Category Archives: What Makes A Good Cardiologist

A Voodoo Coronary Calcium Scan Could Save Your Life

The skeptical cardiologist received this reader comment recently:

So I went and got a Cardiac Calcium Score on my own since my cardiologist wouldn’t order one because he says they are basically voodoo.. Family History is awful for me.. I got my score of 320 and I’m 48 years old.. Doc looked at it and basically did the oh well.. so I switched docs and the other doc basically did the same thing.. I try so very hard to live a good lifestyle..I just don’t understand why docs wait so long to actually take a look at your heart.. I would have thought a score of 320 would have brought on more testing.. It did not..

I was shocked that a cardiologist practicing in 2019 would term a coronary artery calcium (CAC) scan (aka, heart scan or calcium score) “voodoo.”

I’m a strong advocate of what I wrote in a recent post with the ridiculously long title, “Prevention of Heart Attack and Stroke-Early Detection Of Risk Using Coronary Artery Calcium Scans In The Youngish“:

It’s never too early to start thinking about your risk of cardiovascular disease. If heart disease runs in your family or you have any of the “risk-enhancing” factors listed above, consider a CAC, nontraditional lipid/biomarkers, or vascular screening to better determine where you stand and what you can do about it.

Here’s what I told this young man:

If your cardiologist tells you coronary calcium scores are voodoo I would strongly consider changing cardiologists.

A score of 320 at age 48 puts you in a very high risk category for stroke and heart attack over the next 10 years.

You need to find a physician who understands how to incorporate coronary calcium into his practice and will help you with lifestyle changes and medications to reduce that risk


Let’s analyze my points in detail and see if these off the cuff remarks are really justified

1,  Changing cardiologists.

Recent studies and recent guideline recommendations (see here) all support utilization of CAC in this kind of patient. If you have a strong family history of premature heart disease or sudden death you want a cardiologist who is actively keeping up on the published literature in preventive cardiology,  Such cardiologists are not dismissing CAC as “voodoo” they are incorporating it into their assessment of patient’s risk on a daily basis.

2. High risk of CAC score 320  at age 48

I plugged normal numbers for cholesterol and BP into the MESA risk calculator (see my discussion on how to use this here) for a 48 year old white male.

As you can see the high CAC score puts this patient at almost triple the 10 year risk of heart attack and stroke.

Immediate action is warranted to adjust lifestyle to reduce this risk! This high score will provide great motivation to the patient to stop smoking, exercise, lose excess weight, and modify diet.

Hidden risk factors such as lipoprotein(a),  hs-CRP and LDL-P need to be assessed.

Drug treatment should be considered.

3. Find physician who will be more proactive in preventing heart disease

This may be the hardest part of all my recommendations. On your own you can get a CAC performed and advanced lipoprotein analysis.

However, finding progressive, enlightened, up-to-date preventive cardiologists can be a challenge.

We need a network of such cardiologists.

I frequently receive requests from readers or patients leaving St. Louis for recommendations on cardiologists.

If you are aware of such preventive cardiologists in your area email me or post in comments and I will keep a log and post on the website for reference.

Voodoophobically Yours,

-ACP

Dear Kim, I Am Indifferent To My Online Reputation

The skeptical cardiologist keeps getting  emails from Kimberly of mypracticereputation.com who informs him how important his online reputation is. The last email has quite an urgent, almost threatening tone: Kim reminds me of the multiple previous attempts to contact me and asks me if there is someone else in my practice she could speak with.

According to Kimberly, my online reputation “has become the primary way that patients, colleagues, referring practitioners, and even your friends  will come to learn about you.”

Kimberly informs me that her assessment “includes your online reputation score (A-F) scoring), the total number of reviews found about your practice online (some of which you may not be aware of) and your calculated current Reputation Danger Level™ (In Danger, At Risk or Protected).”

She has a really slick website:

Screen Shot 2016-01-31 at 12.41.36 PM.

However, I have no interest in checking my online reviews nor do I care what my Reputation Danger Level is.

If I were just starting a practice or fighting for new patients I might view this differently and consider engaging in such folderol.

However, at this point in my career, I am really only concerned with having positive interactions with the patients I have and helping them achieve optimal health as best I can. I get more than enough new patients by word of mouth from my current patients, their relatives, and from referring physicians who respect my patient care skills.

Also, I have a feeling that the majority of patients who take the time to write online assessments are disgruntled about something and want to tell the world. I’m not really interested in coming across a review of me that is totally unfair. It would only give me unnecessary stress.

I’m sure there are ways to expunge the negative reviews, likewise there are bound to be effective ways to ramp up the positive reviews. For positive reviews, for example, I could just ask the patients I know who really like my care and style to post something online. I don’t do that: it makes me uncomfortable.

But this just doesn’t seem right. If my online reputation can be manipulated by me or by myonlinereputation or their ilk, it would seem to further delegitimize the whole process.

Kimberly, if you happen to read this, please accept my apologies for not accepting your complementary (normally $249)  analysis.

And please stop sending me emails.

Disreputably Yours,

-ACP

 

My MOC Status Has Changed!

I am Board Certified by the American Board of Internal Medicine (ABIM) in both Cardiovascular Disease and Internal Medicine.

Recently the ABIM has changed the rules and started a Maintenance of Certification (MOC) Program which is chock-full of useless forms, fees and tests.

I, and thousands of other doctors have rebelled against this program, recognizing that there is no evidence it will improve doctors care, patient outcomes or overall quality of medical care but that it will fill the coffers of bureaucrats and bureaucratic institutions and fritter away valuable time we could be spending on patients.

I did not pay my several hundred dollar fee the ABIM demanded for 2015.

MOCAs a result, I received this morning an email from ABIM telling me that “your MOC status has changed”. I logged in and found that I was listed as “Certified, Not Participating in MOC.”

I’m still the clinical cardiologist I was yesterday and I still spend hours weekly reading about the latest developments in cardiology that impact clinical care, teaching residents, and giving conferences but I wonder what the ramifications of this will be.

Dr. Wes, a cardiologist who has been a vociferous opponent of MOC is alerting physicians that one ramification is that the SGR bill the Senate is considering would tie doctor evaluations to MOC status.

You can read his comments here. He includes sample letters to send to Congress.

If the federal government puts their weight behind sanctifying MOC, then all physicians will be forced to participate.

I strongly all urge all physicians to consider weighing  in on this with your local congresspeople.

-ACP