As odd as this might sound, my mother was upset when I declared my intention to go to medical school.
It wasn’t the mountain of debt I was sure to incur since I’d already figured out how to get Uncle Sam to pick up the bill (a small deal that put me in a military uniform for a decade). It wasn’t the …
Why are so many doctors complete jerks?
I saw a patient in my office this week who had received a stent from one of my partners last month. The man was highly satisfied with his experience—the procedure was tolerable, the recovery short, and the nurses were pretty (he specifically made a point of this, presumably because the post-hospitalization customer surveys don’t include what seemed to him to be the most important feedback metric)—but his wife had a …
Meaningful treatments in the battle against coronary disease
When I recommend that a patient needs coronary angiography (synonyms: heart catheterization, coronary angiogram, cardiac catheterization, or simply “cath”) I take a moment to bring up the risks of the procedure—complications that include the rare likelihood of stroke or heart attack (less than one in a thousand), a reaction to the dye, and bleeding at the arterial access site (most often the femoral artery in the …
Celebrating 50 years of coronary angiography
I find that it takes more effort for me to talk patients out of doing tests than it takes to get them to submit. It doesn’t seem like it should be that way:
I need you to undergo a test where you fast for 12 hours, show up to the hospital 3 hours before the sun comes up, strip down and slide into a breezy hospital …
Talking patients out of doing tests takes effort and time
I see a lot of patients who are sent to me for evaluation of dizziness. On the surface you wouldn’t think a cardiologist would have much to do with a symptom that relates more to the head than the heart, but there is some logic to it—poor blood flow to the brain could lead to dizziness and, since blood flow starts in …
Evaluating dizziness in the cardiologist’s office
How often do you see your doctor? Once a year? Every 6 months? Never? Most of you are pretty healthy and only show up for screening physical exams or aches and pains. Some of you may have more health problems and come more frequently.
What if you had diabetes, coronary disease, hypertension, high cholesterol, and sleep apnea, but no symptoms to indicate any …
How often to see your doctor when feeling well
To celebrate your 50th birthday you head to your doctor’s office to get your yearly exam. He rewards you for your diligence by poking and prodding you, sticking you with needles, and arranging for a colonoscopy (happy birthday!). He also sends you for a stress test out of concern about your strong family history of premature heart disease.
A slightly abnormal treadmill test leads to …
Never hesitate to seek a second medical opinion
Let’s say you develop some heart problem and get sent to me for an evaluation. You show up to the office, check in, get ushered into an exam room, then you wait and wait and wait. When I finally come into the room I seem terse, impatient and rushed, and you end up visiting with me for less than 5 minutes. I provide you with a diagnosis, order a couple …
Finding a doctor using ratings is a sound idea, but poorly executed
There is no class of medications in the history of the world that has been better studied that statins.
This class of drugs is more properly termed HMG CoA reductase (3-hydroxy-3-methyl-glutaryl co-enzyme A reductase) inhibitors, but with a name like that a terser nickname is almost mandatory (the name statin comes from the suffix of the members of this class: lovastatin, pravastatin, etc.).
Simply …
Statins for heart disease and stroke, and debunking statin myths
My medical school at the University of Utah developed a clever computer program in the late 80s that was meant to both educate medical students and assist in the treatment of patients.
For several years the tech geeks at the school had collected an immense database of information from all the patient admissions at the hospital—presenting symptoms, exam findings, tests, and final diagnoses. They took all this data and crunched …
The art of medicine and whether computers can replace doctors
Just last week I saw a full-page ad in the newspaper for a series of medical screening tests — EKG, echocardiogram, aortic ultrasound, and the like (all interpreted by “certified doctors”) — that a person could arrange for oneself or a loved one.
We newspaper readers were told we could arrange to have these tests performed without a doctor’s order as …
A cardiologist discusses screening for vascular disease
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