Decision-Making Shortcuts: The Good and the Bad
A patient comes to the ER complaining of 2 hours of substernal chest pain. An electrocardiogram reveals ST-segment elevation in 3 leads. A critical, ad hoc decision is made to call a “STEMI alert,”...
View ArticleDoes Intuition Lead to Bad Medical Decisions?
Discussing how medical practitioners use intuition and cognitive shortcuts (heuristics) to make decisions can elicit strong reactions. Some people heartily agree that reflecting on their use is...
View ArticleThe Art of Arriving at a Diagnosis
A 55-year-old man came to the emergency room complaining of aching chest pain radiating to the back. The pain had started the day before and recurred several times. It seemed to worsen with exertion...
View ArticleWrestling with Uncertainty in Clinical Practice
About a week ago I was asked to consult on a patient I’ll call Betty. This delightful 92-year-old woman, who lived alone, was admitted during the night with pain in the upper chest and shoulders. She...
View ArticleHow Randomness Affects Quality of Care
Each month I meet with administrators at my hospital to review the quality of our cardiology program. At several meetings I’ve complained that our performance thresholds are too high and fail to...
View ArticleSizing Up Clinical Trials — Quickly and Intuitively
A pharmaceutical sales rep comes to your office bringing lunch. He shows you a graphic stating that Multaq (dronedarone) reduced the primary endpoint in the ATHENA trial by 24%. The fine print shows an...
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Selections from Richard Lehman’s Weekly Review: Week of February 13th
CardioExchange is pleased to reprint selections from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with...
View ArticleShared Decision Making in Advanced Heart Failure
Larry Allen is the lead author and co-chair of the AHA Scientific Statement on Decision Making in Advanced Heart Failure. Patient-centered care ensures that clinical decisions are guided by an...
View Article“Your Mortality Risk Is 11.827%”
An 85-year-old woman named Betty presents with a non–ST-segment elevation myocardial infarction. Despite her advanced age, she is active, lives by herself, and continues to work as a volunteer in the...
View ArticlePractice Variations and Quality: Ask the “Uber” Expert
In response to recent reports of variation in practice and outcomes of elective PCI, CardioExchange’s Rick Lange asks Harlan Krumholz to elaborate on what constitutes high-quality decision making....
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