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Differences Between American And German Healthcare Systems: One Physician’s Perspective

I have been in Hamburg, Germany for the past five days. I enjoyed an amazing opportunity to visit one of the world’s most respected heart rhythm labs. Among other things, the main purpose was to learn a new way to ablate atrial fibrillation.

It was an incredible learning experience, one for which I owe an enormous debt of gratitude to the kind and generous people of Dr Karl-Heinz Kuck’s EP lab. Though these people are famous, they treated me as a respected colleague.

Details of all that I learned regarding this newly-approved ablation technique is a matter for future posts. Suffice it to say, I already feel like a better AF doctor.

For now, may I highlight a few of the more striking differences between Europe and the States, as noted by a Kentuckian on his first trip across the Atlantic? Read more »

*This blog post was originally published at Dr John M*

Cyclist Asks: Is Sugar Abstinence Possible?

After spending an entire vacation reading stories, I would like to start tonight’s post with a tiny dose of fantasy. Can we try using a daydream to learn something about the challenge of making good nutrition choices?

The fantasy goes something like this…

You have just been sentenced to eternal life on a far-away sun-drenched island. This island has mountains, paved roads, wide bike lanes, and mountain bike trails. You get to take two bikes, a couple riding buddies and your family—if they’ll go. You also get to take one Apple product.

Sounds good so far.

The kicker is that you only get four food choices—and liquids count.

You are a cyclist, so after coffee and beer there are only two food choices remaining. Obviously, you will need a protein source. Smart choices here would include nuts, mercury-free fish or organically-fed animals. The protein isn’t the point, let’s keep moving.

Now we are down to the carbohydrate source.

Choose one of the following:

A.) Arugula
B.) Quinoa
C.) Cranberries
D.) Fruit Loops

Herein lies the primary hurdle that smart-nutrition advocates face: unhealthy simple sugars taste really good. Read more »

*This blog post was originally published at Dr John M*

Is Church Attendance A Risk Factor For Obesity?

For competitive cyclists, Sunday morning usually signifies a time for combining spirituality with calorie-burning. Whether we are immersed in the total focus of a hotly-contested bike race or meditating our way through a seemingly endless training ride, it’s a given that most cyclists use Sundays to churn out the kilo-joules.

This kind of Sunday-behavior differs significantly from many regular (normal) people, who like to sleep late, get up slowly, dress themselves nicely and amble off to church. It goes without saying that this kind of spiritual exercise doesn’t burn many calories. And it is also well known that worship and consuming high-calorie comfort food frequently go hand in hand.

In the hard-to-believe-that-people-study-this kind-of-thing category, comes a report that frequent churchgoing in young adulthood increases the risk of obesity in middle age. Really, I am not making this up. The story was reported prominently here, on the theHeart.org. Read more »

*This blog post was originally published at Dr John M*

Physical Activity Versus Physical Fitness: It Could Mean The Difference Between Life And Death

My neighbor Ed was a thin man all his life. He maintained an ideal body weight by combining regular physical activity with a modest intake of calories. He was a “young” seventy year-old who looked the picture of heart health.

Ed regularly read the newspaper while walking on his treadmill, he hit a golf ball straighter and longer than his peers, and he wore the same size jeans now than he did in college 50 years ago. What’s more, he bragged about his low blood pressure, normal cholesterol level and perfect blood chemistries. He took no pills. I think he went to his primary care doctor each year just to show off his health.

The morning he woke with crushing chest pressure and shortness of air stunned him. “This couldn’t be a heart attack?” he thought. An hour later, minutes after his urgent heart catheterization showed severe blockages in all three of the main coronary arteries, a sternal saw provided a heart surgeon access to his dying heart.

Ed did well. The story had a happy ending. He still looks the picture of health, but now there’s a scar on his chest and a few pill bottles in his medicine cabinet.

How can a human who exudes heart health go to bed well and wake up with severe heart disease? What’s missing? What could Ed have done differently? Could his doctors have measured anything—over and above the traditional risk measures—that might have suggested his obviously higher cardiac risk? Read more »

*This blog post was originally published at Dr John M*

Healthy Thought For The Day

A new blog has entered the medical world.  She’s only a couple months old, but she has an awesome name: happy internist.   happy internist shows us all   how to die healthy:

my patient saw her gynecologist.  he told her to eat right, get lots of exercise, and lose weight.  that way, he said, you can die healthy.

What a great quote.  It’s called finishing strong.  Given what I know about the incredible pain and suffering I witness everyday from self induced disease, dying healthy is a goal worth living for. Death is inevitable.  Dying healthy takes hard work and personal sacrifice.

She was discovered at this week’s Grand Rounds, where Dr Val has done an excellent job of organizing the best of this week’s Internet medical offerings.

*This blog post was originally published at The Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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