This is a good, seasoned mindset to learn, and especially important to expose the younger doctors in training to some caution with their budding “superpowers.”
Doing something always feels more heroic than not doing anything... but evidence based restraint, especially amid the pressure to act, can be doubly heroic!
I know you have already latched on to the term conservative, but it has inextricable baggage. Politically it is also associated with the overturn of Roe v Wade, contraception under pressure, dogged attempts to repeal the Affordable Care Act leaving tens of millions uninsured, and perennial threats to cut Medicare and Medicaid. “Liberal” medicine would be similarly toxic, although associated with more social safety nets and trial lawyers.
What about medical prudence? Medical temperance? Or “Prudent medicine”/ “Temperate medicine”?
Each of these is not perfect either - but less off-putting to the other 50%.
This article leaves me wanting much more information.
May I suggest a spreadsheet of different studies & the results that counter typically recommended treatments? Would be amazing source of information for medical professionals & patients alike. Something I personally would link in my emergency file in case I’m faced with these kind of decisions.
Thanks for making the effort to determine if interventions are actually advantageous to the patient! Many medical decisions are based on taking advantage of the fearful patient & profits for the Drs & Medical facility.
Appreciate you shouting out, into what I hope isn’t a void.
Thank you. As someone with a background of severe childhood trauma and a history of lifelong generalized anxiety and not PTSD but TSD because if traumatic stress is all we have ever known since birth, as Bessel Vander Kolk says, " There is no return to "normal" as in PTSD people who receive treatment. Because for these people, this HAS been the norm".
I developed AFIB in 2013 after the death of both my parents and losing 75% of my soul tribe - the closest people in my life. It left me feeling almost completely alone in this world, because those were the core true people who loved me and cared about me. and it was mutual. We were soul tribe and we were family.
Having growing up in a mentally ill alcoholic family with a narcissist actress mother and a violent, emotionally shut down father, my soul tribe had been my family and now they had all left the building including my parents. At the same time I lost my income overnight and I became homeless. This was all devastating to me and it felt like the floor dropped out from under me.
I spent a decade doing it Cardiology's way with drugs that I hated, blood thinners that I hated, and 10 count ' em TEN cardioversions ending up with not one but two cardiac ablations. [Nothing worked because nobody was addressing the root cause of my heart problem period].
The first lasted a year. The second which I had done by supposedly the world's leading expert, left me a shell of the person I had been and left me bedridden for a year, unable to compose music - and although my voice is still there, I have no wind in my sails or desire to sing - which for my whole life had been my primary passion. Even when I was a fibbing I still sang; singing was like breathing to me.
I went from eight cylinders down to about a half. I spend most days of my bed and I have to force myself to go out and walk to the store or ride my bike which is always good - but my chief goal in life is to go back to bed. because my exhaustion is so debilitating.
This is not me. This is some zombie who has been compromised and traumatized by cardiologists who threw drugs and surgery at me - without ever ONCE (!!!!!!) ASKING ME HOW I WAS FEELING EMOTIONALLY, WHAT MY CHILDHOOD WAS LIKE, MY FAMILY, MY JOB, AND IF THERE HAD BEEN ANY STRESSFUL EVENTS IN MY LIFE RECENTLY THAT MAY HAVE SET OFF A 5 ALARM FIRE IN MY SYSTEM? HELLO DUH.
I knew there was nothing wrong with my physical heart ( even though my physical heart had been affected) and that my AFIB was caused by terror,stress, grief, shock and just taking too many hits in succession which had been the case in the years that led up to my parents deaths with me at the center being heroic for everyone and pushing myself over the limit again and again.
Cardiology didn't want to know about that. They never once looked for root cause .
Like, HELLLLLO.... there's a living breathing person sitting in front of you who is suffering who has a story that led them to have this disturbed rhythm.
The first time I was hospitalized and had my first cardioversion, the attending doctor came in sat down and gave me the results of my tests. He said, "Well… It's like this. Your heart is not so much beating as it is quivering". Given the 5 alarm emotional fire 🚨🚨🚨🚨🚨that had been taking place in my life and how frightened I felt about the floor having collapsed from under me with all these losses and trauma that I went through trying to care for my mother for 8 yrs and all the craziness I encountered in my alcoholic family during those years, is it any wonder really? That word "Quivering" touched the very core of my poetic soul. But nobody but me connected those dots.
This is my beef with the current inhumane system that I have completely lost faith in. I am Holistic, and a professional massage therapist from California for many years and I believe that all medicine should be Holistic. It's the only thing that makes sense. And the old time doctors knew this.
