Cardiology

Cardiologists, other physicians, and patients writing on KevinMD about heart disease: statins and the cholesterol guidelines argued since 2013, blood pressure thresholds, stroke and the clock, cardiac arrest and what CPR can and cannot do, stents and atrial fibrillation, heart failure drugs that go unprescribed, prevention from salt to calcium scores, and a specialty that became procedural because procedures were paid. One maintained record draws on this archive: Heart disease: what physicians say, in their own words.

Medicine isn’t about mechanics. It’s about the soul.

Johnathan Yao, MD, MPH

Medical Education

March 6, 2018

In medical school, the lessons and stories have a unifying theme that connects the threads of humanity. In medicine, I could find these stories, the feelings of loss and fear and hope and love. In the face of illness, suffering, and death, we often see the unvarnished sides of the human condition — the more raw sides of our nature hidden behind the decorum of everyday living, behind the curations …

The role of telemedicine in monitoring blood pressure

Dustyn Williams, MD

Health Technology

March 4, 2018

Hypertension, or high blood pressure, is a leading cause of heart disease and stroke that has escalated to alarming rates in recent years, affecting nearly 1 in 3 adults in the U.S. In an attempt to reduce its prevalence, the Eighth Joint National Committee (JNC-8) released a set of hypertension management guidelines. However, various concerns arose regarding the recommendations and as a result, the American College of Cardiology (ACC) and …

Building our care team made me lonely

Ami B. Bhatt, MD

Physician

March 1, 2018

I began practicing cardiology a decade ago caring for a cadre of young adults with congenital heart disease. I got to know their families (parents often still accompanied them to office visits), and I learned about their lives in addition to their hearts. “How do you remember the patients so well?” trainees often asked me. “Because I remember their story as a person and then the medical journey follows,” I …

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Building our care team made me lonely

MKSAP: 26-year-old woman with a mechanical mitral valve prosthesis

mksap

Conditions and Diseases

February 24, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 26-year-old woman with a mechanical mitral valve prosthesis visits to discuss anticoagulation management during pregnancy. Her last menstrual period was 6 weeks ago and her pregnancy was confirmed by laboratory testing in the office. Her mitral valve was replaced 5 years ago. Her medications are low-dose aspirin, metoprolol, and warfarin (4 mg/d).

On …

Think critically about for-profit donor entities and their commitments to health

Emi Okamoto, MD

Physician

February 2, 2018

At my job as a primary care doctor in a federal safety net clinic, I was given a free T-shirt to wear the following day. It reads “Crucial Catch — Intercept Cancer” in between the logos of the National Football League (NFL) and the American Cancer Society (ACS). This celebrates the 8-year partnership of almost $18 million dollars donated to fund cancer screening and prevention. These philanthropic gestures of large donors …

This physician won’t practice parachute-based medicine

Kenneth Lin, MD

Physician

January 29, 2018

I try my best to practice evidence-based medicine on a daily basis. When I know that the test or intervention that I am recommending for my patient is based on expert opinion rather than reliable data on patient-oriented outcomes that matter, I invariably make a point of saying so. It has been my position for several years that despite the impressive effectiveness of newer antiviral medications for hepatitis C at …

What is the right reaction for a physician when her daughter goes pre-med?

Elizabeth Blanchard, MD

Medical Education

January 8, 2018

I asked a colleague at a recent dinner meeting about his children. They’re all grown, he said, one is actually a doctor. But, he added quickly, “I had nothing to do with it.” His son had chosen his father’s field of radiology, though my colleague similarly disavowed any influence. He did mention, with some relief, that his son was happy with his choice.

About a year earlier, I was catching up …

How value-based pay can worsen patient outcomes

Matthew Hahn, MD

Health Policy

December 28, 2017

Results of a study released JAMA Cardiology demonstrated that lower readmission rates among hospitalized heart failure patients, a key focus of recent Medicare value-based payment efforts, were associated with increased patient mortality. In other words, patients admitted to the hospital for heart failure are being re-admitted less frequently, but dying at higher numbers. Value-based pay, as it turns out, where monetary incentives and penalties are tied …

Many digital health solutions lack evidence: How physicians can help

Bronwyn Harris, MD

Health Technology

December 10, 2017

Technology makes this an exciting time for health care. Not only are technological advances making health care better, they’re also making it more affordable. To get a taste of the potential of where health and technology are going, you only need to look as far the recent Fortune article titled, “Prepare for a Digital Health Revolution,” or to search through the more than 300,000 …

A reaction to ORBITA: Keep on stenting, judiciously

Dr. Saurabh Jha

Conditions and Diseases

December 10, 2017

Physicians’ reactions to ORBITA — a blinded, randomized controlled trial (RCT) from Britain with a sham arm comparing percutaneous coronary intervention (PCI) to placebo in patients with stable angina — are as fascinating as the cardiac cycle. There were murmurs, kicks and pulsating jugulars. Though many claimed to be surprised and many unsurprised by the null results of the trial, the responses were predictably predictable. Some basked in playful schadenfreude, …

The surprising way email can make you a better doctor

Joe Bellistri

Health Technology

December 4, 2017

Doctors, you need to improve the patient experience. Your intentions are there, but patients are starving for more.

