Private practice with Dr Seth Bilazarian

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How do you tell an academic cardiologist from a private practitioner?

Aug 6, 2010 09:30 EDT


Contrary to private practitioners, academic cardiologists frequently respond with the same adage when consulted on management of a difficult case. How do these three words sum up the difference between private practitioner and academician?





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Your comments
How do you tell an academic cardiologist from a private practitioner?
# 1 of 3
August 7, 2010 07:11 (EDT)
Kishore

Dr Bilazarian,

I am delighted that you brought up this topic for your videoblog. I believe that the reason for the difference is that private practitioners, unlike the academic folks, feel that "evidence" consists of not just large double blind randomized trials but the totality of information one obtains from all studies which may include single patient and purely observational studies. The problem with all randomized studies, simply stated is that they ignore the significant biological variability which exists amongst all human beings (except identical twins) not all of which can be overcome by having a very large study population. Hence the perpetual discussions about the reasons for differences between various studies which are similar yet sometimes have significantly different outcomes.
# 2 of 3
August 11, 2010 10:27 (EDT)
joanincarolina
I can't keep the smile off my face either! Back in 2005 I had my first symptom of Cardiac endothelial dysfunction. Searching on the Web led me to my self diagnosis while I went through a series of specialities who eliminated everything that current technology could discover.I eventually was confirmed MVD at Emory in 2008 with provocative testing. "What do you mean there is no data" as I got tossed out of all the studies due to severity.That's the only response for MVD. I didn't believe it and continued trial and error medications and my own research which has revealed nothing new. It's 2010 and I am now nitro dependent, debilitated, love my doctors at Emory ( Samady and Quyyumi) and now I tell others " there is no data". Signed, The Patient. 
# 3 of 3
August 13, 2010 10:16 (EDT)
Joyce Wahr
I love this blog entry!  As someone keenly interested in patient safety I often start with how patients are at risk - when we don't know what or how to treat a patient (or think we know and are wrong!); when we know what to do but don't do it (follow the guidelines) and just cussed old human error.  Because we live in the data day to day, and often create it through our research, we academicians are more willing to admit "there is no data" than our colleagues in private practice. Uncertainty is an anathema to humans, so our subconscious convinces us that we know (experience, intuition, vague hints in the literature) when we really don't.  If there is one thing we must teach or students, residents and fellows, it is to be willing to rigorously ask every time, "Is there any data for what I am about to do?"  Thanks for bringing up this key point!

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About Dr Seth Bilazarian
Seth Bilazarian MD has been a Clinical and Interventional Cardiologist at Pentucket Medical Associates in Massachusetts since 1993. He is board certified in Internal Medicine, Cardiovascular Medicine, Nuclear Cardiology, Vascular Ultrasound, Interventional Cardiology, and Vascular and Endovascular Medicine.

Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy.

Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
About this blog
My intent is to create a forum for dialogue on issues pertinent to private practice cardiology around topics such as:

  • Integration of new data and guidelines on inpatient and outpatient practice in clinical and interventional cardiology
  • Practice approaches to the extra clinical issues in dealing with managed care insurers
  • Strategies for navigating the restrictions of pharmacy benefits managers (PBMs) on pharmacologic therapies for our patients
  • Experiences with restrictions on testing and imaging
The video blog (VLOG) will provide an opportunity to share broadly different approaches to the common conundrums we face in caring for patients. My hope is that this forum will provide useful data points for practice outside of tertiary and academic centers and a look inside community hospitals and physician?s practice patterns in the office, starting with mine.