August 26th, 2013
Practice Variations and Quality: Ask the “Uber” Expert
Richard A. Lange, MD, MBA and Harlan M. Krumholz, MD, SM
In light of reported variation in practice and outcomes of elective PCI, Rick Lange asks Harlan Krumholz to elaborate on what constitutes high-quality decision making.
June 7th, 2013
“Your Mortality Risk Is 11.827%”
John E Brush, MD
John Brush reflects on what clinicians understand about the concept of probability and how to explain it to patients.
March 6th, 2012
Shared Decision Making in Advanced Heart Failure
Larry Allen, MD, MHS
Larry Allen is the lead author and co-chair of the AHA Scientific Statement on Decision Making in Advanced Heart Failure. Patient-centered care ensures that clinical decisions are guided by an individual patient’s values, needs, and preferences; shared decision making is the act of putting this type of care into clinical practice by asking health care providers […]
February 13th, 2012
Selections from Richard Lehman’s Weekly Review: Week of February 13th
Richard Lehman, BM, BCh, MRCGP
This week’s topics include communicating with patients about screening and treatment and the association between blood-pressure-lowering drugs and gout.
January 26th, 2012
Sizing Up Clinical Trials — Quickly and Intuitively
John E Brush, MD
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
John E Brush, MD
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
John E Brush, MD
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
John E Brush, MD
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?
John E Brush, MD
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
John E Brush, MD
How awareness of heuristics can affect your practice
NEJM Journal Watch — Recent Cardiology Articles- Anticoagulation in Patients with Cancer-Associated Pulmonary Embolism: How Long is Long Enough?
- Spironolactone Use After Percutaneous Intervention for Acute Myocardial Infarction
- CRISPR/Cas9 Gene Editing for Transthyretin Cardiomyopathy
- Does Colchicine Reduce Cardiac Events After Myocardial Infarction?
- First-Line Therapy for Ventricular Tachycardia After MI: What's the Best Approach?