Feeds:
Posts
Comments

Posts Tagged ‘ethics in medicine’

Welcome to the exciting new era in scientific  Medicine

Posted in Uncategorized, tagged , , , , , on October 11, 2025|

Read Full Post »

Trying to become a truly Professional Physician !

Posted in Uncategorized, tagged , , , , , , , , on August 10, 2025|

.

Post-amble

Are you a professional physician doctor ?

Honestly I am struggling to become one , it is still a long way to go.

Read Full Post »

Evidence based common sense, is rare entity in medical literature

Posted in Uncategorized, tagged , , , , , , , , , , , , on July 10, 2025|

Read Full Post »

Management of ACS : The eleven new commandments

Posted in acute coroanry syndrome, acute coronary syndrome, Medcal research, Medical education, Medical ethics, Primary -PCI, Primary PCI, Thrombolysis, tagged , , , , , , , , , , , , , , , , , , , , on June 8, 2025|

How can we use AI as a tool of knowledge distillation ?

Here is a deep discussion with Grok 3, on the merits, limitations & validity of DANAMI 2 and PRAGUE 2 , the two old studies on pPCI. Curiously , we don’t have any other studies to quote. As on 2025 , superiority of pPCI hangs precariously on these two decade old studies, which has some serious omissions in the primary end point and its Interpretation. To get into the facts , please go through the following link.

https://grok.com/Is primary PCI really superior to lysis in a global perspective /

It is a long chat, I am sure most of you can’t spare your vital time. But, the truth comes out only at the fag end of the conversation.

Read Full Post »

False enemies in medical practice

Posted in Uncategorized, tagged , , , , , , on November 9, 2024|

Read Full Post »

Over-diagnosing MI is not* as negligent as missing it !

Posted in Uncategorized, tagged , , , , , , , , , on April 25, 2024|

As the medical literature expands exponentially, the quality and intent of the research questions sound awry. There are only a handful of journals like JAMA that are bold enough to ask some tough and pragmatic questions in this glitzy world of medical extravaganza.

The current issue wants to set the pace for an important debate, on a topic that is rarely discussed.

The question is

Link to the article

Check whether your answers concur with this crucial query from Harvard Medical School and Massachusetts General Hospital. Three questions this article wishes to address.

1.What is the reason it is happening?

2. What are the implications?

3. What can be done for it?

My thoughts

“It is indeed over diagnosed. Once labeled, a chain reaction is set in. The cost, and resource consumption that follow a misdiagnosis are nearly identical to that of a true MI. More than that, the adversities of the tense investigative protocol can convert a misdiagnosis into a real one because that sadly includes even an overzealous poking right at the mouth of the coronary artery just o exclude a non existing MI . and ICU-related anxiety stand apart in this scientific comical game of ruling out a cardiac emergency.

The paper seems to blame mostly on the powerful screening test high sensitivity Troponin, Everyone will agree it has a major role in this. But, the more important reason is the cardiology community’s vigorous adoption of a universal definition of MI criteria (which is never intended to apply at the bedside) .Next factor is probably more important. The fear of missing a potential MI and legal consequences thereafter. I wish, the experts who sit on medical juries need to learn few extra lessons in the art of medical uncertainties.

Medical jurists, need to take some Intellectual cues from their criminal courts. How is it that, even well-planned criminal murders are successfully allowed to be argued and won in courts,…while inadvertent events such as missing an inconsequential MI by doctors are rarely pardoned?

How to avoid over diagnosis of MI ?

In this scenario, It is sad, that only very few cardiologists have the guts to ignore this omnipotent molecular sub-fraction of cardiac muscle Troponin, with their clinical skills. What we can do, at our level is to incorporate a new term “benign or micro myocardial Infarction” – akin to lacunar infarcts or TIA equivalents of the brain in the heart. We need to de-list the vast majority of chronic ischemic,non-ischemic, or systemic causes of Troponin leaks from the myocardial infarction chart. Physicians must realize, that protocol violation should not be deemed a crime always, rather it has a sure potential to benefit your patient if it is done properly and intelligently.

Final message

Recently one cardiologist in a sub-urban center was thrashed both physically and in social media ,for missing an ACS , which was subsequently recognised and treated well and good.

“Doctors should be legally allowed,* (rather forgiven) to make permissible levels of errors in the medical decision-making process ” like any other profession .However, we must ensure our constant pursuit towards zero error, which may not be possible always. This should include overlooking apparently positive lab results if they have reasonably applied their clinical acumen. *Until this happens, the unquantifiable suffering of our patients* due to over-diagnosis and inappropriate interventions can not be reigned in.

*Maybe, this sounds more controversial statement in my 15 years of writing. Beloved patients shall note, it is a rare for me to make what probably, look like an anti-patient statement. Till now, I have been blamed my many of our colleagues, as self slandering my own profession for too many errors in many of the posts. Nothing can be done for this. When you search for truths , you need to tolerate all these.

Reference

1.McCarthy CP, Wasfy JH, Januzzi JL. Is Myocardial Infarction Overdiagnosed? JAMA. Published online April 24, 2024. doi:10.1001/jama.2024.5235

2.Shah  ASV, Sandoval  Y, Noaman  A,  et al.  Patient selection for high sensitivity cardiac troponin testing and diagnosis of myocardial infarction: prospective cohort study.   BMJ. 2017;359:

Read Full Post »

What is conservative management ?