1) Identify condition based on symptoms
2) Look for ROOT CAUSE of condition
3) When toot cause has been identified, then and only then can the correct remedy for the CURE be given.
Otherwise, you are nearly treating symptoms.
SOUND FAMILIAR??
" Doctors today have lost their curiosity. The word missing from the doctors' vocabulary today is "WHY?"
- Larry Palevsky MD
Meanwhile during this decade I had a holistic team including emotional spiriitual support helping me to restore harmony to this heart and heal what was broken - ( like my heart💔).
This was completely pooh-poohed by the cardiologists who told me it was "never going to work… You need the ablation!!"
Meanwhile I had successfully restored my heart to normal sinus rhythm many times by walking, drumming in a drum circle, dancing, being happy at the beach, swimming in the ocean, doing things to restore harmony with music and happiness and joy to my body mind and spirit. but I hadn't yet been able to restore it permanently ~ nor had I been able ( yet) to remove the sources of stress from my life.
And after seven years of dealing with this constant rollercoaster of in and out burger Afib, I finally caved in and consented against my gut (which was screaming NOOOOOOO!!!! the whole time) to have the damned ablation.
It was a mistake I will regret for the rest of my life and if I were a litigious kind of person I would sue.
The heart is not a machine, it's not merely a pump and you can't manhandle it and force it to behave ny burning freezing or shocking it. That's INSANE. There is so much more to the human heart than Cardiology today has any clue of . I'm very angry that I was a victim of their ignorance and I'm very very deeply upset about what happened to me.
I trusted them and they failed me.
I was invisible to them as a person.
In 2014 when I asked my cardiologist in Massachusetts (who ps was the HEAD of cardiology) " WHY do I have this?"
He without empathy or eye contact says,
" WHY IS THE SKY BLUE?" and walks out of the room.
On a subsequent visit and I tried to tell him about what had been going on in my life ~ the terrible losses and stress and emotional hits and shocks I had taken, the terrifying ride I had been on and how I was feeling, he very coldly told me to see a psychiatrist. When I told him I didn't want to be on drugs for the rest of my life, or have the balloon ablation he had begin talking to me about, he fired me as his patient. This Head of Cardiology had the empathy of a door knob and had a reputation for being hostile.
UNACCEPTABLE!!!!!
I was harmed, traumatized and compromised by the current practice of Cardiology. They hurt my heart and they compromised my health.
They were in violation of the Hippocratic oath: I am outraged, with no energy to do anything about it. The severe trauma I endured as a child has made it difficult to stand up for myself with authority figures. That's a real bind.
Those ablations ALTERED ME.
I know myself very well and I know my body. I am not the same person.
This has destroyed my life as I had known it and sidelined me from my singing career, my music, my one woman show I had been planning, my tour, my desire to sing and create and perform and record and live and move and have my being. If you lose your reeason for living, you have no life - you're just existing like a zombie.
I appreciate your good article, Dr Mandrola. I thought that I would tell my story as an example of what can go wrong when doctors aren't taling a more conservative approach yelling "STOP!!" and looking more deeply for the root cause of a person's heart problem.
When that cause has not been uncovered, seen or addressed ~ thoroughly, consciously, with kindness intelligence empathy and care, that's when harm happens.
" The care of the patient means, caring FOR the patient…"
- FRANCIS PEABODY, M.D.
Harvard Medical School 1926
" The heart is the hub of all sacred places. Go there and roam."💖
Great read and left me wanting more. Someone commented on making a spreadsheet of different studies and outcomes ect. That would be very interesting and resource.
Would love to read more of your thoughts or hear your presentation. Thanks for sharing this !
Great read. Thanks again. I deeply appreciate your work as, if I may say so, the leading public medical conservative in the North American cardiology space.
I harken back to season 1 of Mad Men, the Carousel episode, when Don Draper said “the greatest thing in advertising is ‘new’, and whatever the latest industry-funded orb is proposed as the “calamine lotion”. But rather than “nostalgia….as a deeper connection to the product”, I think “medical conservatism as a deeper examination of the evidence, and of what we actually SHOULD do” would be the better prescription in our profession’s case.
I'm a patient. I've been reading a lot about the medical conservative approach both from Dr. Mandrola's writing and Sensible Medicine articles. How do I find a doctor who uses the medical conservative approach?
By the way I love Dr. Mandrola's writing and think his writing and podcast should be read and heard by all doctors.
This is a good, seasoned mindset to learn, and especially important to expose the younger doctors in training to some caution with their budding “superpowers.”
