rev-sharpton However you see the Reverend Al Sharpton, one thing is certain: you see less of him now. His Twitter pic tells you he is proud of his 167-pound weight loss. Good for him, he should be. If you care about health, the disappearance of the Sharpton-of-old is worth mention. His story teaches us a lot, and, if one dares to look a little ...

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Let’s be honest. If you are bold enough to hit the "publish" button, it’s normal to care what readers think. I write about medicine: I like doctors, I respect doctors. So it matters how colleagues react to my words. I was both proud and concerned when the Greater Louisville Medical Society decided to republish my "Changing the Culture of American Medicine" piece in their monthly journal, Louisville Medicine. The reaction of my colleagues has ...

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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 ...

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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 ...

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What follows are not complaints. These are just the facts. Here’s a recent exchange from an enlightened physician leader, one who has yet to give up: “My colleagues are discouraged and frustrated every day, leaving the office defeated and fatigued. There are other ways to practice.” High health care costs get most of the attention, but there’s a more important crisis coming your way. First a review, then to the looming crisis. When Americans travel ...

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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 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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It’s been a while since I did a cycling topic. As I was skimming thorough the Journal of the American Medical Association recently, I came across this review article on spinal injection therapy for low back pain. It was a shocker. Two factors brought my attention to the article. First, almost all the cyclists or runners I know have been beset with either back pain or sciatica (referred pain or weakness down the leg). In ...

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alarm fatigue Patient safety and hospital quality is a scary topic. I’ll go easy. I’m just a doctor. I don’t know much. Entire departments, filled with cubicles, computers and well-meaning people, now exist to keep hospitals tightly regulated and running perfectly. There is data to analyze, regulations to read, and oh so many meetings to attend. This place of healing will be safe—and perfect. The ...

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When an employee leaves a position, management might conduct an exit interview. The idea is obvious: one can learn a lot from those who are free to speak candidly. This is why I think it’s worth listening to doctors who no longer practice medicine. Enter Dr. Ed Marsh, a former pediatrician, who writes this poignant and relevant essay. His tone and candor is one of a man who still cares about ...

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Here is an edited email I received from an athletic colleague:

John, A 50 year-old male healthy athlete has the new problem of occasional periods of premature beats. She (or he, doesn’t matter) has visited the doctor and an ECG shows PVCs, or premature ventricular contractions. Otherwise the history, exam, ECG, ECHO and electrolytes are normal. What’s up with PVCs? Why? Could they be 1) consequence of (chronic) exercise or 2) related in ...

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Perhaps it’s because I love the practice of medicine so much. Or maybe it’s because doctors (and teachers) have always been my heroes. I’m trying to sort out why I feel so offended by Paul McHugh’s editorial in the Wall Street Journal. His sensational and paternalistic view of physician-assisted suicide can be summed up in one word—shameful. It is true, thankfully so, that in the United States offensive speech is protected. And ...

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Look at this sample question from the American College of Cardiology self-assessment. Tell me whether you see the problem. (It came in a mass advertisement-email, so I don’t think it is a secret.)

Sample question
A 75-year-old woman is referred to you with a murmur. She has had the murmur for many years and has been followed by her primary care doctor. Recently she has noted increasing symptoms of shortness of ...

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How should doctors behave online? This is a funny question, isn’t it? Medical establishment loves rules and hierarchy. Social media does not. Social media levels the playing field of who gets to talk; it gives real caregivers a voice. That’s very cool. This is just a guess, but I suspect there are many more acts left to play out in the healthcare social media play. The American College of Physicians and the Federation ...

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Text message: “John, This cough and congestion is killing me. It’s turning thick and green. Can you write me a Z-pak? It always works for me.” If you write a blog on medical decision-making and heart rhythm matters, it seems an incredible omission not to opine on the FDA warning concerning the commonly used antibiotic azithromycin (the drug in a Z-pak). Quoting directly from the FDA warning:

[Azithromycin] can cause ...

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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 ...

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Every once in a while a news item becomes so big that a threshold is reached. Thinking people must weigh in. When the US Supreme Court hears two cases involving the rights and treatment of individuals who are lesbian, gay, bisexual or transgender, there is a lot at stake. Our country faces a really important test. It’s not so much about the specific legal issues, though they are not insignificant. Much more ...

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Every once in a while a topic comes up that takes me back to the origins of this blog. At its core, DrJohnM aims to merge the worlds of athletics, health and medicine. The glue, the secret sauce, is mastery of the obvious. As an athlete and doctor, I get to see how both plans parallel each other. Katie Compton is an American ...

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I hope my patients are satisfied. This is everything. Improving the lives of people is why doctors do what they do. How much we help our patients is the metric. It’s the peg we hang our self-esteem on. So yes, of course, patient satisfaction is really important. But that doesn’t mean it’s a good idea to link it with dollars. In fact, on a list of well-meaning but really dumb reform ...

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I grew up in Connecticut. It was in a town just like Newtown. It was safe and it was quiet. I am a father and a grandfather. My life is surrounded with children. This weekend has been tough. You try to read or write something, but the mind wanders. Then you feel sadness. The more you think about the specifics, the sadder it gets. Your heart aches. Our nation feels it. I recently ...

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There was good news recently in the atrial fibrillation world. Though no surprise to heart rhythm doctors, an FDA investigation reveals no evidence that new cases of bleeding are any higher with dabigatran (Pradaxa) than with warfarin. The full statement from the FDA is here. The assessment was undertaken because after approval of the novel anticoagulant (blood-thinner) a large number of adverse events were reported to the FDA. Despite conscientious medical ...

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