Are cardiologists the enemy?

I'm sitting at dinner with two colleagues. One is a cardiology colleague, another an internist who, in addition to practicing general internal medicine, also takes heart disease prevention very seriously. He has, in fact, participated in the Track Your Plaque program and dropped his heart scan score substantially.

"Why don't we see you in the cath lab much?" my cardiology colleague asked me. He was puzzled, since he knew my background in cath lab work from years before, spending day and night doing procedure after procedure. He spends virtually all his days there.

"Well, my patients simply don't have events any more. Heart attacks and angina among people in my program are just about non-existent. They don't have symptoms and they don't have to go to the hospital. I can't remember the last time that I was woken up in the middle of the night for an urgent procedure for one of my patients."

The internist across the table smiled and expressed his agreement. "That's the same thing I'm seeing: No heart attacks, very few if any referrals to cardiologists for procedures. I remember when it was a several times a week thing. Now, almost never. "

Looking at my cardiology colleague, I saw the usual cardiologist reaction: Eyes searching left and right and behind us for something more interesting. Certainly, talking about a virtual cure for coronary heart disease was just too damn dull.

Such is the attitude of 98% of my colleagues: If it doesn't generate a revenue-producing procedure, why bother? Prevention is for general practitioners, the line of thinking goes. "And anyway, I'm too busy doing procedures! I don't ahve time to talk about prevention and health!" Of course, the poor general practitioner is already overloaded with caring for arthritis, flu, diabetes and all the new drugs for diabetes, headaches, vaccinations, diarrhea, and . . .oh, yes, heart disease prevention.

Are cardiologists the enemy? No, of course they are are not. But they often act like they are. Talking to cardiologists is like going to the car dealer with your checkbook out, pen in hand. The salesman gets to write the check himself and you just sign it. Talk to a cardiologist and more often than not you will end up with a heart procedure--whether or not you need it.

Unfortunately--tragically--they often forget what they are supposed to be doing: Taking care of a disease by preventing it. Putting in a defibrillator is not preventing a disease. Putting in three stents, laser angioplasty, and thrombectomy are not ways of preventing a disease.

I'm thankful for my internist friend who sees the light. Coronary heart disease is a an easily measurable, quantifiable, preventable, and REVERSIBLE process for many, if not most, people when provided the right tools. But don't ask your neighborhood cardiologists to give you those tools.

Comments (12) -

  • Anonymous

    11/7/2007 4:30:00 PM |

    My grandfather, who had a great sense of humor, had heart disease and was a frequent visitor to the cardiologist office.  One day we were sitting in the cardiologist's waiting room and I was reading an article on doctors that get sued for malpractice.  In it was a list of doctors more likely to be sued and those not.  Leading the list of doctors least likely to be sued for malpractice was cardiologist.  I pointed this out and granddads response was, "That's because cardiologists are better at burying their mistakes."

    I'm guessing the best way to make cardiologists change their ways is by using the court system - unfortunately.  Just a few weeks ago I encouraged my mom to talk to her long time friend about doing that.  The friend’s father was on a hunting trip when he experienced chest pains.  He was rushed out of the woods to his hospital.  Cardiologists performed tests and everything came back normal.  No measures were taken.  A few weeks later the guy died from a heart attack.  As I told mom, a simple CT scan would have shown he had plaque and needed to immediately take preventive measures.  With all that is known now about detection and prevention it was criminal what was done and not done to that man.

  • Dr. Davis

    11/7/2007 8:11:00 PM |

    It's sad and unfortunate, but sometimes your hand is forced. I agree: Legal action in selected cases may be necessary to obtain justice and raise public awareness of the magnitude of this wrongful activity.

  • summersam

    11/8/2007 12:26:00 PM |

    Dear Dr Davis; I enjoy your column...  my question is this; I lap swim three days a week. I consider it to be a every other day stress test. i can certainly tell rapidly what foods are not good for: Red meat, butter, ice cream, shrimp, those are the biggys. Certainly the other meats that i eat have cholesterol; why dont they bother me? Ive had friends that swim relate the same to me: Beef and dairy is OUT.

