I hope you all had wonderful holidays! I have too much to recap from Christmas Eve and Christmas day, so I thought I would start with Christmas Eve Eve.
I think I mentioned in my last post that I got called into work on Tuesday, to cover for another intern who was sick. I normally would have gone to my radiology elective that day, but instead I covered the Diabetes Consult Service. It was actually a really great day learning wise, and I appreciated a one day crash course in diabetes management.
But the highlight of the day had to be these:
I never pass up dessert and when I saw these served at our noon conference, I quickly grabbed one and ate it before digging in to my salad 🙂
Monday night (before I thought I was going to be working early the next day), I did a quick 3 miles on the treadmill in the afternoon. (still working on finishing the Wolf of Wall Street).
Then, Kyle and I decided to go play tennis which was quite a workout itself! We like to hit with the ball machine, and this time we sped it up so that we didn’t have much time between balls! Phew!
So after work on Tuesday, I decided to relax and not worry about working out since I had done multiple activities the day before.
Instead of doing anything physical, I made a huge bowl of popcorn and sat down on the couch to watch The Great Gatsby with Kyle.
I read this article in JAMA (Journal of the American Medical Association) and wanted to hear what you guys think.
Apparently, a group at Harvard wanted to look at cardiac outcomes when all the cardiologists are away at the big national cardiology conventions. A similar study was done a few years ago and showed that outcomes were worse if you were admitted overnight or on a weekend vs. being admitted during regular office hours. Most assumed this was due to the lack of hospital staff. But what happens to those with high-risk cardiac problems when all the cardiologists are away?
Shockingly, they seem to do better.
In teaching hospitals, adjusted 30-day mortality was lower among high-risk patients with heart failure or cardiac arrest admitted during meeting vs nonmeeting dates (heart failure, 17.5% [95% CI, 13.7%-21.2%] vs 24.8% [95% CI, 22.9%-26.6%]; P < .001; cardiac arrest, 59.1% [95% CI, 51.4%-66.8%] vs 69.4% [95% CI, 66.2%-72.6%]; P = .01).
The statistics are all significant and show that in this study, mortality and cardiac arrest were both lower when cardiologists were away.
If you’re just as puzzled as I am, one reason people are using to explain the study, is that these patients are less likely to undergo risky procedures without cardiologists nearby, and so maybe the conservative approach is leading to these better outcomes?
In the study there was no difference in mortality for low-risk patients, only high risk. Also, there wasn’t a difference in non-teaching hospitals. I suppose less cardiologists from non-teaching hospitals go to conventions, so there wouldn’t be much of a difference there.
But this whole thing got me thinking about how less is often more, and how medicine (however well intentioned) may not be the best for the patient. I got this book for Christmas:
and I’ve been thinking about how modern medicine always pushes us to do more, treat more, operate more. When maybe, less is more?
What do you think?
Have a great day friends!!