Heartfelt with Dr Melissa Walton-ShirleyView all posts »
Surgeons and interventionalists: The same crystal ball?Aug 3, 2009 08:30 EDT
I found the forum post from Luc Missault entitled “Cardiothoracic surgeon shortage likely by 2020, study predicts” very interesting. He writes that he “remembers being overtly and loudly laughed at by a group of different surgeons after a talk on angioplasty held for a mixed group of local doctors in Belgium”. He then goes on to describe their accusation that they would have to “clean up our mess”. He remembers feeling very humiliated and wondered if he had “made the right choice” by becoming an interventionalist at all. Indeed Luc is not the only interventionalist out there with an “I told you so”. Look back at how far the profession has come since the dark days of balloons the size and shape of a banana with virtually no guides or wires to speak of. Who would have thought it?
I was also a witness to such ridicule when I was in training in 1988. I remember waddling down the sidewalk, about 8 months pregnant as an internal medicine resident. I almost ran headlong into a much admired and revered thoracic surgeon (who shall remain nameless but suffice it to say, he chairs one of the best known and successful academic programs in this country today). No doubt, I was a sight, complete with braces I’d put off wearing until I was the ripe old age of 27. “Just one question” he quipped, “just how did you ever get pregnant looking like that?” Knowing this was the typical humorous banter I could expect, I flashed my repulsive metallic grin through edematous lips and waited for the next punch line. I would have taken any amount of grief from this guy. I had an enormous amount of respect for his skill and compassion. As a fourth yr. med student, he had awarded me the much coveted “honors” notation, recognizing I had “busted my butt” for him. However, after a couple of minutes of small talk, the conversation grew more serious. His eyes narrowed. He lowered his voice and said after looking over his shoulder “tell your bosses, I’ve got a message for them”. Not certain if he was serious or not I replied with a smirk and said “and what would that be?” He then growled, “this balloon angioplasty stuff will never work. It’s completely ridiculous. The entire premise is ridiculous”. He then stormed off as if I were his worst enemy.
The next time I saw my extraordinary friend, we were back to our usual banter, but I never forgot that conversation. Technically, he was right. Balloon angioplasty doesn’t work…….unless you are happy with a 50% restenosis rate. Twenty years later, coronary intervention has achieved the unspeakable from a surgeon’s perspective. My friend’s natural insticts were to fight for his survival by initially trying to psych out his enemy. The battle had begun in his mind to try and avoid the same fate as the wooly mammoth. No one likes to think of themselves as extinct and I’m certain that is what every thoracic surgeon feared in the dawn of the interventional era.
In the “not too far distant future”, it may be interventionalists who will be making threats to unwitting medicine residents on hospital sidewalks. The cardiologists’s crystal ball holds the promise of HDL analogues that virtually melt plaque away like “Drano”. There is no doubt that in our lifetime, stents and balloons will be ridiculed as archaic band-aid like scaffolds. Our mechanical attempts at correcting a metabolic endothelial disaster with a piece of twisted sticky metal will be scoffed at.
We can learn a lesson from the uneasy transition that we have forced upon our friends the thoracic surgeons. We should be paying far more attention to the metabolic and preventative aspects of the disease process that we have vowed to combat. Perhaps by gazing into the same crystal ball that predicted sweeping changes uneasily navigated by our surgical colleagues, we may be able to embrace the future of cardiology rather than fear it.