The Average Heart Beat More Than 1,000 Times per Day. What Can You Do if Yours Beats Irregularly?

Posted on by Michael Chananie

What is the most common heart rhythm disorder?

Atrial fibrillation (AFib) is the most common heart rhythm disorder in the United States, affecting close to 10 percent of people over 65, according to the Centers for Disease Control. Other common disorders are atrial flutter, tachycardia (fast beats), bradycardia (slow beats) and premature ventricular contractions.

What is a cardiac electrophysiologist?

Cardiac electrophysiologists are specialists in heart rhythm disorders. As “electricians” of the heart, we specialize in the complex electrical system that controls the heartbeat and pumping of the heart.

What is your approach to treating patients?

My philosophy has always been to lay out all the options for patients and let them ask all the questions they need to, so they can make an informed decision.

Are there new technologies to treat atrial fibrillation?

Yes. Procedures that used to take eight to 10 hours now take an hour to an hour and a half. For example, catheter ablation (a minimally invasive procedure that uses either radio frequency energy or very low temperatures to “ablate,” or destroy, the problematic electrical pathway) is now done on an outpatient basis. 3D mapping for ablation procedures now enables us to pinpoint the exaction location of the arrhythmia. This reduces the time the procedure takes, avoiding excess radiation exposure and increasing patient safety. The Watchman™ Device: Left Atrial Appendage Closure (LAA) is another new technology. The Heart and Vascular Institute at Englewood Hospital now offers the FDA-approved Watchman™ LAA closure device. Closing off the LAA (a small pouch off the left atrium) can greatly reduce the risk of stroke from atrial fibrillation. For many patients, it is considered safer than blood thinners.

Any words of wisdom for people with AFib?

With atrial fibrillation, you used to just have to live with it. Now there are ways to fix it. You don’t have to compromise on quality of life. There are options for treating your heart rhythm disorder with excellent results.

Posted September 2018

Bare-Bones Advice: Breaking Down the ‘Kneed’-to-Know Info on Orthopedic Health

Posted on by Michael Chananie

Many people don’t think about bone and muscle health on a daily basis, or realize they have a need for treatment. But when the seasons change, our choice of physical activity often changes. And if we’re not prepared, injuries can arise. Taking simple precautionary measures, adjusting our daily routines, tailoring our seasonal activities appropriately, and listening to our bodies can help us prevent injuries and best heal those that do develop.

Who should see an orthopedist?

People should be tested for their bone health in general, but especially if they have a family member with osteoporosis or osteomalacia. These conditions can be passed on, but are treatable. Those with targeted issues such as shoulder pain or arthritis pain should also take special care.

How can people prevent injury in the fall and winter months?

In the fall and winter, people are starting to clean their gutters, tend their lawns, rake leaves, and shovel snow—all activities that rely on your low back, your quads, and your shoulders. So it’s important to spend a lot more time on your core exercises, stretching out your quads, and strengthening your back to get those muscles activated again. And if you’re an avid skier, remember that you have to get your body trained again before picking up a set of skis.

And with the holidays around the corner, how can people avoid accidents while celebrating?

We see a tremendous increase in fractures when families bring elderly loved ones home for the holidays, taking them out of their controlled environments. Make the home environment safe — remove loose rugs from the bathroom, fix unstable handles or balusters on the railings. When you’re waiting on calls from family and friends, don’t jump up to get the phone—take those extra few seconds to avoid injury. We also see wrist fractures and ankle sprains from people falling on snow and ice, so wear appropriate footwear for the weather. Lifting and moving heavy objects, like boxes of holiday decorations, also takes a toll. Always bend at your knees and hips, rather than your spine, and lift with your legs.

When do you know if you should see a specialist for an injury?

When in doubt, get checked, particularly if pain is disrupting your life or an injury is impacting your function. We always look to treat patients with the least invasive approach possible, using noninvasive or minimally invasive techniques to help them safely get back to enjoying normal activities. The majority of issues can be treated conservatively with anti-inflammatories, like Advil, Tylenol, or over-the-counter medications, and physical therapy.

