Heart and cardiology

1,642 articles · Since 2004

Articles, page 34

The great irony of health care reform

October 7, 2013Oct 7, 20139

The great irony of health care reform is that really, nothing is new. Everything, it seems, remains cloaked in secrecy. Yes, there are things called exchanges now. And millions upon millions of dollars will be spent on Internet, social media,…

The great irony of health care reform is that really, nothing is new. Everything, it seems, remains cloaked in secrecy.

Yes, there are things called exchanges now. And millions upon millions of dollars will be spent on Internet, social media, TV, print, and radio advertising touting the law. There will be counselors there to help people make an informed choice.

But there’s still a new complicated, unreadable law that promises much, but …

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The great irony of health care reform

Health policy

The problem with Obamacare is that it doesn’t do enough

John Mandrola, MD

October 7, 2013Oct 7, 201340

Obamacare is here. It’s really here. You might be wondering what’s been going on in the hospital or office -- the contact points where health care actually happens. The funny thing is: nothing seems any different. And this is the…

Obamacare is here. It’s really here.

You might be wondering what’s been going on in the hospital or office — the contact points where health care actually happens.

The funny thing is: nothing seems any different.

And this is the problem with Obamacare. It hasn’t, won’t, or perhaps couldn’t, change the fundamental problem with US health care. Namely, that it is too big, too disruptive, and too devoid of nuance. In this way, health care …

Medical education

The price for improvement sometimes outweighs the benefits

Joyce Ho, MD

September 30, 2013Sep 30, 20134

After getting off a 15 hour call day, all I want to do is write. These past 2 weeks death has been on my mind a lot, more than it ever has been. I have always known that physicians counsel…

After getting off a 15 hour call day, all I want to do is write.

These past 2 weeks death has been on my mind a lot, more than it ever has been. I have always known that physicians counsel patients and families on dying, but actually being the one to do it is entirely different.

How do you tell someone that their best medical option, the best thing you can offer …

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Physician voices

Improve health care by seeing through the patient’s eyes

Harlan M. Krumholz, MD

September 27, 2013Sep 27, 20139

Is there a patient who goes through a hospitalization who does not have stories to tell about the obstacles, errors and indignities that they endured? I just wonder sometimes. A family relative was hospitalized this week with a stroke at…

Is there a patient who goes through a hospitalization who does not have stories to tell about the obstacles, errors and indignities that they endured? I just wonder sometimes.

A family relative was hospitalized this week with a stroke at a hospital a few hours from me — and his experience left me demoralized about medicine.

Joe (not his real name) is an 82-year-old grandfather, father, husband and one of a kind. …

Physician voices

What to do after you make a medical error

Brian J. Secemsky, MD

September 21, 2013Sep 21, 20135

Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery. Her story of her symptoms and disease course was the story…

Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery.

Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year. It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, …

Physician voices

Doctors shouldn’t criticize other physicians in front of patients

Kevin R. Campbell, MD

September 18, 2013Sep 18, 201326

We all try to do our very best for our patients. Often the decisions we make have profound impacts on outcomes. Medicine is not always cut and dry, and many times gut instinct and judgement calls must play a role in choosing therapies for patients (especially when made in the setting of best available data). As it is in most professions, Monday morning quarterbacking frequently occurs in medicine as well. It is …

Physician voices

The Sunshine Act: A chilling effect on medical education?

John Mandrola, MD

September 17, 2013Sep 17, 20133

Recently, I awoke to a picture of myself in the Wall Street Journal. I was asked to comment on the effects of the coming Sunshine Act. Respected health care journalist Peter Loftus found me through social media channels. What follows…

Recently, I awoke to a picture of myself in the Wall Street Journal. I was asked to comment on the effects of the coming Sunshine Act. Respected health care journalist Peter Loftus found me through social media channels.

What follows are some thoughts about how the Sunshine Act might play out.

Every Thursday during my cardiac fellowship training, at noontime, the entire department gathered for an hour-long conference on echocardiography. Unknown …

Physician voices

Dissection of a needless hospitalization

Jordan Grumet, MD

September 13, 2013Sep 13, 2013

If Hattie had but one flaw, it was that she held her doctors in too high esteem. It was not unusual for an eighty-year-old woman of her culture to want to please her cardiologist. So when her blood pressure came up a little high, she was too embarrassed to admit that she had forgotten to pick up the Toprol and hadn’t taken it in over a week.

The cardiologist hemmed and …

Drugs and prescribing

Remember the side effects of needed drugs that go untaken

David L. Katz, MD

September 12, 2013Sep 12, 20136

You probably already know that what you do know about your medicine could kill you. You may not know that what you don't know could do so as well. Hold that somber thought -- we'll get back to it. You,…

You probably already know that what you do know about your medicine could kill you. You may not know that what you don’t know could do so as well. Hold that somber thought — we’ll get back to it.