  • Paul Kelly - 95.1 WAYV

    11/8/2007 12:34:00 PM |

    Hi Dr. Davis,

    Speaking of prevention - at what age should we start thinking about getting a CT Heart Scan? Also, would the scan show if there were heart problems other than plaque build-up?


  • jpatti

    11/9/2007 7:32:00 AM |

    I'm a 45 yr old female with diabetes, but no history of heart disease in my family even in the other diabetics.  Obviously, I didn't die from my heart attack in May, but...

    I went to the ER complaining of recurrent chest pain, got an EKG and blood work, and was sent home with an antacid for my "heartburn."

    A couple days later, after vomiting and screaming off-and-on for a couple hours at a time all night, my husband took me back to the ER.  He carefully explained we already *knew* it wasn't a heart attack, but something is really wrong here - he had to speak for me because I could neither walk nor speak when we went to the ER the second time.  

    This time, I was transported to another hospital for an emergency angio and subsequent bypass for my so-called "heartburn."  

    Pretty amazing that I developed a heart condition requiring two surgeries two days after I didn't have a heart condition, eh?

    I remember being really terrified when the surgeon told me there was a 5% chance of dying during the bypass.  She thought I misunderstood, that a 95% chance of living was good, but no... 5% *is* BAD.  I don't normally do things that have a one in twenty chance of killing me!  

    It was much later at home learning about heart disease that I discovered I'd had a 50% chance of dying just from the heart attack itself; sudden death is the first symptom in half of the folks with heart disease.  

    I'm a very lucky chick that my husband isn't currently suing someone for letting me die.

    As the holiday approaches here in the states, I was asked what I am thankful for.  This year, just being alive at all qualifies as something I have profound gratitude for.

  • Dr. Davis

    11/9/2007 12:22:00 PM |

    You are a survivor of a flawed system. To me, even worse than the mis-diagnosis of the ER, is why wasn't your heart disease diagnosed during the DECADE before your heart attack?

    Have you looked at Jenny Ruhl's wonderful Diabetes Update Blog and the associated website? It provides interesting commentary on diabetes, with intelligent nutritional commentary that flies in the face of the idiocy coming from the American Diabetes Association.

  • Dr. Davis

    11/9/2007 12:24:00 PM |

    Summersam--I wonder if you are just among the people who struggle with digestion of fats, regardless of type.

    Paul-Men, 40 and over, women 50 and over, earlier if an outstanding source of risk is present. For other abnormalities seen on heart scans, please refer to my Heart Scan Curiosities posts on this Blog.

  • Anonymous

    11/10/2007 2:05:00 AM |

    can you please comment on the latest study out that says the Ornish diet is best for hesrt disease. I think it ranked south beach and atkins very low. I know Dr. Ornish has a new book out soon "The Spectrum Diet" these findings were presented at the AHA.

  • Dr. Davis

    11/10/2007 12:48:00 PM |

    The study I believe you are referring to was a University of Massachusetts rating system, not truly a study. They simply gave grades of presumed health factors, using the so-called "Alternate Healthy Eating Index (AHEI)" that ranks fiber content and other healthy ingredients. It was NOT a real world comparison of diets, nor did it study effects on heart disease. In other words, it was just a speculative discussion.

  • jpatti

    11/10/2007 7:23:00 PM |

    Dr. Mike Eades blogged about the anti-Atkins poster presentation here:

    and here:

    And I agree, Dr. Davis, Jenny's site and blog (and her previous sites and Usenet posts) are a great resource for diabetics.

  • Richard Poor

    11/25/2007 7:15:00 PM |

    I had 2 CABG and have researched like crazy. Conclusions: we still don't know much. Cytokines & etc. from stress can be lethal regardless. 256 slice CT scan is best test but only one machine in USA. VAP combined with LIPOPRINT best blood tests. Antioxidants understudied. Mainstream medicine is mercenary, more concerned with profit that healing.

  • Dr. Davis

    11/26/2007 12:52:00 AM |

    Hi, Richard--

    I'm afraid you are right. However, I do believe that we still do know a fair amount. I would encourage you to read prior Heart Scan Blog posts, along with the website. Our philosophy is that heart disease can be halted or reversed in most people (not all). While not perfect, it is the best approach I am aware of. It is certainly better than the "take Lipitor and pray" mentality of conventional, "mercenary," medicine.