Posted September 2018

What You Need to Know About Colorectal Cancer

Posted on by Michael Chananie

Dr. Anna Serur, chief of colorectal surgery at Englewood Health, shares the latest recommendations about screening and prevention, a topic she says is not often discussed during regular health check-ups.

What is the most important information to know about colorectal health and cancer risk?

Dr. Serur: Recent data from the American Cancer Society has shown an increased prevalence of colorectal cancer in younger patients. However, most people only need to have a colonoscopy every 5-10 years, beginning at age 45. Screenings may detect abnormalities like inflammation or precancerous polyps—growths on the lining of the colon and rectum—that can then be removed, which is cancer prevention at its best. The most important recommendation to otherwise young, healthy patients is to share all symptoms with their primary care doctors or gastroenterologists. This includes any change in bowel habits, abdominal pain, blood in the stool, fatigue, or unintended weight loss. Many people may assume their symptoms are unrelated to colon health, ignoring signs that there may be something more serious going on. If you experience two or more of these symptoms, make an appointment to see your doctor immediately.

What are the causes of colorectal cancer?

Family history or genetic risk can be a major factor for people who are diagnosed with colorectal cancer. Colon polyps and genetic conditions, such as hereditary polyposis syndrome, should be actively monitored by a gastroenterologist. Environmental and lifestyle factors including physical inactivity, diets high in processed food and red meat, obesity, stress, alcohol consumption, and smoking are also known risk factors for developing cancer. If you engage in two or more of these lifestyle habits, you should develop an immediate plan to reduce these risk factors in your life.

What are some steps people can take to reduce their risk?

Staying active, maintaining a healthy weight, and reducing stress can lessen your cancer risk. Follow up regularly with your primary care doctor, and reach out right away if you notice symptoms. As a colorectal specialist, I work closely with patients’ primary doctors to make sure we’re monitoring those at high risk for developing a GI cancer. Being proactive can positively affect your overall well-being, while minimizing your cancer risk.

For those hesitant to get a colonoscopy, can you offer any reassurance?

Think of your colonoscopy as a safe juice cleansing—all the rage lately! The procedure itself is quick and painless. Also, talk to your doctor about what screening options are right for you. If you’re 50 and older with an average risk for colon cancer— and without symptoms—you may be able to do noninvasive screening, right from the comfort of your home, using stool sample kits that can detect abnormalities.

Any advice for managing colon health and cancer risk?

The gastrointestinal tract is sensitive to emotion. Anger, anxiety, sadness, elation—all of these feelings (and others) can trigger symptoms in the gut. There is, undoubtedly, a gut/brain connection. If you’re looking to manage stress to improve your gut health, try out acupuncture, yoga, massage, or meditation. If you’re not sure where to start making changes to your diet, consider nutritional counseling to help improve your eating habits and avoid high-risk foods we encounter every day.

Updated February 2023

Heart to Heart: Taking a Proactive Role in Your Cardiac Health

Posted on by Michael Chananie

Cardiovascular disease is currently the leading cause of death worldwide. However, there are steps we can take to reduce our chances of developing this serious condition. According to the American Heart Association, 80 percent of heart disease and stroke events may be preventable through education, lifestyle changes, and risk-factor modification.

For those looking to get serious about heart health, but not sure where to start, what simple lifestyle changes would you recommend?

One of the easiest and most important changes people can make is diet modification. Here are a few “dos and don’ts” to remember.

  • Do eat the rainbow. Aim to include a wider variety of “color” in your foods.
  • Consume unprocessed healthy foods rich in nutrients and vitamins, such as green leafy vegetables, fresh berries and fruits, fish, lean meats, and whole grains.
  • Do stop the salt. You don’t have to cut it out all at once, but reduce the amount you use with each meal, and work toward preparing foods with little or no salt.
  • Don’t regularly indulge in sweets. Read labels and minimize the amount of sugar you consume in beverages and prepared foods. Opt for Valentine’s Day flowers over jumbo heart-shaped boxes of chocolate.

