Dr. Wes

When Patients Make Their Own Diagnosis

2013-06-18T16:13:00.000-05:00

"Doctor, I've been taking my vitals signs and they've been very stable, but recently I've noted I just have no "get-up-and-go." I feel short of breath climbing stairs now. Any idea what might be going on? Here's what I've recorded:" The patient's self-recorded vital signs(Click to enlarge) So, what's the diagnosis? (Hint: remember who the patient came to see...) -Wes

How to Quell Physician Discontent with EMRs

2013-06-13T07:01:00.000-05:00

How do you quell physician discontent with Electronic Medical Records (EMRs)? Easy. Have the leadership of your physician organization interview the National Coordinator for Health Information Technology, then make sure your physicians read the spin. This is one of my favorite excerpts: Q: Many physicians are not seeing the expected financial return on investment after EHR implementation.

The IRS, NSA, and Justice Department Scandals and What They Mean for HIPAA

2013-06-08T08:54:00.001-05:00

As my head reels at the implications of the IRS scandal mushrooming in Washington, the IRS's recently disclosed ability to access e-mails without warrant, the intricacy of the NSA PRISM wiretap techiques that includes their ability to acquire tech firms' digital data, and even the Justice Department's ability to secretly acquire telephone toll records from the Associated Press, I wonder (as a

Guideline Apathy

2013-06-06T13:51:00.003-05:00

With yesterday's publication of the 2013 ACCF/AHA Guidelines for the management of heart failure, the 101st guideline for cardiologists since 2005 published jointly by the ACC and American Heart Association appeared in the literature (if my count is correct). Then again, the National Guideline Clearing House set up by our own US Government suggests there are 483 previous guidelines pertaining to

What I'd Tell the Graduating Medical School Class of 2013

2013-06-04T14:57:00.003-05:00

Next week I'll be attending our medical school graduation and I wondered what I would tell them if I were chosen to give them a commencement address. This would not be an easy speech to write right now, given all of the uncertainties in health care that lie ahead, but I thought it would be interesting to try. Readers are invited to add their words as well in the comments section. Dear

How To Simplify Consents

2013-05-31T09:34:00.001-05:00

He arrived at the emergency room diaphoretic, hypotensive, and with substernal chest pressure. The patient was brought immediately to an emergency room care area and a stat EKG disclosed classic ST segment elevation in the inferior leads. The cath lab team was immediately summoned as the ER team worked to stabilize the patient. Within minutes, the attending cardiologist was on the scene,

A Critical Review of the Insurance Claim Denial Process

2013-05-30T17:35:00.001-05:00

"If you can speak what you will never hear, if you can write what you will never read, you have done rare things." -Henry David Thoreau "Doctor, how much longer?" The case had gone smoothly, but the challenges of mapping the infrequent skipped beats that signified the initiating sequence to the tachycardia was getting more difficult. "Could it be left sided?" I wondered. "Anterior

Transitions

2013-05-30T15:32:00.000-05:00

"I think this will be my last day here. Thanks for everything." The world was ahead of him now as the year ended. He had so much to do, so much ahead: a graduation, new city, wife with a new job, a need to find a home and new nanny, the need to learn a new hospital, community, and yes, even a need to sit through four hours of EPIC training, again, to fulfill his educational prerequisite for

Status Check

2013-05-22T10:22:00.003-05:00

For my regular followers, I apologize for being so negligent on updating this blog recently. Rest assured, I'm not dead, sick, or having family troubles - I'm just busy as hell. Taking a week off for attending a Scientific Session wreaks havoc on one's professional life these days. I also find that I am more judicious about what I post these days. For me, I enjoy supplying original content

Heart Rhythm Society 2013 Scientific Session Wrapup

2013-05-12T09:52:00.003-05:00

Opening Day HRS2013 As the Heart Rhythm Society's 2013 Scientific Sessions are a thing of the past, it is interesting to reflect on what constituted the main thrusts occurring our field. Summarizing thousands of abstracts and hundreds of sessions from scientists (literally) all over the world is impossible, of course. But it did appear a few sea changes in our field are in the works, at

Happy Mother's Day

2013-05-12T05:00:00.000-05:00

From Tom's Burned Down Cafe, Madeline Island, WI -Wes

Former President Bill Clinton Kicks off Heart Rhythm Society Meeting

2013-05-09T06:59:00.002-05:00

While the above title is true, I admit that it was used more for garnering readership than suggesting that former U.S. President Bill Clinton had any real news to share with the world's pool of heart rhythm specialists. Oh how we hoped he would tell us about his pacemaker or implantable defibrillator that he had installed but, alas, it was not to be. But the man can still draw a crowd. The

HRS2013 Pre-meeting Reflections

2013-05-08T08:50:00.004-05:00

This morning I sit quietly in my hotel room, contemplating the day ahead at the 2013 Heart Rhythm Society Scientific Sessions in Denver. Emotions clash. On one hand, it will be great to see old friends an colleagues, to be spoon-fed information, and to relax. On the other hand, I find myself in an electrophysiologic angst: how I can spend the time upbeat knowing that the relative value of