Office visits offer definitive evidence that patients need to change. Tests results provide real data to make patients aware of health concerns. This is a clear and obvious starting point.

But after this information is gathered, the framework of change gets cloudy. Doctors go from offering clear and focused details like:

” You have high …

This is the deadly virus you need to look out for

Melvin Sanicas, MD

Conditions and Diseases

November 30, 2017

Days are getting shorter and evenings are getting cooler in temperate regions in the Northern hemisphere. This also means that the flu season will be around the corner soon. Most people group influenza (flu) and cold together and refer to the “cold and flu season” as the time of the year when we expect to come down with a “flu bug” and consider it “normal” or customary. Some are even …

Who’s really to blame for the obesity epidemic?

Peter Ubel, MD

Health Policy

November 21, 2017

Growing up Republican, I have long believed in personal responsibility. In junior high school, when I observed close relatives who struggled with obesity, I vowed to never let myself get out of shape. (“Junior high” is what we called middle school back in the day.) When hip surgery gone wrong dramatically reduced my level of physical activity two and a half years ago, I cut back on what I ate …

What I learned as a corrections physician

Robert J. Tilley, MD, MBA

Physician

November 18, 2017

As a corrections physician I frequently heard the question, “How can you take care of those people?” I understood what they were asking, after all, I was caring for people convicted of such crimes as murder, rape and child abuse.

And yet I had very little difficulty providing the same care to inmates that I provided to everyone else. In fact, the corrections environment was generally easier to work in and …

Here’s why we don’t care about our health

Jim Schroeder, PhD

Physician

November 17, 2017

A little ways back, I was at a gathering of friends and family and was in the kitchen setting out a dish of black bean and quinoa dip. Suddenly, I heard someone from behind me exclaim: “What is that? If that’s something healthy, I am not eating it.”

Although somewhat intended as a joke, there was no doubt a truthfulness to what was said, just as exists in similar comments which …

Prescribe exercise like you prescribe medicine

Nicole L. Stout, DPT

Conditions and Diseases

November 17, 2017

We have all seen and heard the story: a patient who is overweight and has heart problems (or arthritis, diabetes, low back pain or any number of other chronic conditions) is told by their doctor that they need to exercise.

The patient agrees, “Yes, I really will try to start an exercise program.”

Six months later, the patient is back in the doctor’s office, and the conversation goes something like this:

“Well, I …

We all treat the whole patient. We must avoid tunnel vision at all costs.

Sara Scarlet, MD

Physician

November 10, 2017

In loving memory of my grandfather, my first physician mentor.

Earlier this year, my 90-year-old grandfather passed away unexpectedly after undergoing transcatheter aortic valve replacement (TAVR). Similar to many elderly patients who die each year in the United States, his death was preceded by a litany of costly and time-consuming tests and treatments. Despite this extensive workup, the end of his life was shadowed by suffering left unaddressed. But, unlike the …

Being a doctor has saved my life

Christine Nedeau, MD

Physician

November 9, 2017

I ran a 5K last weekend. I succumbed to peer pressure. The more others talked about running it, I decided I could be a runner too.

My patients describe their HIIT workouts (high-intensity interval training, for those of you not in-the-know), PiYo classes (Pilates-Yoga combination), increasing mileage for an upcoming duathlon/triathlon/marathon, and now I can proudly share my measly 5K experience with them. Of course, I will leave out the small …

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Being a doctor has saved my life

Thank you for performing CPR on my child

Mick Connors, MD

Physician

November 7, 2017

I wonder what the best thank you any physician has ever received? I think this one is mine. This recent thank you was for our efforts to not save a child but for simply allowing this family to have a few more days with their infant who ultimately passed away. This amazing thank you has deeply and positively affected me so much …

When a diet is changed, a behavior is changed first

Michel Accad, MD

Physician

November 4, 2017

Here’s the typical story we come across every day:

Jack was overweight and had a terrible cardio-metabolic profile. Jack changed his diet: He eliminated X, Y, Z and added more A, B, and C. He’s now lost 30 pounds, and he feels fantastic. His numbers are also perfect: His HDL is through the roof, his LDL is undetectable, and his A1c is smack in the normal range.

Todd was overweight and had …

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