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.

We continue to fall short in treating women with heart disease

Kevin R. Campbell, MD

Conditions and Diseases

May 20, 2013

Women are undertreated and underserved when it comes to cardiovascular disease and stroke. Now, more than ever, this may even be more important due to several recent studies that have been published recently.

Several investigations have demonstrated two troublesome facts. In certain areas of the country, life expectancy for women is decreasing and women who smoke are much more likely to have lung cancer than men who smoke. These facts argue …

The legal risks of prescribing the AliveCor ECG

Wes Fisher, MD

Health Technology

May 20, 2013

AliveCor-ECG

With the announcement that the FDA granted 510(k) approval for the AliveCor EKG case for the iPhone 4/4S, the device became available to “licensed U.S. medical professionals and prescribed patients to record, display, store, and transfer single-channel electrocardiogram (ECG) rhythms.”

While this sounds nice, how, exactly, does one become a prescribed patient? Once a doctor prescribes such a device, what are his responsibilities? Does …

When the business of medicine trumps appropriate care

Jordan Grumet, MD

Physician

May 16, 2013

I almost fell off my chair. It was bad enough that he showed up to the ER. But what happened next really blew my mind. He fell and bruised a rib. The pain in his left chest had obvious enough origins. But triage had put in for an electrocardiogram and the interpretation apparently scared the resident. The attending took a look, and shook his head.

“Left bundle branch block. Better call …

Should families be allowed to witness CPR?

Christopher Johnson, MD

Physician

May 15, 2013

This is a topic that comes up from time to time for often spirited discussion. The most recent example comes in a couple of articles in the New England Journal of Medicine. One was a research paper; the other was a pro and con discussion.

The research paper studied cardiac arrests that happened outside the hospital. The authors tested the premise that allowing families to watch the efforts of …

Medical problems can be uncovered by a history and physical exam

Jim deMaine, MD

Physician

May 10, 2013

Bobby was admitted to the hospital once again with overwhelming fatigue and shortness of breath. Yet this 37 year old farmer looked the picture of health. He grew up on a farm rising before dawn, milking cows and working long days in the fields with hay or corn. He was never seriously ill as a child and was a good football halfback in high school.

But this was his third admission …

Why hospital culture influences medical costs

Jason H. Wasfy, MD

Physician

May 8, 2013

“You have to be affable, available, and able,” a senior general internal medicine physician taught me during my final year of residency. “Trust me,” he added, “when you’re in practice, you will love easy consults.”

A consult – short for “inpatient consultation” – occurs when physician caring for a hospitalized patient requests another physician to evaluate the patient and provide recommendations. Typically, both physicians are paid – one for providing overall …

It’s natural to skimp on care when it’s costly

Josh Trent

Patient

May 7, 2013

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“Have you ever been told you have a heart murmur?” a young doctor gently asked my friend, Ben. Ben’s mind reeled. Ben was in his early 30s, relatively young and healthy. But his father had died from a heart attack before age 50. And his mother had a heart problem. What did this question signal for him, he worried.

“Um, ah, no, I haven’t,” …

As I sit by my father in the hospital, there is a choice to be made

Miranda Fielding, MD

Physician

May 6, 2013

With gratitude to Doctors Rafael Espada and Michael Madani, for fixing my father’s heart, twice.

When Michael Phelps was interviewed during the Beijing Olympics, the world first learned about the extraordinary amount of food needed to fuel the swimmer with the wingspan of a pterodactyl. He said that he ate 12,000 calories a day, and no one believed him except for me. I believed him because I too was a swimmer …

Medical residents expect the data to be fed to them

Wes Fisher, MD

Physician

May 1, 2013

“What’s the most important finding on this chest x-ray?”

There he was, standing before 5 ICU residents, each peering at a chest film on displayed on the over-sized computer screen.

“Um, the pleural effusion?” whimpered a third-year resident.

“No!” barked the attending.

The others, standing dumbfounded in front of the computer display, searching for another finding but finding none, stood silently.

“Come on, folks! Look!”

And try as they may, no one saw it.

“The name, folks, …

Copy and paste medicine is not new

David Mokotoff, MD

Physician

April 28, 2013

As a second year medical student in 1971, I still remember an article in the prestigious New England Journal of Medicine, describing a new phenomenon, The Emperor’s New Clothes Syndrome. It was based upon the famous Danish author, Hans Christian Anderson’s fairly tale from the 1800’s.