Doing something always feels more heroic than not doing anything... but evidence based restraint, especially amid the pressure to act, can be doubly heroic!
I know you have already latched on to the term conservative, but it has inextricable baggage. Politically it is also associated with the overturn of Roe v Wade, contraception under pressure, dogged attempts to repeal the Affordable Care Act leaving tens of millions uninsured, and perennial threats to cut Medicare and Medicaid. “Liberal” medicine would be similarly toxic, although associated with more social safety nets and trial lawyers.
What about medical prudence? Medical temperance? Or “Prudent medicine”/ “Temperate medicine”?
Each of these is not perfect either - but less off-putting to the other 50%.
Would be great if this talk was recorded.
This article leaves me wanting much more information.
May I suggest a spreadsheet of different studies & the results that counter typically recommended treatments? Would be amazing source of information for medical professionals & patients alike. Something I personally would link in my emergency file in case I’m faced with these kind of decisions.
Thanks for making the effort to determine if interventions are actually advantageous to the patient! Many medical decisions are based on taking advantage of the fearful patient & profits for the Drs & Medical facility.
Appreciate you shouting out, into what I hope isn’t a void.
Thank you. As someone with a background of severe childhood trauma and a history of lifelong generalized anxiety and not PTSD but TSD because if traumatic stress is all we have ever known since birth, as Bessel Vander Kolk says, " There is no return to "normal" as in PTSD people who receive treatment. Because for these people, this HAS been the norm".
I developed AFIB in 2013 after the death of both my parents and losing 75% of my soul tribe - the closest people in my life. It left me feeling almost completely alone in this world, because those were the core true people who loved me and cared about me. and it was mutual. We were soul tribe and we were family.
Having growing up in a mentally ill alcoholic family with a narcissist actress mother and a violent, emotionally shut down father, my soul tribe had been my family and now they had all left the building including my parents. At the same time I lost my income overnight and I became homeless. This was all devastating to me and it felt like the floor dropped out from under me.
I spent a decade doing it Cardiology's way with drugs that I hated, blood thinners that I hated, and 10 count ' em TEN cardioversions ending up with not one but two cardiac ablations. [Nothing worked because nobody was addressing the root cause of my heart problem period].
The first lasted a year. The second which I had done by supposedly the world's leading expert, left me a shell of the person I had been and left me bedridden for a year, unable to compose music - and although my voice is still there, I have no wind in my sails or desire to sing - which for my whole life had been my primary passion. Even when I was a fibbing I still sang; singing was like breathing to me.
I went from eight cylinders down to about a half. I spend most days of my bed and I have to force myself to go out and walk to the store or ride my bike which is always good - but my chief goal in life is to go back to bed. because my exhaustion is so debilitating.
This is not me. This is some zombie who has been compromised and traumatized by cardiologists who threw drugs and surgery at me - without ever ONCE (!!!!!!) ASKING ME HOW I WAS FEELING EMOTIONALLY, WHAT MY CHILDHOOD WAS LIKE, MY FAMILY, MY JOB, AND IF THERE HAD BEEN ANY STRESSFUL EVENTS IN MY LIFE RECENTLY THAT MAY HAVE SET OFF A 5 ALARM FIRE IN MY SYSTEM? HELLO DUH.
I knew there was nothing wrong with my physical heart ( even though my physical heart had been affected) and that my AFIB was caused by terror,stress, grief, shock and just taking too many hits in succession which had been the case in the years that led up to my parents deaths with me at the center being heroic for everyone and pushing myself over the limit again and again.
Cardiology didn't want to know about that. They never once looked for root cause .
Like, HELLLLLO.... there's a living breathing person sitting in front of you who is suffering who has a story that led them to have this disturbed rhythm.
The first time I was hospitalized and had my first cardioversion, the attending doctor came in sat down and gave me the results of my tests. He said, "Well… It's like this. Your heart is not so much beating as it is quivering". Given the 5 alarm emotional fire 🚨🚨🚨🚨🚨that had been taking place in my life and how frightened I felt about the floor having collapsed from under me with all these losses and trauma that I went through trying to care for my mother for 8 yrs and all the craziness I encountered in my alcoholic family during those years, is it any wonder really? That word "Quivering" touched the very core of my poetic soul. But nobody but me connected those dots.
This is my beef with the current inhumane system that I have completely lost faith in. I am Holistic, and a professional massage therapist from California for many years and I believe that all medicine should be Holistic. It's the only thing that makes sense. And the old time doctors knew this.
1) Identify condition based on symptoms
2) Look for ROOT CAUSE of condition
3) When toot cause has been identified, then and only then can the correct remedy for the CURE be given.
