CardioExchange Archive

John Mandrola is a cardiac electrophysiologist and blogger on matters medical and general. Here is a recent post from his blog, Dr John M.

One of the coolest things about keeping a medical blog is interacting with people. It’s immensely gratifying to hear from folks who stumble upon my site.

Take this example: While cooling down after tonight’s ride, a cycling friend and ER doc mentioned that my website turned up on his Google search of the new blood-thinner Pradaxa. I was delighted to hear that my posts gave him what he needed for the care of the patient. Hearing that meant more to me than having good legs on the ride.

It’s also gratifying, and at the same time humbling, that so many contact me about their heart rhythm (most commonly, AF) experience. Gosh, there’s a lot of AF out there, and AFibbers are an educated, information-hungry crowd. There is little doubt in my mind that – for many – AF is an overachiever’s disease.

Patients tell me their AF stories; ask great questions; seek to understand the mysteries of an infinitely mysterious disease. I try to read and respond to anyone who takes the time to write. But with tapping the “send” button comes a big, bad, scary conflict.

What conflict?

On the one hand, AF treatment options are finite and knowable. “Just give the answer, John; it’s easy,” I think to myself.  I’d like to tell patients to have an ablation, or stop worrying about one AF episode, or take the blood thinner because strokes are horrible. Like I was their doctor.

But these kinds of specific responses would constitute medical advice. And I’m not my readers’ doctor. I have not sat in the same room with them. I haven’t seen their expressions, listened to their hearts, or watched how well they walk around — a good measure of how well one tolerates having 50-plus burns made in the heart. Without seeing a patient, there’s no gestalt, no nuance. Even worse, I haven’t seen the ECG – and there’s a lot of helpful information buried in those squiggles. Call me old-fashioned, but I think interacting human-to-human and looking at an ECG are on the checklist of good doctoring.

But on the other hand, information is so vitally important in AF treatment. Information rocks! Though I know far less than most, I do know AF. I live and breathe this disease. I have even had the dang butterfly heartbeat myself. It stunk. (AF caused me to get dropped by a person of size going uphill.)

Though limited in scope, I could easily tap out a couple suggestions for a reader’s problem. It’s tempting. For instance, in writing to an AF patient tonight, I offered this bottom lime: “Ultimately, an AF patient ends up choosing from just three options: live with AF, take drugs, or have a procedure(s). And sometimes, no check that, often, AF treatment involves combination platters of all three.” Statements like this are general advice, which hold true for many medical conditions. I could not tell her which of the three options to choose, though I knew – from her words – which one I leaned toward.

One of  my goals in writing about medical matters is to mesh real-world experience and my take on the scientific data with words that all can understand. If successful, readers are more informed. There’s a large difference, however, between providing general information and giving specific medical advice.

This notion seems inherent, understood (smart people might say “tacit”), but I am going to make it overt: Medical recommendations for treatment should come from the patient’s doctor.

I plan to continue writing about my life’s work. I hope to keep on hearing from readers. 

JMM