The QT interval—a measure of the duration of the overlapping action potentials from two billion ventricular muscle cells—has fascinated physiologists since the dawn of electocardiography. Too long or too short, it can be a harbinger of ventricular arrhythmias and sudden death. Sensitive to electrolytes, drugs, and autonomic tone, susceptible to congenital ionic channel mutations, difficult to… Continue reading Hacking the QTc
Category: Medicine
Cutting Down on Coffee
This morning as I write this, there is on my desk a steaming hot cup of fake coffee. The ingredients are roasted barley, roasted malt barley, roasted chicory, and roasted rye. This is the sort of stuff people drank as a coffee substitute during wartime rationing. It smells odd. It is hot and black and… Continue reading Cutting Down on Coffee
The Death of Dr. Shock
The call came from one of my attendings at night during my cardiology fellowship. It had a touch of the black humor that medical persons don’t like to admit bubbles up to the surface from time to time. “You know Dr. Shock, the guy on TV? He’s being transferred. He’s having a big infarct and… Continue reading The Death of Dr. Shock
George Mines and the Impermanence of Knowledge
It was a chilly Fall morning in Montreal. A Saturday, the campus of McGill University was quiet. Students, not much different in 1914 from those of today, were sleeping off their Friday night activities. A cleaning woman entered the Physiology Laboratory to dust the glassware and wash the floors. As she turned a corner she… Continue reading George Mines and the Impermanence of Knowledge
The Smartphone is an Essential Medical Instrument
The storage capacity of the human mind is amazing. One estimate of the size of the brain’s “RAM” is as high as 2.5 petabytes (a million gigabytes). The number is based on the total number of neurons in the brain and the total number of possible connections per neuron. I suspect it is an overestimate,… Continue reading The Smartphone is an Essential Medical Instrument
EHR Copy and Paste Considered Harmful
How bad are Electronic Health Record (EHR) programs? Let me count the ways. Rather, let me not, as I and many other folks have already done so. Even non-tech savvy doctors (of which there are fewer and fewer) realize something is wrong when they compare their experience using an EHR with virtually every other computer… Continue reading EHR Copy and Paste Considered Harmful
Do No Harm
Cardiac neuroses are often iatrogenic in origin. A well-meaning but careless comment by a physician can change a person’s sense of well-being in an instant. The effect can be permanent and devastating. Many clinicians who complain about overly anxious patients don’t appreciate their own role in the genesis of this problem. Our words matter. They… Continue reading Do No Harm
Thoughts on Mark Josephson
I’m sure there will be plenty of tributes to Dr. Josephson in the next few days from his colleagues who knew him well and those who didn’t know him personally but learned so much from his books and articles. I fall somewhere in the middle. I wasn’t one of his students at Penn who learned… Continue reading Thoughts on Mark Josephson
A Tale of Two Histories
Compare the following two versions of the same medical history: Version 1 CC: chest pain Mr. Smith is a 57 y/o white man who comes into the office today for the first time with a complaint of chest pain. He states he has been in generally good health in the past, though he has smoked… Continue reading A Tale of Two Histories
Massive Heart Attacks
Carrie Fisher’s sad, premature death is an occasion to reflect upon the poor job the news media does in reporting medical news. The initial report from TMZ had the headline “Carrie Fisher Massive Heart Attack on Plane.” If one equates “heart attack” to the more precise medical term “myocardial infarction,” as is usually done, then this… Continue reading Massive Heart Attacks