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| If you have heart disease
you deserve to be cared for by a cardiologist.
To limit health costs, health maintenance organizations in the United States are shifting medical care from specialists to primary care physicians (internal medicine, family medicine and general practice). This shift should lower medical costs because primary care physicians "provide care that is less resource-intensive"(medical business babble meaning they are less likely to refer the patient for heart catheterization, angioplasty or bypass surgery, and their patients have shorter hospital stays). What is the true cost of this trend? A recent study of all 220,535 Medicare patients who had heart attacks in the United States in 1992 revealed that patients cared for by a cardiologist were 12 percent less likely to die over the next year as those cared for by primary care physicians. I know of a lot of medicines and/or interventions that will result in improved survival, but I am unaware of any other single intervention that will result in 12 fewer deaths per 100 patients with heart attacks per year. Other studies have shown that cardiologists are more likely to prescribe medicines that have been proven by scientific study to improve survival, and still other studies indicate that patients cared for in hospitals that have active cardiac catheterization laboratories and surgical programs are the hospitals with the best survival rates. This does not mean that every patient needs cardiac catheterization or that there are not (in some hospitals) unnecessary cardiac catheterizations being done. It does mean that a well-trained cardiologist (and not necessarily the cardiologist who would do the catheterization) should make the decision. How much is a life worth? How much are 12 lives for every 100 heart attacks worth? Think about this if you are an individual or an employer about to sign up for care by the HMO that offers you the lowest rate. The right to choose one's own physician is a right that Americans should not relinquish without a tremendous fight.
Professor and Chief of Cardiology
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