Posted in Uncategorized, tagged , , , , , on December 16, 2023|

Conservative management conveys two tangentially opposite meaning.

For the superior “physicians & Interventional cardiologists” it would mean

For the “Inferior genre of physicians” it will sound like this

Reference

This is a partial repost from a 2008 article . https://drsvenkatesan.com/2008/11/30/what-do-we-mean-by-conservative-management-why-it-is-often-considered-as-an-inferior-form-of-treatment-in-medicine/

Read Full Post »

“Low quality” Interventions in “high quality” cath labs

Posted in Uncategorized, tagged , , , , , , on October 20, 2023|

Recently, I visited a seven-star cardiology center. It had a fascinating lab with a near-360-degree roaming arm and floor (even the roof, I think!). The lab also had provision for optional thoracotomy support by surgeons and a CT scan. What’s more, I was told that an adorable robot will soon be added to the cath lab workforce to assist in delivering and maneuvering catheters. It’s truly amazing to see the advancements in science!

I asked the chief staff nurse how many procedures are being performed per day. She pulled out an Excel chart from a gesture-controlled touch panel. It was clocking about 20 to 25 cases per day. The lab performed the best of all procedures in our country. Great, well done, and congratulations, even as my lips uttered, my mind was thinking the opposite. Do we require such labs when the majority of the population struggle to get even basic medical care in emergencies?

Quantity vs quality of procedures 

The said lab went on to achieve 2000 cases recently. It was crowned with glory in a stunning anniversary bash. We all take pride in numerical accomplishments. Quantity is easily measured. It’s simple mathematics. Assessing quality is a tricky one. Even professionally well-accomplished interventions may be of low quality.

Low quality and low impact may not be synonymous; still, it conveys the same meaning if we look at it from the patient’s perspective. The quality of the procedure shall be assessed with reference to the cost involved, clinical outcome, procedural as well as a perpetual chain of risk, finally, and most importantly the test of time.

Overall, the quality check of a cath lab is not only for the machines, it is also about the operators  &  what they do. 

Postamble

Whover wants join this cath lab award session. Welcome .

“Top 10 low-quality (Impact) cardiac Interventions” 

There were 10 nominees

  1. Distal bifurcation lesion
  2. LAA closure
  3. Delayed PCI in STEMI
  4. Valve in valve 
  5. VSR closure post-STEMI
  6. Septal ablation in HOCM
  7. His bundle pacings & CRTs 
  8. Poorly planned TAVRs
  9. Clumsy Paravalvular leak blockage
  10. Complex EVARS

 * The winner was selected without any difficulty: No 3 : Its delayed PCI beyond 24 hours after STEMI (This accounted for 30 % of all procedures put together)

Meanwhile following competes for “high-quality” intervention 

  1. PTMC
  2. Left the main/ proximal LAD stenting in UA/NSTEACS
  3. Permanent pacemakers in CHB (Not all in SND)
  4. ICD implantation for the truly deserving
  5. RF ablation for AVNRT/ Some VT
  6. Selected cases of Primary PCI
  7. Some life-saving palliation in the newborn(Ductal stenting/IAS septostomy)
  8. Diagnostic coronary angiogram in a strongly suspected ACS.

Choosing the winner was really tough, just leave it to the readers.

Final message

It’s worthwhile to go for such an analysis periodically to improve procedural quality & Impact. It’s wiser to allow our brains to prevail over hands. Global health is all about technology optimization, outcome analysis, comparative efficacy. The future sounds exciting though, with deep machine learning, data mining, skill transfer. However, there seems to be a definite risk. In the name of artificial intelligence, we might contaminate machines as well with humanness.

 Let us restrict funding and stop Insurance coverage for low impact procedures. Instead, may use the resources for a truly life-sustaining & healing process.

Reference & Further reading

Posted in Uncategorized | Tagged comparative efficacy trials, cost effectiveness in medicine, ethics in medicine, EVO;LUTE PRO SAPIENS XT, health economics, HYBRID CATH LAB, TAVR TAVI VALVE IN VALVE, top 10 best and worst interventions in cath lab |

Read Full Post »

Patient empowerment movement, definitely has a good intention , but …

Posted in cardiology-ethics, Medical education, tagged , on November 11, 2022|

 

 

The definition & intended purpose of patient empowerment

WHO defines empowerment as “a process through which people gain greater control over decisions and actions affecting their health” and should be seen as both an individual and a community process.1

Four components have been reported as being fundamental to the process of patient empowerment: 1) understanding by the patient of his/her role; 2) acquisition by patients of sufficient knowledge to be able to engage with their healthcare provider; 3) patient skills; and 4) the presence of a facilitating environment.2

Based on these four components, empowerment can be defined as A process in which patients understand their role* and are given the knowledge and skills by their healthcare provider to perform a task in an environment that recognizes community and cultural differences and encourages patient participation.

Reference 

Patient-empowerment—Toolkit

 

Read Full Post »

What is the true success for a scientist ?

Posted in bio ethics, Histroy of medicine, Medcal research, Medical education, Medical ethics, medical quotes, tagged , , , , , , on November 26, 2021|

What is the true success in a scientific career?

It is not the number of publications in journals or getting those big awards or memberships in prestigious scientific societies. True success is “something else,” says the Nobel Medical Laureate  Dr Willam Kaelin 

Great thoughts. Just wondering, what are those elements beyond our controls he was alluding to?

 

Video courtesy and thanks : http://www.nobel.org

Read Full Post »

Older Posts »