It is hard to know what to say about a doctor that would recommend anticoagulants and a group of cardiovascular tests for an 81 year old wheelchair-bound demented patient. Please tell me that was made up and not a real life example.
I tell my fellows that “we have to do something” are some of the most dangerous words in medicine. I hear them too often from heart failure docs with patients as they approach death. Was a repeated argument for TriClip in one old frail lady. Thankfully she was eventually able to pass peacefully in hospice without a Clip.
Clearly the 81 year old patient wasn't pushing for these things - could it be that the son had " done his research" and decided that his father needed all this intervention? While it could be a nefarious cardiologist looking to pad his bank account sometimes families push for things to be done and refusing appears to them as not caring, or valuing the life of their loved one as lesser. It can be hard to resist these types of demands.
We are soon headed to the public voting polls as to what constitutes threshold effects that are worth public investments and service-compensations for interventions.
I agree with the two comments shown below. To those I would add "guidelines and metrics". We are held to these, in Cardiology and in other areas of medicine. We get dinged if we don't use whatever the standard is said to be, regardless of the individual patient's situation. We also don't adequately train our residents and fellows to apply common sense in such situations.
So, should it include tort reform ? Like stated many a times in this forum, we think aging and dying are options. And, the three main causes of malpractice are failure to diagnose, delay in treatment, failure to consult. We are programmed / mandated / expected to do something or else If the standard of care is dependent on where you are practicing, then, you see the snowball getting larger by the second.
I've never lost a suit on programmed/mandated/expected. And I work in a very litigious juristriction. Sensible medicine has served me and my patients quite well.
As a side note, standard of care is actually quite fluid and any good lawyer can use the fluidity as a cudgel against the opposition.
The compulsion to “do something” is embedded deeply in the medical education process. This is an issue independent of financial incentive. The notion that to do less is of patient benefit is a hard sell in the procedurally based American medical system. To teach this point would require a major ethical overhaul in the collective mindset of academic leadership in this country. Sadly I don’t see that happening.
It is hard to know what to say about a doctor that would recommend anticoagulants and a group of cardiovascular tests for an 81 year old wheelchair-bound demented patient. Please tell me that was made up and not a real life example.
He’s doing things to the patient not for the patient.
Follow the $.
To use LAAO in 2026 requires extremely motivated reasoning, and $ is an extremely powerful motivator.
Go with Occam. No need to make it more complicated than it is.
I tell my fellows that “we have to do something” are some of the most dangerous words in medicine. I hear them too often from heart failure docs with patients as they approach death. Was a repeated argument for TriClip in one old frail lady. Thankfully she was eventually able to pass peacefully in hospice without a Clip.
Clearly the 81 year old patient wasn't pushing for these things - could it be that the son had " done his research" and decided that his father needed all this intervention? While it could be a nefarious cardiologist looking to pad his bank account sometimes families push for things to be done and refusing appears to them as not caring, or valuing the life of their loved one as lesser. It can be hard to resist these types of demands.
We are soon headed to the public voting polls as to what constitutes threshold effects that are worth public investments and service-compensations for interventions.
As soon as I read "a Watchman Procedure" I just rolled my eyes. That "device" should likely be outlawed. And consequences to any medics who employ it.
I agree with the two comments shown below. To those I would add "guidelines and metrics". We are held to these, in Cardiology and in other areas of medicine. We get dinged if we don't use whatever the standard is said to be, regardless of the individual patient's situation. We also don't adequately train our residents and fellows to apply common sense in such situations.
Aren't we professionals? Nah, I guess we're now providers.
So, should it include tort reform ? Like stated many a times in this forum, we think aging and dying are options. And, the three main causes of malpractice are failure to diagnose, delay in treatment, failure to consult. We are programmed / mandated / expected to do something or else If the standard of care is dependent on where you are practicing, then, you see the snowball getting larger by the second.
I've never lost a suit on programmed/mandated/expected. And I work in a very litigious juristriction. Sensible medicine has served me and my patients quite well.
As a side note, standard of care is actually quite fluid and any good lawyer can use the fluidity as a cudgel against the opposition.
The compulsion to “do something” is embedded deeply in the medical education process. This is an issue independent of financial incentive. The notion that to do less is of patient benefit is a hard sell in the procedurally based American medical system. To teach this point would require a major ethical overhaul in the collective mindset of academic leadership in this country. Sadly I don’t see that happening.