We’ve hit a new low @Humana FDA approved procedure denied… by an ED physician. Not a board certified cardiologist. Not a board certified cardiac surgeon. For shame.

That’s another thing that drives me bananas: sending pts w AF for coronary angiography. Dumb. Dumb. Double dumb.

We Can’t Compromise Our Values for RVUs. I often hear from a number of docs expressing frustration that "patients don't listen to them". Well.... that's okay!! Let’s dive into this… One of the hardest conversations in this profession is between the patient who wants something done and the surgeon who knows that something isn't the answer. PTs and docs tell me regularly that they feel stuck, that they've explained the evidence, and the patient still wants the procedure. What do you do? My answer is that our job is to educate and inform. Not to convince. We can explain what the research shows, what the risks are, and what rehab is likely to accomplish that surgery won't. We can be honest and direct about our clinical judgment. What we cannot do, and shouldn't try to do, is override a patient's autonomy. Informed patients get to make their own decisions. That's not a failure of communication. That's medicine working correctly. I like to operate. I became a surgeon because I find it meaningful, and I'm decent at it. When surgery is the right answer, I don't hesitate. What I find genuinely puzzling, after all these years, is when a patient tries to convince a knee surgeon with 30 years of experience that they need an operation, and every instinct that surgeon has developed over those 30 years is telling them otherwise. That clinical intuition exists for a reason. It should be trusted, not negotiated away. The harder version of this is the surgeon who says: If I don't do it, someone down the street will. And that's true. But I can only answer for what I do in my operating room. If I believe surgery might genuinely help, I'll recommend it, and I'll do it. If a patient has moderate arthritis and wants me to clean out a joint that the evidence says won't benefit from cleaning out, I won't do it. Not because I'm judging the patient. Because I can't compromise my principles for RVUs. This isn't self-righteousness. It's the only way I know how to practice medicine and look at myself in the mirror. The patient may find someone else. That's their right. My obligation is to tell them the truth as clearly as I can, and then let them decide.

Peter has the patience that I do not. peterattiamd.com/there-is-no…

My doctor put me on a statin after my heart attack at 52. I trusted him. I took the pill. I never asked a question. Then I found this study. 60 clinical trials. 323,950 people. Every cholesterol lowering drug ever made. Statins. PCSK9 inhibitors. Ezetimibe. They measured how much each drug lowered LDL cholesterol. Then they measured whether people lived or died. The line is flat. It did not matter if they lowered LDL by 10% or by 70%. The death rate did not change. In some trials people died more. 323,950 people. Near zero benefit. Published in the Journal of Cardiovascular Pharmacology. 2023. Nobody showed me this chart. Not my cardiologist. Not my pharmacist. Not the drug rep who visited my doctors office every month. I had to find it myself. After the heart attack.