NY Times Column on Cardiology Gets It Half Right

Thursday, December 3, 2015 | Larry Sobal

“Are Good Doctors Bad For Your Health?” article makes some harsh statements about older physicians and community hospitals.

Hello to the MedAxiom community!  After 2 years working outside of the cardiovascular world, I am thrilled to be back as a member of the MedAxiom team.

One of my many responsibilities at MedAxiom, and something I am really excited about, is to write a weekly blog. So, consider this my introductory posting.

While 52 blogs a year might seem like a daunting task, I was a newspaper health care columnist for over a decade; writing on topics that are relevant to you, is something I look forward to. Think about it, there is probably not a better industry than health care to be blogging about. Between legislative confusion, technological innovation, presidential elections and reimbursement redesign, there are many things to talk about each week.

One of the things I enjoyed the most about my time as a newspaper columnist was the feedback from readers, both positive and not so positive (some didn’t hesitate to tell me when my head wasn't screwed on straight). I look forward to hearing from you and promise to reply back.

One of my many responsibilities at MedAxiom, and something I am really excited about, is to write a weekly blog. So, consider this my introductory posting.

Let's start this first blog off with an interesting topic. Recently (November 21st), The New York Times ran a commentary by Dr. Ezekiel Emanuel, an oncologist and Vice Provost at the University of Pennsylvania, titled "Are Good Doctors Bad For Your Health?".

Certainly an eye-catching title and an interesting read if you haven't seen it. Dr. Emanuel had two themes, one of which I tend to agree with and one I don't.

The second half of his column I felt did a wonderful job of arguing that more care is not necessarily better care and cites some well-known examples where clinical prudence has proven to be more effective. You don't have to look any farther than the Choosing Wisely initiative as an example of the sometimes seemingly paradoxical truth that has emerged over decades of research that more treatment doesn't always mean better treatment. I can't argue on this point.

Where Dr. Emanuel and I diverge is in the first half of his column where he cites some recent JAMA research and makes two inferences.

His first inference is that going to a teaching hospital, versus a community hospital, makes a positive difference in quality. I don’t think the narrow scope of his column is capable of making such a broad conclusion.

The second is that when the senior Cardiologists at academic institutions are away at meetings, care is better. The JAMA article can be found at JAMA Intern Med. 2015;175(2):237-244. Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings, Anupam B. Jena, MD, PhD; Vinay Prasad, MD; Dana P. Goldman, PhD; John Romley, PhD.
 
When you dig into the research, they linked the data to when cardiologists were off attending ACC and AHA meetings – a seemingly small sample size don't you think?

His first inference is that going to a teaching hospital, versus a community hospital, makes a positive difference in quality. I don’t think the narrow scope of his column is capable of making such a broad conclusion.

Dr. Ezekiel suggests that senior cardiologists are great researchers while their junior counterparts “recently out of training” may be better clinically. He goes on to suggest another possible rationale for the findings is that senior cardiologists try more interventions.
 
I’m troubled by both suggestions, as they potentially paint a dangerously broad picture of cardiology care and contribute to the findings in a 2014 Gallup poll that the United States is tied for 24th place in terms of the proportion of adults who express trust in physicians. The average American probably can’t easily distinguish between what is considered an academic institution versus a community hospital. Furthermore, exactly when do you become a “senior” cardiologist?  This is not the kind of confusion and publicity our industry needs. Leave this type of innuendo for the Enquirer—the New York Times, and Dr. Emanuel, should know better.
 
There you have it, blog #1. You've heard my views – what do you think?

 


Larry SobalLarry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

Leave a Comment

« Back