Sensible Medicine

Discover the balance of anticoagulation therapy for atrial fibrillation, weighing benefits against risks like stroke and gastrointestinal bleeding. Delve into the critical reflections on the opioid epidemic, with a call for evidence-based approaches in medicine. Explore the necessity of curiosity and critical thinking among healthcare professionals, while examining the challenges of medical education and the importance of engaging with foundational research in cardiology and oncology. This discussion reveals the complexities of modern healthcare and the need for proactive patient care.

This podcast is one of three we will be posting to answer the questions that came to us in response to this post. We had a nice set of questions so we will certainly be doing it again. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

In this discussion, Elizabeth Fama, the author of the 'Back to Sleep' series, tackles the complexities of infant sleep safety. She highlights the potential downsides of back sleeping, which is traditionally recommended for SIDS prevention. The conversation covers the critical role of tummy time in infant development and the challenges parents face. Fama also dives into the world of infant sleep aids, revealing both their benefits and safety concerns, while questioning conventional wisdom surrounding SIDS and how various factors affect risk.

Ask general internists what they love about their field, and they are likely to talk about long-term relationships with patients and the pleasure of solving clinical puzzles.  This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

My lecture to the cancer care staff at a county hospital. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

Even when a decision is clear, and things turn out badly, the lack of a counterfactual allows endless second guessing. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

I discuss how medical students are selected, and perhaps how they should be selected. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

Remarks about a model clinician. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

It would be foolish to argue that doctors are unaffected by how they are treated by patients. Their treatment may not affect the care they deliver and only affect how they feel at the end of the day. It is probably impossible to know. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

When I type the words coronary artery disease I bet that you picture angiograms with stenotic lesions—blockages in colloquial language. Indeed a high grade plaque from atherosclerosis in the inside of a coronary artery can limit flow to the heart muscle. But. But. Not as much as you think. You know why? Because there is something called the coronary microcirculation. Before blood gets to the beating heart muscle it has to go through small blood vessels. So small that you can’t see them. A study in the NEJM—on one patient—elegantly shows the ability of the microcirculation to autoregulate blood flow in the face of increasing degrees of obstruction in large coronary vessels. We’ve all seen patients who have severe flow-limiting proximal stenoses, which create little to no angina. A likely reason is the ability of the microcirculation to dilate and improve blood flow—at least at rest or minimal exertion. My friend Venk Murthy explains this elegant study. I learned a bunch and likely you will too. We refer often to this figure from the paper. It would be useful to have it handy while you listen. JMMRemember all, Sensible Medicine is a reader supported site that is free from industry advertisement. Thank you for your support. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe