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Why cardiac patients are safer when senior cardiologists are away

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As Cambridge Management Group has reported before, research  published recently in JAMA Internal Medicine found that patients with  life-threatening cardiac conditions did better when the senior cardiologists at the most famous academic teaching hospitals weren’t around.

Indeed,   mortality decreased by about a third for some patients when those star doctors were away.

Still, as Ezekiel J. Emanuel, M.D., wrote in the New York Times, “Overall for all heart conditions examined, patients cared for at the teaching hospitals did significantly better than those cared for in community hospitals. So choosing a teaching hospital, when possible, makes a difference.” Better nurses?

Dr. Emanuel suggested a couple of explanations for the higher death rate when the big-foot physicians are around:

“One …is that while senior cardiologists are great researchers, the junior physicians — recently out of training — may actually be more adept clinically. Another potential explanation suggested by the data is that senior cardiologists try more interventions. When the cardiologists were around, patients in cardiac arrest, for example, were significantly more likely to get interventions, like stents, to open up their coronary blood vessels.”

“We — both physicians and patients — usually think more treatment means better treatment. We often forget that every test and treatment can go wrong, produce side effects or lead to additional interventions that themselves can go wrong.”

“One thing patients can do is ask four simple questions when doctors are proposing an intervention, whether an X-ray, genetic test or surgery. First, what difference will it make? Will the test results change our approach to treatment? Second, how much improvement in terms of prolongation of life, reduction in risk of a heart attack or other problem is the treatment actually going to make? Third, how likely and severe are the side effects? And fourth, is the hospital a teaching hospital? The JAMA Internal Medicine study found that mortality was higher overall at nonteaching hospitals.”


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