Diet aside, what habits can people change to be heart-smart?

There’s still time to stick to those New Year’s resolutions. It’s important to maintain a healthy weight, not only to care for your heart, but also for your overall well-being. Make sure you’re not sitting still all day—move more! Build exercise into your weekly schedule so it becomes a habit. Aim for at least 30 minutes of moderate-intensity aerobic activity, five days a week. If you have a job that keeps you deskbound, take breaks to stretch and go for a walk. It’s also the perfect time to quit smoking. Even casual smoking can do a lot of damage—so don’t start if you haven’t already! And limit your alcohol intake to one drink per day. If you do overindulge, don’t be too hard on yourself and don’t give up. Each new day counts when it comes to heart health.

How does stress affect the heart, and how can we better manage it?

Stress and anxiety affect the entire body in a number of ways. Stress itself can cause and aggravate hypertension. It can also lead to unhealthy coping mechanisms such as smoking, excessive drinking, overeating, and physical inactivity, causing high blood pressure and cholesterol—both of which increase the risk of heart disease. So the most important advice I can give is to relax more. Learn healthy ways to cope with stress—a hobby, a new exercise routine, time with family and friends. The Graf Center for Integrative Medicine at Englewood Health offers yoga, guided meditation, massage, acupuncture, aromatherapy, Reiki, nutritional counseling, and various other services to help relax the mind and body.

What are the key takeaways, and how can we track our progress?

This year, focus on you.

  • Manage and prevent high blood pressure, high cholesterol, obesity, and diabetes through proper nutrition, exercise, medication (if necessary), and regular follow-up visits with your physician.
  • Come prepared to discuss your family history, which can influence your risk factors for heart disease.
  • Know your numbers. What are your blood pressure, cholesterol, and glucose levels? Ask for printouts of your lab work or make use of your physician network’s online portal. Taking steps to reduce these levels if elevated can significantly decrease your risk of developing heart disease.
  • Take note of your activity and behavior changes between visits, as well as any resultant changes in your levels.
  • Most important, don’t ignore the warning signs. If you develop new chest discomfort or experience difficulty breathing, palpitations, lightheadedness, or are feeling faint, be sure to reach out to your doctor immediately, as these could be symptoms of heart disease.

Posted September 2018; Updated January 2023

Minimally Invasive Treatment for Colorectal Cancer at Englewood Health

Posted on by Michael Chananie

When Anna Serur, MD, was a little girl in her home country of Russia, she dreamed of becoming a doctor. “My mother says that from the time I was three, I always said I wanted to be a doctor…a surgeon. There was never anything else; not a ballerina, not an actress, always a surgeon.”

“When my parents decided to move to the United States from Moscow, when I was 15 years old, I was glad. I wasn’t sure I would be able to get into medical school in Russia because I was Jewish. Here in the U.S. it wasn’t an issue.”

Dr. Serur received her medical degree from SUNY Downstate in Brooklyn, then completed a surgical residency at NewYork–Presbyterian Hospital and a fellowship in colorectal surgery at North Shore–LIJ Medical Center. She became director of colorectal surgery at Maimonides Medical Center in Brooklyn, where she was an attending surgeon for 10 years. Today, she is chief of colon and rectal surgery at Englewood Health. She specializes in minimally invasive and robotic colon and rectal surgery.

“At Englewood,” says Dr. Serur, “we can perform even the most complex surgeries, such as rectal cancer or ulcerative colitis surgery, using a minimally invasive approach: robotically or laparoscopically. We have excellent outcomes and very low complication rates.

“Minimally invasive surgery is easier on the patient because it causes fewer physiological changes and leads to an easier recovery. The surgery is performed using the same principles, regardless of how it’s done: robotically, laparoscopically, or open. With robotic surgery there is less blood loss, greater precision, and a quicker return to normal activities.”

