Post Author: John Mandrola, MD

Why there’s still value in the routine physical

Physician
November 20, 2012

Millions of Americans believe in the practice.

Government reformers believe in it.

Doctors too.

Heck, even I, an accused therapeutic nihilist, tracked down a poor soul who agreed to be my primary care doctor. Call it old-fashioned, but I wanted my own doc, and I wanted yearly “checkups.”

No procedure—not even AF ablation–is as good as prevention. Taking your body in for routine checks and scheduled maintenance makes perfect sense. Call such a notion–obvious.

But …

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The growing culture of hostile dependency towards doctors

Physician
November 8, 2012

Let’s start with a disclaimer: I am not complaining; I’m just stating the facts.

Honest fact: The morale of doctors in the real world is low–and sinking lower.

I know what you are thinking. “Come on Mandrola, you are nuts if you expect us to feel sympathy for doctors–of all professions.”

Well, you can think that if you wish, but I’m calling it as I see them. And here is why it matters:

Because …

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Doctors who manage patients in the office aren’t the problem

Policy
October 31, 2012

I am riled up—almost to the point of being inflamed.

I hate it when doctors get dragged through the mud. It’s a matter of pride. Doctors are my team.

The latest kerfuffle centers on how much we should charge for return patient visits. The difference here is between moderate and moderately high visits–or about $30.

When the Center for Public Integrity is investigating your profession, it’s unlikely to be good news. And it …

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What can we learn about health care from Europe?

Policy
September 18, 2012

May I tiptoe onto a ledge for a moment?

Some (just-back-from-Europe) thoughts on health care policy, perhaps?

One of the many differences between the European Society of Cardiology (ESC) Congress and a typical American cardiology meeting was the scarcity of healthcare policy sessions at the ESC. That’s hard to explain; perhaps European countries are settled on their own systems and do not wish to — or can’t — influence their neighbors.

It goes …

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Fat cells are factories of inflammation

Conditions
August 1, 2012

The headline called it “the new” science behind America’s deadliest diseases. Wall Street Journal reporter Laura Landro was talking about inflammation and its role in causing human disease.

Now, you all know my reaction when a prestigious newspaper features a founding principle of this blog. Well, let’s just say it felt awfully nice.

A brief Mandrola review of inflammation is in order.

First, acute inflammation is normal, and required for life. …

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Mainstream media can foster an engaged public on health issues

Policy
July 16, 2012

On the surface, two Wall Street Journal articles painted a gloomy and depressing picture of US healthcare, now and beyond.

That wasn’t my take. I felt a rush of optimism. Let me explain.

In, ObamaCare’s Lost Tribe: Doctors, deputy WSJ editor, Daniel Henninger wrote about the (forgotten) plight of doctors in the Affordable Care Act. He critiqued the mainstream media coverage of the Supreme Court decision because it left out mention of …

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Start the difficult conversation with ICD patients

Conditions
June 18, 2012

There was a very important article written in the New York Times recently. It highlighted a common medical scenario in my world—the defibrillator (ICD) world.

I am going to talk about ICDs here, but the big picture inherent in this story illustrates the important issue of how best to apply invasive therapy to elderly and sicker patients.

The Times piece delved into medical decision-making when patients present with battery depletion of their …

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Why Pradaxa is not a bad drug

Meds
May 23, 2012

It’s crazy out there in blood thinner land.

The novel blood thinning drug for patients with atrial fibrillation, dabigatran (Pradaxa) cannot get a break.

It’s all over the TV: Pradaxa = Bad drug.

Look at this image:

On the prestigious heart news site, theheart.org, an insignificant 113-patient study presented as a poster at a small symposium — by a researcher with ties to anti-coagulation clinics …

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Choosing Wisely is the health reform we need

Physician
April 9, 2012

Let me tell you about a possible paradigm-changing idea in the seemingly hopeless matter of controlling runaway healthcare costs—a topic that has far-reaching implications, not just for healthcare, but for our nation’s economy and vitality.

Organizations of doctors have decided to embrace common sense in the practice of Medicine.

Led by the American Board of Internal Medicine Foundation and joined by many other medical societies, the Choosing Wisely movement aims to …

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Let’s close the chapter on statin safety

Meds
December 6, 2011

There was important news recently on statin drugs. As one of the world’s most effective and commonly used medications, statins provide great writing topics. Lots of people have high cholesterol–including cyclists. Lots of people are interested in avoiding our mostly deadly disease.

I’d like to tell you about a recently-published landmark study in the Lancet that should quell safety concerns over statin drugs.