You, and I, and everyone else has seen those direct-to-patient drug ads that Big Pharma runs on primetime television. Invariably, they feature a person skipping through butterflies and wildflowers, demonstrating …

Conditions and diseases

Use visual aids to teach patients and improve decision making

Peter Wei

September 8, 2013Sep 8, 20135

We all know that physician-patient communication is important. Poor communication, not deficient clinical skill, is the primary driver of malpractice suits; conversely, good clinical communication alone can improve patient outcomes. For example, patients of physicians with superior communication skills have been shown to have superior blood pressure control. Fortunately, physicians generally recognize the significance of good communication, and often take the time to ensure that it happens. Yet there …

Physician voices

The knowledge that one wasn’t alone in an uphill fight

StorytellERdoc, MD

September 3, 2013Sep 3, 2013

I smelled the patient, unfortunately, even before walking into his room to introduce myself. From the hallway, his odor of lingering stale smoke flared my nostrils, instigating childhood recollections of the wood-burning furnace at my grandmother’s home. From a distance, the scent of smoke was just that — charred-burnt air, its weight clinging to my nostrils. As I approached the patient, however, the scent of smoke smoldered my wishful memories …

Physician voices

The hubris of medicine has to end

John Mandrola, MD

September 3, 2013Sep 3, 201340

I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat. That’s not…

That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at …

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The hubris of medicine has to end

Health policy

What good is Medicaid expansion if no doctor sees Medicaid patients?

Peter Ubel, MD

August 29, 2013Aug 29, 2013168

With its expansion of Medicaid eligibility, the Affordable Care Act (a.k.a. Obamacare) was supposed to go a long way towards providing healthcare coverage to millions of uninsured Americans. That accomplishment was dealt a large blow by the Supreme Court, when it forbade the federal government from requiring states to expand Medicaid coverage. Nevertheless, many states plan to offer Medicaid to anyone with incomes at or below 138% of the Federal …

Physician voices

Does your doctor know ACLS? Does it matter?

Michael Kirsch, MD

August 26, 2013Aug 26, 20139

Folks must think than all doctors know all things medical. I know this is true by the questions that I have been asked over the years. While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology. When I can’t answer questions about a new medicine for hypertension or if an MRI of …

Conditions and diseases

Doing more than necessary in medicine is the opposite of safe

John Schumann, MD

August 23, 2013Aug 23, 20138

In case you missed it, former President George W. Bush had a stent placed in one of the arteries that feeds his heart. The 67-year-old came through the procedure with flying colors, we are told. Stents are tiny metal mesh…

In case you missed it, former President George W. Bush had a stent placed in one of the arteries that feeds his heart.

The 67-year-old came through the procedure with flying colors, we are told. Stents are tiny metal mesh tubes that get inserted into clogged arteries, essentially to prop them open.

Bush, heretofore thought to be in excellent shape, seems an unlikely candidate for the procedure. We hear tale of him riding his …

Conditions and diseases

We offer patients too many unproven treatments at too much expense

Peter Ubel, MD

August 22, 2013Aug 22, 20137

Ten years ago, my tennis partner suffered a stroke. He was a sixty-year-old at the time, working to move up into the top ten players in his age group. In the country! You could not have found a healthier sixty-year-old. He played tennis three-plus hours a day, scampering across the court like a hyperactive adolescent. In other words, he was not …

Medical education

Teaching medical students to provide high value care

Brian Powers

August 17, 2013Aug 17, 20132

Edward arrived at the hospital following a stroke; a standard work-up failed to reveal an obvious cause. His physician explained that a previously diagnosed patent foramen ovale (PFO), a hole in between the chambers of his heart, may have led to his stroke. He presented three possible treatment options to Edward: (1) medical management with drugs; (2) open surgery to correct the defect; or (3) interventional catheterization to correct the …

Health technology

Does home monitoring make a difference in cost and outcomes?

Kevin R. Campbell, MD

August 15, 2013Aug 15, 2013

Technology in medicine advances at a rapid pace. In the US today most patients have access to mobile phones, smartphones and tablets. Medical device makers continue to innovate and create ways in which these technologies can be used by patients and physicians to monitor complex biologic machinery such as implantable cardiac defibrillators (ICDs) and pacemakers at home — without the need for …

Conditions and diseases

How do I live longer? Here are 10 ways backed by evidence

Alex Lickerman, MD

August 12, 2013Aug 12, 201321

Patients often come to me seeking advice about what they can do to live longer. The number of things that have been proven to extend life, however, remains shockingly small. What follows are things that have enough support in the…

Patients often come to me seeking advice about what they can do to live longer. The number of things that have been proven to extend life, however, remains shockingly small. What follows are things that have enough support in the scientific literature that I generally recommend them (though the strength of the evidence varies even with these):

Take simvastatin (brand name Zocor). That is, if you have coronary artery disease. (This is one of

…

Conditions and diseases

MKSAP: 76-year-old woman with dizziness and palpitations

mksap

August 3, 2013Aug 3, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 76-year-old woman is evaluated in the emergency department for dizziness, shortness of breath, and palpitations that began acutely 1 hour ago. She has…

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

A 76-year-old woman is evaluated in the emergency department for dizziness, shortness of breath, and palpitations that began acutely 1 hour ago. She has a history of hypertension and heart failure with preserved ejection fraction. Medications are hydrochlorothiazide, lisinopril, and aspirin.

On physical examination, she is afebrile, blood pressure is 80/60 mm Hg, pulse rate …

Heart and cardiology

Articles, page 34

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