Modern Colorectal Surgery

The techniques used to perform colon and rectal surgery have become more routine over the past 10 years. This is important because research has shown that the way the surgery is done, and who does it, strongly influences the outcome. “You want to go to a surgeon who does the surgery day in and day out. It’s extremely important. Particularly in rectal surgery, where the first treatment is critical,” adds Dr. Serur.

“Crohn’s disease and ulcerative colitis are common in Ashkenazi Jews. A person who has had ulcerative colitis for more than eight years—even if it is well controlled—is has a higher risk of colorectal cancer. It is important to find a physician with a lot of experience, someone with whom you are comfortable and can connect to. Our colon and rectal surgery team also performs surgery for diverticulitis, rectal prolapse, and chronic constipation not responsive to medical treatment.”

 Don’t Ignore Symptoms

“We are seeing an increase in younger patients with colorectal cancer—sometimes patients 30 years old or younger,” says Dr. Serur, explaining that the national increase in obesity, changes in dietary habits, and increased sugar intake are likely having an impact.

“Do not ignore your symptoms,” she emphasizes. “If you start seeing blood in your stool or your bowel habits change, it doesn’t matter if you are 23 or 63, it should always be brought to the attention of a medical professional. Unfortunately,” she adds, “with colorectal cancers, it is often very late in the game when people are diagnosed. The current recommendation is age 50 for first colonoscopy, unless there is a personal or family history of ulcerative colitis, Crohn’s disease, or polyps. Then it should be earlier.”

 A Team Approach

“Multidisciplinary care is so important in the treatment of cancer. At Englewood Hospital and Medical Center, we take a team approach,” explains Dr. Serur. “You get oncologists, surgeons, geneticists, a nutritionist, and other specialists. Good minds are put together, and a personalized pathway is developed for each patient. We really see each person as a person, not as a disease.”

 Why colorectal surgery?

“I like treating cancer and being specialized. Of course, it’s very satisfying when a worried patient comes to me with a potentially life-threatening disease, and two weeks later all visible cancer is gone. It gives me a lot of satisfaction. For those with more advanced disease, I let them know that we are there for them, and that we will do everything in our power to make them well. I also treat a lot of benign conditions. When patients get better from something that was taking over their life, it’s a big blessing.”

How do you work with patients?

“Number one, I’m honest with them—I believe in sharing information with patients. I want to make sure that my patients understand that many cancers are potentially curable and that they understand the procedure they are about to undergo. I’m thorough in my explanation, and I try to bring it to their level of comprehension. Number two, I see the patient as my family member. It’s my mother, my grandmother, my sister. I treat them as I would want to be treated myself.”

Posted September 2018

Cholesterol – What is it and Why is it Important?

Posted on by Michael Chananie

A recent U.S. study that followed 36,375 adults over the course of 27 years has yielded new findings that may affect the treatment of low-risk cardiovascular patients.

None of the individuals in the study had a history of heart disease or diabetes, and all had a low 10-year risk for events such as heart attack or stroke. Most had levels of what we call “bad” cholesterol that would not be considered significant enough to warrant a prescription for a cholesterol-lowering medication such as a statin.

Over the course of 27 years, 1,086 of those in the study died of cardiovascular disease, and 598 died of coronary heart disease.

What does this mean exactly? It means that there is a segment of the population whose cholesterol levels do not qualify them for a statin prescription, but whose moderate levels of “bad” cholesterol will result in cardiac death all the same.

You may wonder why a moderate cholesterol problem couldn’t be solved through diet and exercise. Unfortunately, while diet and exercise can help mitigate cholesterol issues for many people, some people have a genetic predisposition to high cholesterol.

“You can always minimize the effects of your genetics through diet and exercise. But for some people, no matter how meticulous they are with their diet, and no matter how much time they spend in the gym, their cholesterol levels are going to be problematic,” says Christopher Di Giorgio, MD, board-certified cardiologist in the Englewood Health Physician Network.

