{"id":10976,"date":"2011-08-17T17:33:43","date_gmt":"2011-08-17T21:33:43","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=10976"},"modified":"2011-08-17T17:49:34","modified_gmt":"2011-08-17T21:49:34","slug":"e-doctoring","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/08\/17\/e-doctoring\/","title":{"rendered":"E-doctoring?"},"content":{"rendered":"

John Mandrola is a cardiac electrophysiologist and blogger on matters medical and general. Here is a recent post from his blog,\u00a0Dr John M<\/a>.<\/em><\/p>\n

One of the coolest things about keeping a medical blog is interacting with people. It\u2019s immensely gratifying to hear from folks who stumble upon my site.<\/p>\n

Take this example: While cooling down after tonight\u2019s ride, a cycling friend and ER doc mentioned that my website turned up on his Google search of the new blood-thinner Pradaxa. I was delighted to hear that my posts gave him what he needed for the care of the patient. Hearing that meant more to me than having good legs on the ride.<\/p>\n

It\u2019s also gratifying, and at the same time humbling, that so many contact me about their heart rhythm (most commonly, AF) experience. Gosh, there\u2019s a lot of AF out there, and AFibbers are an educated, information-hungry crowd. There is little doubt in my mind that \u2013 for many \u2013 AF is an overachiever’s disease.<\/p>\n

Patients tell me their AF stories; ask great questions; seek to understand the mysteries of an infinitely mysterious disease. I try to read and respond to anyone who takes the time to write. But with tapping the \u201csend\u201d button comes a big, bad, scary conflict.<\/p>\n

What conflict?<\/p>\n

On the one hand, AF treatment options are finite and knowable.\u00a0\u201cJust give the answer, John; it\u2019s easy,\u201d<\/em>\u00a0I think to myself.\u00a0 I\u2019d like to tell patients to have an ablation, or stop worrying about one AF episode, or take the blood thinner because strokes are horrible. Like I was their doctor.<\/p>\n

But these kinds of specific responses would constitute medical advice. And I\u2019m not my readers’ doctor. I have not sat in the same room with them. I haven\u2019t seen their expressions, listened to their hearts, or watched how well they walk around \u2014 a good measure of how well one tolerates having 50-plus burns made in the heart. Without seeing a patient, there\u2019s no gestalt, no nuance. Even worse, I haven\u2019t seen the ECG \u2013 and there\u2019s a lot of helpful information buried in those squiggles. Call me old-fashioned, but I think interacting human-to-human and looking at an ECG are on the checklist of good doctoring.<\/p>\n

But on the other hand, information is so vitally important in AF treatment. Information rocks! Though I know far less than most, I do know AF. I live and breathe this disease. I have even had the dang butterfly heartbeat myself. It stunk. (AF caused me to get dropped by a\u00a0person of size<\/em>\u00a0going uphill.)<\/p>\n

Though limited in scope, I could easily tap out a couple suggestions for a reader’s problem. It\u2019s tempting. For instance, in writing to an AF patient tonight, I offered this bottom lime:\u00a0\u201cUltimately, an AF patient ends up choosing from just three options: live with AF, take drugs, or have a procedure(s). And sometimes, no check that,\u00a0often,\u00a0AF treatment involves combination platters of all three.\u201d<\/em>\u00a0Statements like this are general advice, which hold true for many medical conditions. I could not tell her which of the three options to choose, though I knew \u2013 from her words \u2013 which one I leaned toward.<\/p>\n

One of\u00a0 my goals in writing about medical matters is to mesh real-world experience and my take on the scientific data with words that all can understand. If successful, readers are more informed. There\u2019s a large difference, however, between providing general information and giving specific medical advice.<\/p>\n

This notion seems inherent, understood (smart people might say \u201ctacit\u201d), but I am going to make it overt:\u00a0Medical recommendations for treatment should come from the patient’s doctor.<\/em><\/p>\n

I plan to continue writing about my life\u2019s work. I hope to keep on hearing from readers.\u00a0
\n<\/em><\/p>\n

JMM<\/p>\n","protected":false},"excerpt":{"rendered":"

The possibilities \u2014 and the limits \u2014 of giving medical advice online<\/p>\n","protected":false},"author":655,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13,1],"tags":[341],"class_list":["post-10976","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","category-general","tag-atrial-fibrillation"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/10976","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/655"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=10976"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/10976\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=10976"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=10976"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=10976"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}