more uncertainty about the significance of short-duration AF episodes. Before I tell you about the study, I need to clarify what I mean by short-duration AF episodes, sometimes called subclinical AF (SCAF). SCAF is AF on a monitor that is often […]
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Medicine at its best is a team sport
Patient safety, quality, and value are new buzzwords in healthcare. No doubt, these are all laudable goals. The problem is that true quality care cannot be put on a spreadsheet and publicly reported. It just can’t. Never. Why? My friend Dr. Wes Fisher explains in this beautiful post called “Wingman:” There is talk of quality […]
Three cases first: A young woman I met recently (outside the hospital) told me her Dad died suddenly a couple of years ago. He was fine, then he was stone cold dead. The wife went outside for a minute and came back to find her husband dead in the chair. There were no warnings. No […]
I am changing my policy on comments. In the past, if you had one approved comment then all of your subsequent comments would post without moderation. I changed that. Now I will moderate all comments. That means there may be a delay. Another change is that I am not going to allow personal medical anecdotes. […]
Our brains can easily fool us. No experienced doctor would deny the power of the placebo effect. Today I want to discuss the nocebo effect, which occurs when negative expectations of something causes it to have a more negative effect than it otherwise would. Drugs can exert a strong nocebo effect. If your brain thinks […]
We have to talk about drugs. No, not illicit drugs, but medications used by doctors and patients. Plaintiff attorneys run ads on TV that fool people into thinking certain meds are bad. The current one I deal with is the clot-blocking drug rivaroxaban (Xarelto.) Before that, it was dabigatran (Pradaxa). If, or when, the makers […]
I like thinking and learning. Birthdays surely make one slower on the bike, but birthdays, it seems, do not have the same drag on the brain. For me, birthdays have increased my appreciation of liberty. In the Constitution of Liberty, Hayek defines it as the absence of coercion. Such is a beautiful definition. Don’t coerce […]
Concerned citizens will march this weekend to defend science. Standing up for science is a worthy cause. Look at what medical science has accomplished in recent times: serious diseases, HIV, heart attack, many forms of cancer, have been tamed by the advance of science. We need more not less science. It’s nuts to cut funding […]