Cholesterol management is a complicated and often misunderstood aspect of human biology. According to Dr. Di Giorgio, a common misconception is that having cholesterol in your system—at any level—is bad for you, when in reality cholesterol serves an important purpose. It is responsible for keeping the blood moving smoothly.

“Just as your car needs oil,” says Dr. Di Giorgio, “your heart and blood vessels need cholesterol. Problems arise when the components of your cholesterol are not present in the right quantity and quality.”

Cholesterol is transported through the blood attached to complex particles called lipoproteins. There are two main types of lipoprotein: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). When you hear doctors refer to “good” cholesterol, they mean HDL; when they refer to “bad” cholesterol, they mean LDL.

Keeping cholesterol levels healthy means keeping the “good” (HDL) cholesterol levels high and the “bad” (LDL) cholesterol levels low.

The function, and malfunction, of cholesterol in the body is the subject of much ongoing research—especially as there is still no consensus on what exactly makes cholesterol “good” or “bad” for you.

“A person’s cholesterol is the result of a combination of genetic factors (which are non-modifiable) and dietary factors (which are modifiable),” says Dr. Dr. Giorgio. “Dietary recommendations depend on the type of cholesterol. For high triglycerides (a type of fat found in the blood), for example, the recommendation is low carbs (and brown carbs, such as whole wheat products, are better) and minimal refined sugars. For high LDL, the recommendation is to reduce foods high in saturated fats.”

The information gathered during this study doesn’t answer the question: For whom are statins appropriate? We know for certain they are appropriate for patients whose cholesterol levels pose a clear and present danger to their health. But what about those whose levels pose a clear but perhaps distant danger to their health?

Studies such as this one are important because they ask whether there are better and more efficient ways to serve patients over their lifetime, and they acknowledge that our understanding of biology is constantly evolving.

Posted September 2018

Ask the Doctor: Dr. Dennis Katechis

Posted on by Michael Chananie

What is the difference between good and bad cholesterol, and what dietary choices can we make to make sure we have more good cholesterol than bad?

Dr. Katechis: Bad cholesterol, or LDL (low-density lipoprotein), contributes to the formation of plaque in the body’s arteries—not just the coronary arteries, but also the arteries that bring blood to the legs, arms, brain, and rest of the body. Good cholesterol, or HDL (high-density lipoprotein), is responsible for bringing the bad cholesterol back into the liver to be metabolized. The amount of bad cholesterol produced in the liver, and how well the liver metabolizes it, is to some extent determined by genetic makeup—but a healthy lifestyle and a diet low in saturated fat will help the process run more efficiently.

If your cholesterol levels are off, will you experience any physical symptoms?

Dr. Katechis: No, and that’s one of the most important things for patients to understand and appreciate. The same applies to high blood pressure, another risk factor for heart disease. High cholesterol causes zero symptoms until changes have already taken place inside the arteries. This is why it is important to have your cholesterol checked once a year.

Truth or myth: Young people don’t have to worry about their cholesterol.

Dr. Katechis: Myth. It’s important for young people to schedule an early visit to their primary care physician, who will not only give blood tests, but look at other potential risk factors that determine risk profile, such as family history, diabetes, smoking, obesity, and high blood pressure. If some of those factors are added to the profile of a young person who already has high cholesterol, that person may be a candidate for cholesterol-lowering therapy at a young age.

Posted September 2018

Ask the Doctor: Dr. Mahesh Bikkina

Posted on by Michael Chananie

September is National Cholesterol Education Month—a good time for those of us who are concerned about our heart health to make sure we’re doing everything we can to support healthy arteries, control our cholesterol levels, and cultivate a healthy lifestyle.

What is cholesterol, and why should you be concerned about it?

