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Monthly Archives: December 2011

We watch this from across the pond with interest. I suppose our US counterparts have been more familiar with administrative involvement in the delivery of clinical decisions but the moves to more specifically apply criteria of appropriateness to the use of procedures and devices are intriguing. It’s an issue set to affect us all, and anyone who thinks this won’t apply outside the US has another think coming….

Read more here

Shelley Wood. Stents, ICDs, inappropriate? Then, under new audit program, CMS won’t pay. theheart.org. [Clinical Conditions > Clinical cardiology > Clinical cardiology]; Dec 3, 2011. Accessed at http://www.theheart.org/article/1323479.do on Dec 29, 2011

I’m not telling you!

At least for now, I am going to publish this with some degree of anonymity. There are some reasons for this. I’m new to this idea of a blog so I am still not sure that this is the right thing to do.

One thing is for sure, and that is that it would seem easier to go from anonymous to identified, but not vice versa.

It is just that i am not sure if all those who I work with or are associated with will necessarily agree with all the opinions and points of view expressed on the blog. Not that I am in any way intending to offend…

So I am happy to tell things about me but not my identity. To those who work with me, these thing s will probably be enough anyway…

I am, you guessed it, a general cardiologist.

I work in both the public and private sectors. Publicly, in a large, metropolitan teaching hospital in Australia. I trained in more than one country. I spend a good deal of time involved with clinical research, most of which is investigator initiated, but less time than I would like in medical education.

So that is a start. I am sure more will become apparent with time.

Why indeed?

We arrive at a time where a diminishing number of us are prepared to describe ourselves as a ‘general’ cardiologist. Indeed there is probably no such recognised entity as a general cardiologist. The reasons for this, we may discuss, are many.

Our training and career structures now suggest that we must have subspecialty training in the field – we must be an EP, an imaging or an interventional guy or girl – in order to find a successful path. Perhaps more importantly, the medico-politico-industrial complex has swung firmly away from drugs (that might have been prescribed by anyone) and firmly in the direction of device therapies and high tech imaging infrastructure (which may only sensibly be utilised by those with appropriate sub specialist training in their use).

Some of this, of course, makes a lot of sense but it also ignores a lot of truths.

Several facets of the specialty are all but ignored by the current direction – where is the place for cardiac genetics, grown-up congenital heart disease, screening for heart disease, primary prevention, acute rheumatic heart disease, heart disease in pregnancy in the prevailing structure – it’s hard to see. All of these are real, day-to-day issues in my part of the world and indeed in my hospital and some of them increasing in importance.

Finally, the current structure neglects the inarguable political, geographic and demographic realities of the world – that we are all getting older and that many of us, probably the majority, remain isolated, either by distance or economics, from the delivery of the high level cardiovascular medicine and interventions that we are driven to provide.

I think that you can see where I am heading with this…