Discussion about this post

User's avatar
The Skeptical Cardiologist's avatar

I've worked with many great PCPs over my career and I can tell you would be fantastic to work with. . But I've also worked with many who are very much wedded to the old paradigm of CAD and who were very much complicit in the freight train to the cath lab mind set. At one health center I worked it was not uncommon for the PCPs to directly contact a cardiologist who only did caths/stents, i.e. he didn't do cardiology consults, didn't manage cardiology patients post stent or pre-stent, just did any cath that any doctor wanted done. Frequently, if the PCP wanted a cath done and the cardiologist felt it wasn't warranted , that cardiologist would not get any more referrals. On top of that, if any lesion was found it got a stent, somewhat irrespective of the severity and without any requirement of ischemic testing, FFR, etc.

Many PCPs view the stable CAD patient as a "hot potato" and only feel comfortable once the coronary anatomy is outlined by an invasive angiogram and a stent implanted.

What they don't realize is that the patient has been converted from stable CAD to an unstable situation with that stent.

Expand full comment
Walter Bortz's avatar

Very well done exploration of therapeutic cardiovascular misguidance. These reviews are an invaluable roadmap to providers who know these assertions to be true but who need the evidence based corroboration. Great job!

Expand full comment
11 more comments...

No posts