Dr. Bikkina: Cholesterol, a form of fat produced predominantly by the liver, affects the blood and circulatory system throughout the body. When certain types of cholesterol levels are high, the blood vessels can incur damage, and damaged or blocked blood vessels can cause heart attacks and strokes. At normal levels, cholesterol is essential for normal cellular function, particularly certain hormones.

Is all cholesterol bad for you?

Dr. Bikkina: No. LDL (low-density lipoprotein), or “bad” cholesterol, causes plaque to form in the body’s arteries. HDL (high-density lipoprotein), or “good” cholesterol, helps to keep the effects of bad cholesterol under control.

To what extent are our cholesterol levels a result of our lifestyle, and to what extent a result of genetic predisposition?

Dr. Bikkina: Genetic makeup is one of the main factors in cholesterol health. Whether your liver produces more or less cholesterol, and how efficiently cholesterol is broken down in your body, depends upon your genetics. That said, the lifestyle aspect of cholesterol control should not be ignored. Avoiding certain types of fatty foods and carbohydrates, working out regularly, and supporting your overall health also affect cholesterol levels.

Truth or Myth: A low-fat diet is the best way to regulate cholesterol levels.

Dr. Bikkina: Myth. It is actually less about a low-fat diet and more about choosing the right kinds of fat. Perhaps the most common misconception about cholesterol is that the optimal diet is a low-fat, high-carb one, when in fact, not all fats are bad for you. Unsaturated fats, found in foods such as avocados, fish, olives, nuts, and seeds are shown to help lower the risk of heart disease and stabilize blood sugar levels.

Posted September 2018

The Future of Precision Medicine

Posted on by Michael Chananie

You can match a blood transfusion to a blood type… What if matching a cancer cure to our genetic code was just as easy, just as standard?” asked President Barack Obama, addressing a crowd of health representatives in the East Wing of the White House, in January 2015.

Precision medicine is a new approach to disease prevention and treatment that takes into account a patient’s genes, environment and lifestyle, and customizes medical decisions based on that information. This is a departure from traditional medicine, wherein medical decisions were made for patients based on the typical characteristics of the disease they have, rather than their bodies’ unique characteristics in relation to that disease.

Dr. Steven Brower is the medical director of The Lefcourt Family Cancer Treatment and Wellness Center, as well as chief of surgical oncology at Englewood Health.

“Everything used to be about treatment,” he said. “You would make the diagnosis and then hopefully deliver the most appropriate surgery, radiation or chemotherapy. But it was a therapy based on a tumor type, not so much an individual patient’s tumor.”

Dr. Brower explained that what has changed is the foundational questions doctors ask themselves when faced with making decisions for their cancer patients. “The questions were once: what is best for all breast cancer patients? What is best for all lung cancer patients? Well today, precision medicine is just about that patient, that particular tumor, at that moment in time,” Dr. Brower said.

Instead of using what Dr. Brower refers to as “a shotgun approach” to all tumors, doctors are now studying cellular and molecular characteristics and genes in order to provide customized treatment to their patients. Removing the generalizations means that doctors will only embark upon treatment that is appropriate for their patients, potentially eliminating needless surgeries, invasive tests and wasted efforts.

Advancements in diagnostic technology play a major role in pushing forward the mission of precision medicine. The invention of the MRI/ultrasound fusion biopsy has revolutionized the process of detecting prostate cancer and strategizing treatment. Determining whether a prostate cancer patient is high or low risk is crucially important because the treatments for prostate cancer can range anywhere from surveillance of the cancer, to surgery or radiation treatment.

“In the past it was pretty much a blind biopsy. Now, this new MRI/ultrasound fusion biopsy more accurately determines whether a patient has high-risk prostate cancer or low-risk. And by making this determination, physicians can better inform patients about their treatment options,” Dr. Brower said.

Each week at Englewood Hospital an elite group of medical professionals gather in a kind of round-table setting. At the table sits experts in medical, surgical and radiation oncology, as well as experts in genetics, survivorship and pain management. Specialists in all types of cancer are present to discuss thoroughly the best and most precise options for new patients.

