Cardiologist, professor at Keck-USC; believer in science, evidence-based medicine, health care as a right, a single payer system, democracy, and tennis.
An attorney will pay me $500/hour for my time and expertise to review a potential malpractice case. Why should I spend 2-4 hours reviewing a manuscript for a profitable journal for free?
Resident: can I discuss a new heart failure patient with you?
Me: Sure. Why do you say they have heart failure?
Resident: The BNP is elevated.
Me: Let's start over
New Patient: my last cardiologist got stress tests every year.
Me:That's not necessary.
Patient: But that's how he found a blockage that was stented and prevented me from having a heart attack. He was such a caring cardiologist
Me (to myself): Ugh
Me: You stopped taking your blood pressure medications?
Patient: Yes, I feel great
Me: But your BP is 170/100. You could have a stroke. You really should take your medicine.
Patient: But on Twitter you said "you can't make an asymptomatic patient feel better."
Do not try to control the rate in a hypotensive patient (sepsis, bleeding, etc) with atrial fibrillation and rapid ventricular response. It's physiologic. Slowing the rate can kill the patient.
Day 11 of cardiology inpatient service. Lesson for the day: there are only two reasons to do a procedure on a patient-to improve quantity of life or quality of life. If you can't make that argument with high quality rather than anecdotal data, don't do it. First, do no harm.
