John E Brush, MD

All posts by John E Brush, MD

May 12th, 2014

My Recent ABIM Maintenance of Certification Experience

John Brush describes his positive experience with the ABIM’s maintenance of certification process, and explains why he thinks the petition against it asking for the wrong thing.

April 30th, 2014

Thinking About Risk

John E. Brush discusses new ways to help patients consider their cardiovascular risk.

June 7th, 2013

“Your Mortality Risk Is 11.827%”

John Brush reflects on what clinicians understand about the concept of probability and how to explain it to patients.

June 27th, 2012

Panel: Early Surgery for Infective Endocarditis

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Will findings from this trial of early surgery for infective endocarditis change your practice?

January 26th, 2012

Sizing Up Clinical Trials — Quickly and Intuitively

A pharmaceutical sales rep comes to your office bringing lunch. He shows you a graphic stating that Multaq (dronedarone) reduced the primary endpoint in the ATHENA trial by 24%. The fine print shows an impressive P value: <0.0001. You come away satisfied that this drug looks good. You may not realize it, but you also […]

December 8th, 2011

How Randomness Affects Quality of Care

Each month I meet with administrators at my hospital to review the quality of our cardiology program. My administrators don’t want excuses. They aim for perfection. But a discussion at our last meeting about door-to-balloon times for STEMI patients changed their minds.

November 8th, 2011

Wrestling with Uncertainty in Clinical Practice

About a week ago I was asked to consult on a patient I’ll call Betty. This delightful 92-year-old woman, who lived alone, was admitted during the night with pain in the upper chest and shoulders. She had been feeling this discomfort off and on for 2 days, and when it woke her from sleep, she […]

October 27th, 2011

The Art of Arriving at a Diagnosis

A 55-year-old man came to the emergency room complaining of aching chest pain radiating to the back. The pain had started the day before and recurred several times. It seemed to worsen with exertion and resolve with rest. One resting episode was associated with diaphoresis. Exam, EKG, and cardiac enzymes were normal. A portable chest […]

October 5th, 2011

Does Intuition Lead to Bad Medical Decisions?

Discussing how medical practitioners use intuition and cognitive shortcuts (heuristics) to make decisions can elicit strong reactions. Some people heartily agree that reflecting on their use is informative and helpful; others believe that to entertain this topic is to condone sloppy thinking and to renounce rationality and hard science. These critics are concerned that heuristic […]

September 19th, 2011

Decision-Making Shortcuts: The Good and the Bad

How awareness of heuristics can affect your practice