A vain emperor, who cares for nothing except wearing and displaying clothes hires two swindlers who promise him the finest, best suit of clothes from …

Read more…

Copy and paste medicine is not new

Why are some generic drugs so expensive?

Leslie Ramirez, MD

Medications

April 23, 2013

Two of the biggest -selling prescriptions of all time, Plavix, an anti-platelet medication, and Lipitor, a cholesterol lowering medicine, have been available in generic form since May 2012 and November 2011, respectively. However, most retail pharmacies are still charging patients $100-$200 monthly for these medications. Why? And what does this market oddity say about our chances of lowering healthcare costs in the United States?

Patients are used to paying a high …

I am called before the inquisition board: Welcome to modern medicine

David Gelber, MD

Physician

April 22, 2013

Today I had the displeasure of sitting in judgment before a modern inquisition at one of the hospitals I attend. Although the grand inquisitor lacked the trappings of a monsignor or bishop, and without a physical executioner in the room, I was subjected to round after round of questions regarding my apparent disregard for system wide medical and post surgical protocols. Such protocols have been adopted by CMS (which oversees …

Who are the physicians that make the decision to deny care?

Wes Fisher, MD

Physician

April 17, 2013

A phone conference had been arranged. They wanted to talk to me about a denial for payment on a portion of a patient’s pre-authorized procedure after the fact. Its participants: the regional medical director of a large insurance company, his female assistant administrator, and me.

He cordially introduced himself as a pediatrician by trade from a large well-known (and highly respected) academic institution with impeccable credentials responsible for our region of the United States. …

With health reform, flexibility is important

Rob Burnside

Patient

April 13, 2013

Flexibility is important these days, perhaps more than ever before. I’m reminded of this almost every time I order lunch at a fast food joint: “I’d like a double cheeseburger, please, with ketchup only.” “You mean ‘only ketchup,’ don’t you?” “Okay, a double cheeseburger with only ketchup.” “Right, got it, coming up!”

So many changes on the medical care horizon and everyone speaking a slightly different language — it’s bound to …

Quality healthcare isn’t just about clicks and lists

John Mandrola, MD

Physician

April 10, 2013

My hospital has just weathered an impressive upswing in patient volume. The house was full for weeks. The experience highlights an important aspect about quality care–an obvious one that doesn’t always make headlines.

What I notice when the hospital gets full is that patients are sent to units that they don’t normally go to. For instance, at my hospital, like yours probably as well, there are numerous different types of heart …

Medical apps: We are approaching the tipping point

Joe Flower

Health Technology

April 7, 2013

The progeny of the iPhone and the iPad will change the shape of your institution — and your balance sheet.

One of the more striking images, to me, out of the online spew in the last few months was from the inauguration. It was a wide view of an inaugural ball. There was the president waltzing with the first lady, and a crowd of several hundred watching them. What was striking …

5 essential concepts to know about code status

Brian J. Secemsky, MD

Conditions and Diseases

April 3, 2013

Full Code. Do not resuscitate. Do not intubate.

Ask anyone without a personal or family history of a hospitalization on the implication of these terms and you’d likely get a blank stare in response.

Unfortunately, this incomprehension often rings true with those who need to know it most: the hospitalized patients themselves.

Many clinical reports (see here and here) have demonstrated that most physicians are not only inadequate in discussing code status with …

Should family members be present when performing CPR?

Troy Madsen, MD

Physician

April 2, 2013

“We’re doing everything we can,” I said as I put my hand on the sobbing woman’s shoulder. “We’re going to keep trying for about 10 more minutes, but I don’t know if we’re going to be successful with this.”

These are the moments that are truly difficult in my job. Telling people their loved ones have passed away, or preparing them for what seems inevitable.

“You can do it!” the woman said …

Consider new treatment options for aortic stenosis

Steven R. Gambert, MD

Conditions and Diseases

March 31, 2013

I recently encountered a previously functional and independent 80-year-old woman who slipped and broke her hip. Surgery was required to repair the injury and was her only hope of returning to her premorbid state. She lived alone and was still able to shop, clean, and cook for herself, despite being on several medications for congestive heart failure. She had a long-standing history …

How a smart process helped Kaiser Permanente save lives

Chip Heath and Dan Health

Health Policy

March 27, 2013

The following is an exclusive excerpt adapted from #1 New York Times best selling authors Chip and Dan Heath’s new book Decisive: How to Make Better Choices in Life and Work, which was released on March 26, 2013. Click here to order.

One …

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