A listener defends colored boxes in guidelines; mysteries of nonculprit coronary lesions during PCI, and of AF ablation; and surrogate markers are the topics John Mandrola, MD, covers in this week’s podcast.
https://www.medscape.com/viewarticle/...

TRANSCRIPT
In This Week’s Podcast
For the week ending April 26, 2024, John Mandrola, MD, comments on the following news and features stories: A listener defends colored boxes in guidelines; mysteries of nonculprit coronary lesions during percutaneous coronary intervention (PCI) for myocardial infarction (MI); mysteries of atrial fibrillation (AF) ablation; and surrogate markers.

Listener Feedback
I received feedback this week on comments I made during the March 29 podcast regarding guidelines. I opined, as I often do, on the complexity of medical practice, and the folly of guideline writers trying to simplify things with colored boxes of grade 1, 2 or 3 recommendations. I believe it is silly to try to make algorithms for patient care. Because so few patients easily fit into these boxes.

My take has always been to do the guideline documents, write the narrative reviews with references, and leave the boxes out.

However, a physicianfriend who has amazing training at a big center but practices in a remote area of the world wrote to me in disagreement.

He made the case that algorithms and computers may be better than poorly informed doctors. He sent me crazy examples of bad care that he has witnessed. These, he wrote, are errors due to poor training, lack of knowledge, and lack of curiosity.

But then he shocked me because such poor care is not limited to rural areas. He noted that it can be seen in academics. Countries I had previously thought had excellent care, he wrote, can be horribly influenced by poor knowledge and financial conflicts of interest. To paraphrase his comments:

Fraud studies with manipulated data, doctors implanting cardioverterdefibrillators (ICDs) or doing ablations without indication just to get financial support from the companies, stents implanted in stable coronary artery disease (CAD), healthy patients get Holter monitors and echo just to fill the pockets of cardiologists.
I saw a lack of interest and knowledge wherever I lookblack and white thinking (coronary heart disease needs beta blockers, if bradycardia then, needs pacemaker and so on).

Transcript in its entirety can be found by clicking here:
https://www.medscape.com/viewarticle/...