Physician Blogger Insights On Social Media

2013-05-05T19:02:00.004-05:00

A recent e-mail exchange between myself (WGF) and fellow-physician bloggers John M. Mandrola MD (JMM), Edward J Schloss MD (EJS) and Ves Dimov MD (VDMD) resulted in some interesting insights about how physicians are using social media tools today. The following is a lightly edited version of the thread (used with permission). It began with an e-mail from Dr. Mandrola: JMM: "In prep for our

The FDA Azithromycin Softshoe and Why It Matters

2013-05-04T07:54:00.001-05:00

This week, a Danish study by Svanstrom and colleagues appeared in the New England Journal of Medicine that failed to show significant cardiovascular risk to azithromycin compared to other antibiotics in the Danish national health care system. This report was in direct contradiction to an earlier report from Ray, et al. published in the New England Journal of Medicine (and widely hailed in press)

EKG Du Jour #31: A Case of Chest Pain

2013-05-03T13:29:00.001-05:00

A 61 year old patient presented to your ER with chest pain, low blood pressure, and this EKG: (Click image to enlarge) Now before you leap to the answer at the link provided below, ask yourself: (a) What is this? (b) What could cause this? (c) How would you manage it? And when you've really thought about it, click here for the answer but be prepared to describe what you see and what you'd

Dr. John M: Autonomy vs beneficence? Shared decision-making in the patient considered for an ICD

2013-05-01T10:32:00.002-05:00

Dr. Lin and Matlock were quoted in Dr. John Mandrola's post today: "Convincing physicians to engage in shared decision-making is a complex undertaking, as physicians may believe that they are following clinical practice guidelines in strongly recommending an ICD to eligible patients. Because quality-improvement efforts often focus on increasing physician adherence to guidelines and reward

Story Lines

2013-04-28T14:04:00.001-05:00

Doctors are trying to rationalize our current story line: the loss of autonomy and pay cuts are a necessary evil for the greater good. We're taking one for the excess-health care cost team. We're willing to take this personal sacrifice for our fellow man and woman. It is the noble thing to do. It will be good for America's healthcare system if we do our part, work harder to improve

A Few Words About this Week's Block-HF Trial

2013-04-25T17:38:00.000-05:00

Today, press releases about Medtronic's BLOCK-HF trial filled by e-mail inbox, just 24 hours after the results appeared in the New England Journal of Medicine. For those unfamiliar, the trial studied the efficacy of biventricular pacing to reduce a composite endpoint of death, heart failure admission and a particular echo parameter called the left ventricular volume index. The study, reported

Technorati's Social Media Update 2013

2013-04-25T10:55:00.000-05:00

In preparation for my upcoming talk at the Heart Rhythm Society's 2013 Scientific Sessions in May, I came across this information from TechnoratiMedia's 2013 Digital Influence Report. While these data are primarily directed to general online consumer influence, doctors interested in social media might find this information interesting (my comments are italicized): When it comes to community

Retaking Medicine

2013-04-24T23:29:00.001-05:00

If you are reading this, do not forward this to colleagues. Do not forward on to your state medical association. Do not demand relevant discussion of this at your next professional meeting. We are good boys and girls, dear doctor, not activists -- leave that to the lawyers and lobbyists. I think I'm seeing something, something I haven't seen or felt before in medicine: doctors awakening from

The American Board of Medical Specialties Gets Sued Over MOC

2013-04-24T08:51:00.001-05:00

From Sermo this AM: The Association of of American Physicians and Surgeons (AAPS) filed suit in federal court against the Amercan Board of Medical Specialties (ABMS) for restraining trade and causing reduction in access by patients to their physicians. According to the complaint: "Defendent ABMS has agreed with 24 separate corporations, and acted in concert with the Joint Commission, to

The American College of Cardiology Gets a New CEO

2013-04-23T21:46:00.001-05:00

Since when does a pharmaceutical executive become CEO of the American College of Cardiology (ACC)? Since now. Call me crazy, but does this strike anyone else as strange? Are physicians now officially incapable of leading the ACC or any other major professional doctor organization? Have we not learned anything about the appearance of co-mingling pharmaceutical or medical device company

To Burn or Freeze During Catheter Ablation of Atrial Fibrillation, That Is the Question

2013-04-22T14:55:00.001-05:00

With the deaths that have recently surfaced caused by esophageal perforation following cryoablation procedures for the treatment of atrial fibrillation, Dr. John Mandrola (a fellow colleague and EP-blogger) delves deeper into the incidence, issues, and current recommendations that might improve the safety of the procedure over at theHeart.org today. It's an excellent review of the current state

From the ER in Boston

2013-04-20T07:11:00.002-05:00

From the Wall Street Journal this morning, Emily Loving Aaronson, MD, an Emergency-medicine resident at Harvard who is on staff at the Brigham and Womens and Massachusetts General Hospitals, reflects on the scene in the Emergency Room on the day of the Boston Marathon bombing attack: "... The first wave arrived with similar injuries: severed limbs, open fractures and puncture wounds from