Otherwise, you are nearly treating symptoms.
SOUND FAMILIAR??
" Doctors today have lost their curiosity. The word missing from the doctors' vocabulary today is "WHY?"
- Larry Palevsky MD
Meanwhile during this decade I had a holistic team including emotional spiriitual support helping me to restore harmony to this heart and heal what was broken - ( like my heart💔).
This was completely pooh-poohed by the cardiologists who told me it was "never going to work… You need the ablation!!"
Meanwhile I had successfully restored my heart to normal sinus rhythm many times by walking, drumming in a drum circle, dancing, being happy at the beach, swimming in the ocean, doing things to restore harmony with music and happiness and joy to my body mind and spirit. but I hadn't yet been able to restore it permanently ~ nor had I been able ( yet) to remove the sources of stress from my life.
And after seven years of dealing with this constant rollercoaster of in and out burger Afib, I finally caved in and consented against my gut (which was screaming NOOOOOOO!!!! the whole time) to have the damned ablation.
It was a mistake I will regret for the rest of my life and if I were a litigious kind of person I would sue.
The heart is not a machine, it's not merely a pump and you can't manhandle it and force it to behave ny burning freezing or shocking it. That's INSANE. There is so much more to the human heart than Cardiology today has any clue of . I'm very angry that I was a victim of their ignorance and I'm very very deeply upset about what happened to me.
I trusted them and they failed me.
I was invisible to them as a person.
In 2014 when I asked my cardiologist in Massachusetts (who ps was the HEAD of cardiology) " WHY do I have this?"
He without empathy or eye contact says,
" WHY IS THE SKY BLUE?" and walks out of the room.
On a subsequent visit and I tried to tell him about what had been going on in my life ~ the terrible losses and stress and emotional hits and shocks I had taken, the terrifying ride I had been on and how I was feeling, he very coldly told me to see a psychiatrist. When I told him I didn't want to be on drugs for the rest of my life, or have the balloon ablation he had begin talking to me about, he fired me as his patient. This Head of Cardiology had the empathy of a door knob and had a reputation for being hostile.
UNACCEPTABLE!!!!!
I was harmed, traumatized and compromised by the current practice of Cardiology. They hurt my heart and they compromised my health.
They were in violation of the Hippocratic oath: I am outraged, with no energy to do anything about it. The severe trauma I endured as a child has made it difficult to stand up for myself with authority figures. That's a real bind.
Those ablations ALTERED ME.
I know myself very well and I know my body. I am not the same person.
This has destroyed my life as I had known it and sidelined me from my singing career, my music, my one woman show I had been planning, my tour, my desire to sing and create and perform and record and live and move and have my being. If you lose your reeason for living, you have no life - you're just existing like a zombie.
I appreciate your good article, Dr Mandrola. I thought that I would tell my story as an example of what can go wrong when doctors aren't taling a more conservative approach yelling "STOP!!" and looking more deeply for the root cause of a person's heart problem.
When that cause has not been uncovered, seen or addressed ~ thoroughly, consciously, with kindness intelligence empathy and care, that's when harm happens.
" The care of the patient means, caring FOR the patient…"
- FRANCIS PEABODY, M.D.
Harvard Medical School 1926
" The heart is the hub of all sacred places. Go there and roam."💖
- Nityananda
Thank you for your consciousness.
🙏
Great read and left me wanting more. Someone commented on making a spreadsheet of different studies and outcomes ect. That would be very interesting and resource.
Would love to read more of your thoughts or hear your presentation. Thanks for sharing this !
Love your logical, down-to-earth, articles.
I love things that make sense and show caring about people too.
Thank you for sharing your critical thoughts and advice.
Interesting, something to consider for an older person, with stents etc.
Great read. Thanks again. I deeply appreciate your work as, if I may say so, the leading public medical conservative in the North American cardiology space.
I harken back to season 1 of Mad Men, the Carousel episode, when Don Draper said “the greatest thing in advertising is ‘new’, and whatever the latest industry-funded orb is proposed as the “calamine lotion”. But rather than “nostalgia….as a deeper connection to the product”, I think “medical conservatism as a deeper examination of the evidence, and of what we actually SHOULD do” would be the better prescription in our profession’s case.
I'm a patient. I've been reading a lot about the medical conservative approach both from Dr. Mandrola's writing and Sensible Medicine articles. How do I find a doctor who uses the medical conservative approach?
By the way I love Dr. Mandrola's writing and think his writing and podcast should be read and heard by all doctors.