The punch line after I tell you the study’s …

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Aggressive care at the end of life continues to grow

Physician
October 24, 2011

There are important medical studies, and then there are landmark studies–the kind of science that disrupts the entire medical community. The most recent game-changer was published recently in the Lancet.

Well known surgeon and author, Dr. Atul Gawande and colleagues published this important look-back study on the intensity and variation of surgical care of 1.8 million elderly patients in the US. They put numbers to the well-known and ever-expanding problem of …

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How dabigatran is an atrial fibrillation paradigm shift

Meds
July 28, 2011

My iPhone vibrated with an urgent message that read: “Please call … the INR on your atrial fibrillation patient scheduled for cardioversion is too low.  He is on that new blood thinner, Pradaxa.  What do you want to do?”

I responded, sounding like an expert: “It’s ok.  Pradaxa thins the blood adequately, it just doesn’t change the INR.”

She astutely responded, “How do know the blood is thin?  What if …

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Fewer choices for patients with health care consolidation

Policy
May 6, 2011

As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one’s clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes “providers” to consolidate along the lines of major hospital networks this injustice will only worsen.

A decade-or-so ago when I started private practice it was obvious that referrals came to me because of my association with an established …

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How important is a doctor’s skill in the physical exam of a patient?

Patient
February 23, 2011

How important is a doctor’s skill in the physical examination of a patient?

To the lay person, a doctor’s examination might seem really important.  “Of course it is, Dr M … Come on.”

But is it so?  Or, perhaps, is the examination a charade, a show, a necessity to complete the medical record.

It turns out that many in the profession think doctors may be losing the skill of palpating and listening.  At …

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Solve the obesity crisis to ensure our country’s financial stability

Patient
December 22, 2010

If I was Surgeon General, I would follow the lead of our country’s first Mom.

This is serious folks.

We, as an American society, need to solve the obesity crisis.  Not just for our physical health, but for our country’s financial stability.

Reducing the spiraling costs of health care is wanted by all.  So far, prevention of the diseases which contribute most to our health care costs, (heart disease, cancer and orthopedic issues, …

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Conflicting stories on alcohol and heart disease

Physician
November 4, 2010

Have you ever had a cold beer after a mountain bike ride?

Oh my!

But does such indulgence put one at risk for an arrhythmia? Does alcohol exacerbate an existing arrhythmia? How much, if any, alcohol is acceptable?

These are questions I am asked frequently.  And for those asking, they are very important questions.

I wish the answer was straightforward.  But it is not.

Undoubtedly, excessive alcohol can precipitate an abnormal rhythm.  Look no farther …

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Is it the doctor’s fault if an obese patient cannot lose weight?

Patient
September 19, 2010

I need help.  In dealing with obesity as a medical problem, that is.

I am pretty solid at arrhythmia management, but as an obesity doctor, not so much.  If I was the teacher, and my obese patients were the students, I would surely be fired for poor student test performance. At least, if the core measure was the patient’s BMI.

If a student does poorly on an achievement test, is it the student’s …

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Heart health depends on healthy behaviors

Conditions
August 17, 2010

Everyone knows that the heart health of Americans is dismal. Obesity, diabetes, and high blood pressure are all on the rise.

For now, technological advances in cardiac care continue to maintain, or in some cases, lower the death rate from heart disease. Squishing blockages, ablating abnormal heart tissue, and installing cardiac devices have successfully kept the abysmal lifestyle habits of so many at bay. Despite all the fury of modern technology …

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Stents to treat blocked heart arteries are not an easy fix

Conditions
July 15, 2010

Cardiologist Richard Fogoros — aka DrRich — has put out an incredibly timely and pertinent piece of advice concerning the common practice of stenting blockages in the coronary arteries.

He succinctly summarizes a small retrospective study that showed an increased risk of cardiac events after non-cardiac surgery in patients who have recently undergone either a bare metal or drug-eluting coronary stent.

On a website clearly designed to educate patients, DrRich rightly points …

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Heart catheterization worries that every cardiologist face

Physician
June 18, 2010

Malpractice and heart catheterization have been in the news recently.

A spicy concoction for sure. An epidemiological study published in an online subsidiary of Circulation addresses the role of three major medical issues facing cardiologists today: malpractice, heart catheterization, and medical costs.

It is hard to get more controversial.

Heart catheterization, the invasive assessment of the coronary artery lumen, has always been a hot-potato topic. The “percent-normal” was the buzz word when I …

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