“It’s like the patient is getting an opinion, not from one doctor, but from 20 different people. We consider the various new targets that have been introduced so that precision medicine is considered for each patient,” Dr. Brower said.

Precision medicine teaches us that information is power. Dr. Brower and his colleagues at Englewood Hospital arm their patients with information that will empower them to become active participants in their own medical decision-making.

“It used to be that all the information patients got about a disease came from doctors—that’s very old school. Today, there are thousands of advocacy groups out there for patients with cancer that are extraordinarily encyclopedic in their knowledge,” Dr. Brower said.

Dr. Brower urges his patients’ to pursue advocacy groups to connect with other patients who have been treated for similar kinds of cancer. These connections allow patients to trade information and feel more secure in the recommendations given to them by their personal doctors. Patients can access the National Cancer Institute and American Cancer Society websites to begin this process.

Posted September 2018

Discussing Medical Ethics

Posted on by Michael Chananie

You may not know the members of the Medical Ethics Committee at Englewood Hospital—perhaps you’ll never need to. Yet it is important to understand the significant role they play in our community, each and every day. Jeffrey Matican, MD, co-chair of the committee, sheds light on this devoted and essential team.

 What is medical ethics?

Bioethical dilemmas, which usually arise when patients are doing poorly, can be difficult for physicians and families alike. Sometimes there is conflict or confusion among family members. The Medical Ethics Committee may get involved to help family members and the medical team work toward a common goal or treatment plan.

An example is the management of medical devices at the end of life. Advanced heart failure patients with implanted devices such as pacemakers and defibrillators can present an ethical dilemma. As the patient declines, at what point do the patient, family, and physicians decide to turn off the device and let nature take its course? Dealing with such situations can be very emotional and challenging for patients and families. The committee is there to help.

Families also frequently need help in weighing the benefits and burdens of artificial nutrition, as in cases of dementia patients who have feeding tubes. The Medical Ethics Committee might facilitate a discussion with the patient and family on the appropriateness of various options, and help families work through these challenges.

 What is the central role of the Medical Ethics Committee in the hospital?

In my view, medical ethics is the basis of medicine, and guided by three principles: respect for the patient, fostering communication, and finding common ground. It’s about respect for people’s autonomy, and it’s about communication.

Medical Ethics Committee

The Medical Ethics Committee is composed of physicians, nurses, clergy, social workers, and a member of the community. It meets monthly and provides consultations throughout the hospital, as needed.

The committee has three main responsibilities. First, medical policy formulation, which pertains to clinical policies, such as “do not resuscitate” (DNR) orders, declaration of brain death, and withdrawal of care, as well as administrative policies related to organizational ethics, such as vendor relationships and HIPAA. Second, educating hospital staff (doctors, nurses, and ancillary staff) and the community on topics such as advanced directives and health care proxies. Finally, providing families, physicians, and nurses with consultations on ethical dilemmas.

The committee also assists in mediating medical dilemmas. Sometimes, for example, there may be different perspectives involving the patient themselves, their family, and the medical team who are focused on what’s medically and personally in the best interest of the patient’s quality of life. The prevailing principle is that patients who have the capacity to make decisions have the right to self-determination. It’s their decision, and the committee supports them.

Teaching medical residents

Once a week, medical residents shadow me in my cardiology practice, to see firsthand what a physician’s office is like and to observe my relationships with patients who have been under my care for 10, 15, 25 years. This is unlike the episodic care that residents experience in the hospital setting. I want the residents to know how to be a doctor in the broadest and deepest sense.

During this time, I try to impart these three pillars of the patient–physician relationship: respect the patient, listen to the patient, and emphasize that communication is the most important part of the relationship.

I explain to our medical residents, “You are not going to learn everything you need to know during residency, or even in four or five years. Learn how to learn; keep an open mind; learn from your colleagues and patients. It’s about lifelong learning. This is what it really means to be a doctor.”

Posted September 2018