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Angela Lu is training to be a physician. She’s interested in public policy. As a third year medical student, she teamed up with established leaders to ask a unique question regarding public disclosure of financial relationships. When the Centers for Medicare & Medicaid Services (CMS) issues National Coverage Determinations (NCDs) for services or products, they mean business. Such decisions have huge implications. You cannot go against them. Think #HighConsequences. CMS studies the...

Andrew Foy rejoins the Sensible Medicine podcast. We talk first about coronary artery calcium. Andrew is an expert in this area. We have co-written our case against CAC scoring for any cause in the American Family Physician. It’s had little effect as CAC scoring is running rampant. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. The second part of our conversation centers on a big med-ed project...

This week, I talk with Andrew Foy, who is an academic cardiologist at Penn State University in Hershey, PA. Andrew is one of the smartest voices in medicine today. We start with the REMEDIAL trial, published recently in JAMA. Ablation vs Meds. Primary endpoint—depression and anxiety. One of the main issues was the control arm—namely that there was no sham control. We referenced this useful review paper on placebo and nocebo effects in cardiology, from Brian Olshansky. Our second topic was...

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AC is a 56-year-old man brought to the emergency room by ambulance for a trauma evaluation after a bicycle crash. Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber. I’ve tried to stay away from the reflections that end up being part of the “doctor-as-patient” genre.[i] Books, TV shows, and movies are filled with these stories.[ii] A doctor gets sick or injured, spends time as a patient, and then authors a piece with...

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Although it is unoriginal to point out that doctors learn from our patients, here are a few lessons so powerful, so extrapolatable, that I forever associate them with an individual. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit sensiblemed.substack.com/subscribe

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit sensiblemed.substack.com/subscribe

Here is the profile for Harvard Professor Robert (Bobby) Yeh. His most recent Circulation paper: Bringing the Credibility Revolution to Observational Research in Cardiology. We referenced a paper by Professor Miguel Hernan: The C-Word: Scientific Euphemisms Do Not Improve Causal Inference From Observational Data Paper referenced on left ventricular assist devices: Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No...

BW was a 66-year-old woman who presented for an urgent visit to the general medicine clinic. She reported that she had been having dizziness for the last four days. When pressed, she said it occurred intermittently, being present more than absent. She could not identify any palliative or provocative features, and when asked about associated symptoms she said that she felt “bad and scared” when it was present. The doctor encouraged her, many times, to characterize the dizziness, and she could...

There is something valuable about learning to adapt old skills to novel situations. This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit sensiblemed.substack.com/subscribe

Adam and I discuss three topics I) The MIND Trial published in NEJM. Does a special diet reduce the future risk of cognitive decline? II) HFpEF — I am speaking at a congress on heart failure with preserved ejection fraction this week, and Adam helps me out with some pointers. III) NYT published a Sunday front page story on potential overuse of procedures for peripheral artery disease. JMM This is a public episode. If you’d like to discuss this with other subscribers or get access to...

Four pieces of advice nobody asked for.  This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit sensiblemed.substack.com/subscribe

KW was a 58-year-old man with long standing type 1 diabetes mellitus and hypertension. He came to an appointment one Friday afternoon with chest pain. The pain had been present intermittently for 10 days. It was on the left side of his chest and beneath his sternum. It did not radiate anywhere, it was not related to exertion, nor was it associated with diaphoresis or shortness of breath. It was also not positional and there were no areas of tenderness. Sensible Medicine is a reader-supported...

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This ghost panel is made up of people who used to be my patients but no longer are — people who left my practice without telling me.  This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit sensiblemed.substack.com/subscribe

Links The Case for Being a Medical Conservative https://www.amjmed.com/article/S0002-9343(19)30167-6/fulltext ELAN Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2303048 Mandrola on NYC Residents’ Strike https://www.medscape.com/viewarticle/992607 This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit sensiblemed.substack.com/subscribe

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I visit the binder to pay my respects, to learn, to reminisce, and to trace the arc of my career. Get full access to Sensible Medicine at sensiblemed.substack.com/subscribe

Medicine in America will be better, more humane, and more affordable with more good, smart, dedicated primary care physicians. Be part of the solution.  Get full access to Sensible Medicine at sensiblemed.substack.com/subscribe

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Why did it take years for me to reach a time in my career when I am comfortable admitting knowledge gaps? Get full access to Sensible Medicine at sensiblemed.substack.com/subscribe

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When patients meet a new doctor, both patient and doctor should be aware of each other’s philosophy.  Get full access to Sensible Medicine at sensiblemed.substack.com/subscribe