Cardiology Confidential

Okay, so it's a shameless knockoff of chef Anthony Bourdain's titillating Kitchen Confidential.

But the confidences that I've heard whispered in the corridors of health involve something more provocative than how your food was prepared. Any service for humans performed by other humans is subject to the idiosyncrasies and weaknesses of human behavior. That's just life.

In healthcare for your heart, the consequences can be more profound than eating three day old fish on Monday's dinner menu.

Over my 15 years practicing cardiology in a variety of settings in three different cities, I've witnessed just about everything from shocking to sublime. Some of it speaks to the extraordinary commitment of people in healthcare, the unexpected courage people show in the midst of illness, the devotion of family in difficult times. It can also speak of mewling, sobbing carryings-on over the most minor conditions, the meanness that emerges when people are frightened, the vultures circling just waiting for Grandpa to kick the bucket and leave his will declaring the spoils.

For the most part, my cardiology colleagues are a hard-working bunch committed to . . . Uh oh. I was going to say "Saving lives, preserving health." But that's not true. Once upon a time, it was true for many of my colleagues, often revealed over $2-a-pitcher beer-softened, "we're going to save people" conversations in medical school. Ahhh, medical school. I remember walking along the street alongside my medical school in St. Louis, bursting with pride and a sense of purpose.

But, for many of us, something sours our purpose through the years. Maybe it's the smell of money, maybe it's the series of distasteful experiences that show that healthcare providers are, in the midst of health crises, the innocent recipients of anger, frustration, disappointment.

Whatever the genesis, the stage is set for an imperfect scenario that pits healthcare provider against patient in a less-than-perfect system.

This would read as a mindless rant if it wasn't based on such pervasive and pravalent truths, tales of the flawed deliverers of healthcare driven by motives less lofty than "saving people."

Take Dr. S, a doctor who performs a large number of procedures on patients. I'm told he is very capable. He manages an extraordinary amount of heart work--in between jail time for wife beating and Medicare fraud.

Or Dr. C, well-known in the region for his procedural talents, also. Usually acerbic and freely-swearing, he opens up engagingly when drinking--which is most of the time. Paradoxically, as is true for some serious drinkers, he works more effectively while intoxicated.

Or Dr. ST, who proudly admitted to me one evening over dinner that he has accepted 6-figure payments from medical device companies on a number of occasions to use their products.

Or the manic ups and downs of Dr. J, who refers just about every patient he sees for emergency bypass surgery when in his down phase, mangles coronary arteries in daring angioplasties during his up phase.

How about 310-lb Dr. P, who hounds her patients about indulgent lifestyles? That would be excusable as innocent lack of self-insight if it weren't for her propensity to use heart procedures on patients as punishment. "I have no choice but to take you to the hospital."

Dr. M. manages to maintain the appearance of straight-and-narrow during the day, all the way to attending church twice a week with his children. His daytime persona effectively covers up his frequent visits to prostitutes.

We are ALL flawed. My colleagues are no different. But some circumstances cultivate the flaws, fertilize corruptibility, reward it. Such has become the state of affairs in healthcare for heart disease. Why? Is it the excessive potential for money-making that existed until recently? Is there something about the save-the-day mentality of heart disease that attracts imperfect personalities looking for the adrenaline-charged thrill but morphs over time into near-psychopathic lives?

It's not the end of the world. The fact that my colleagues' behavior has reached such extravagant lows signals a bottom: things are about to change.

In the meantime, let me tell you a few more secrets . . .

Copyright 2008 William Davis, MD

Comments (9) -

  • Zute

    6/11/2008 2:50:00 PM |

    Oh my!  Sounds like you have the makings of a juicy book in your head, Dr. D!

  • mike V

    6/11/2008 3:35:00 PM |

    Sometimes I think there is hope for my grandchildren.
    I find you inspiring, Dr. Davis. Not perfect, but nevertheless, inspiring!

  • Anonymous

    6/11/2008 3:48:00 PM |

    Come on Dr Davis... Tell it like it is!

    I Love it. Just plain Love it!

  • Jessica

    6/11/2008 10:25:00 PM |

    It's refreshing to hear this from a physician. So many of them are content with keeping up the perception of perfection and I'm sure its draining.

  • Anonymous

    6/11/2008 10:36:00 PM |

    It is absolutely time for us to wake up to the fire-fighting mentality of the larger medical community.  Sometimes treatment and intervention is necessary, but the focus of medical attention ought to be on Prevention in the most natural way.  Dr. Davis thank you for getting that message to us.

    Recently I came across another book, with a title that might be too strong for some, but it does reflect a very sad, flawed, state of affairs:  "Genocide: How Your Doctor's Dietary Ignorance Will Kill You!!!!  By Dr. James Carlson.


  • Anonymous

    6/12/2008 10:12:00 AM |

    What I have found funny is the large # of people that feel the need to defend hospitals or the practices of  doctor.  It doesn't seem to matter what political persuasion a person is, many just seem to have a need to believe the marketing hype that America has the very best doctors and medical care available, and that doctors always have your best interests at heart.  You don't find this kind of loyalty for other industries.  I often thought this high level of trust is caused by Hollywood shows.  Ever since we were little kids many Americans have been bombarded with movies and television programs glorifying doctors and hospitals.

  • Anonymous

    6/13/2008 12:04:00 AM |

    If only these flaws were limited to cardiolopgy. Over the past 15 years these same themes of unethical and immoral lifestyles has become the norm not the exception in our "new society". It will all end and for the better. The cost for this change to the better will be enourmous.

  • Henry C

    6/14/2008 3:16:00 PM |

    It's amazing what is happening around us and we don't see it.

    Thanks Dr. Davis for opening up our eyes.

    Henry C

  • dotslady

    6/16/2008 2:04:00 AM |

    I befriended my daughter's pediatrician's wife and learned then and there about how imperfect people are.  I learned of his depression and family alcoholism.

    Since my celiac diagnosis (and despite my daughter's medical history he didn't diagnose her as being on the autism spectrum - but that's another story), I've learned so much and have shared with her my thoughts about sugar, grains, carbs etc, which have been scoffed at.  I have all but diagnosed HER son because they have not been enlightened.  It's not appreciated.  And she shared with me about other doctors' lives as well.  What you say is true; you need to be in that culture to know more truths for your own safety!

    BTW, I enjoy living vicariously through Chef Bordain and wonder about his lipid panel ... he smokes and gets out of breath easily.  When the time comes, I wonder what medical advice he'll get.  Knowing him, he won't care.