Tag Archives: cardiologist

What Is A Cardiologist?

The skeptical cardiologist recently received a cease and desist letter from a lawyer representing Dr. Steven Gundry who felt I was defaming the goop doctor and supplement peddler by saying he was not a cardiologist.

The lawyer’s letter reminded me that many patients do not understand exactly what a cardiologist is and mistake us for cardiothoracic surgeons.

Here’s how the American College of Cardiology defines a cardiologist:

A cardiologist is a doctor with special training and skill in finding, treating and preventing diseases of the heart and blood vessels.

And here is part of my response to the lawyer which further clarifies the differences:

I understand your confusion with respect to the terminology of cardiologist versus cardiac or cardiothoracic surgeon. A surprising number of patients and readers think that I as a cardiologist perform “heart surgery.” Of course, actual surgery on the heart requiring “cracking open the chest” (which is what most laypeople consider “open heart surgery”) is always done by a cardiac surgeon not a cardiologist.

Like all other board-certified cardiologists I have gone through accredited training programs in internal medicine followed by a formal cardiology training program. There is no evidence that Dr. Gundry has done this.

Cardiologists, being extremely bright, entrepreneurial  and energetic, have expanded the toolkit they have for diagnosing and treating heart disease without having to engage in surgery. Thus,
cardiologists can insert  stents to open blocked coronary arteries, implant pacemakers and even replace valves all by accessing the cardiovascular system via its arteries and veins.

We don’t call this surgery because we aren’t surgeons and didn’t go through surgical training. We call these procedures. These are invasive procedures, to be fair, as we have invaded the vasculature and the interior of the heart and from these arterial and venous incursions complications may ensue.

A typical invasive procedure that cardiologists do looks like this:

This is a cardiologist  gaining access to the arterial system by inserting a catheter into the radial artery.

 

 

A typical open heart surgery performed by a cardiothoracic surgeon requires large incisions with direct visualization of the heart and looks like this:

 

 

 

 

 

Cardiologists And Cardiac Surgeons Undergo Totally Different Training

I began my response to Gundry’s lawyer by indicating my surprise that the lawyer felt Gundry was a cardiologist:

This comes as quite a surprise to me as my detailed research into Dr. Gundry’s background, training and credentials revealed absolutely no evidence that he is or ever was a cardiologist as we in the medical community define cardiologist. In fact, as you can see in his listing on CTSnet (which is a network of cardiothoracic surgeons) his post medical school training consisted of the following

University of Michigan Hospitals Surgery Internship (1977-78)
National Institutes of Health, Clinical Associate in Cardiac Surgery (1978-80)
University of Michigan Hospitals Surgery Residency (1980-83)
University of Michigan Hospitals Cardiothoracic Surgery Residency (1983-85)

He is trained as a cardiothoracic surgeon. Cardiothoracic surgeons go through surgical training programs which are completely different from the medical training programs that cardiologists like myself go through.

My description of him in this regards reads as follows:

“He is also widely described as a cardiologist but he is not, He is (or was) a cardiac surgeon (like, strangely enough, the celebrity prince of quackery, Dr. Oz)”

As you can see, my statement is perfectly accurate.

As far as him being a being elected a “Fellow of the American College of Cardiology” I can find no documentation of this and he is not currently listed as a member of the American College of Cardiology. But even if he was this does not make him a cardiologist because many cardiothoracic surgeons are members of the ACC.

Might I suggest you ask Dr. Gundry if he thinks he is a cardiologist. I’m pretty sure he would answer no.

What Is A Quack?

The lawyer then went on to accuse me of suggesting that Gundry is a quack because:

A “quack” is defined in common parlance as a lay person pretending to be a licensed physician. In other words, a fake doctor. The term “quack” connotes dishonesty, deception, fraudulent behavior, etc. Dr. Gundry has been a licensed physician and surgeon since at least 1989 (see Exhibit B attached), performed thousands of heart surgeries, and developed patented, life- saving medical technology. Your statements are not only factually incorrect, but are also irresponsible and intentionally misleading, resulting in harm to Dr. Gundry’s reputation and income.

To which I responded:

There seems to be an attempt here to suggest that by saying he is not a cardiologist I am calling him a quack. But as my previous information should have convinced you he is not a cardiologist but a cardiothoracic surgeon. He has done very good work as a cardiothoracic surgeon and I am happy to attest to that. I will be happy to add that information to his description in my up and coming posts on him.

At no point do I call him a quack in my posts. Clearly if I’m calling him a cardiothoracic surgeon I am acknowledging that he is a licensed physician and not, clearly, a fake doctor.

I have to admit my definition of quack has not been the common dictionary definition of “fake medical doctor.”  I have always considered those who engage in quackery to be quacks.

Quackery is defined at Quackwatch (the definitive website on the topic) as the promotion of unsubstantiated methods that lack a scientifically plausible rationale. 

And one can have a perfectly legitimate training as a medical doctor and engage in what most would consider quackery.

Even board-certified cardiologists like myself can engage in quackery.

Clearly there is a disconnect between the common definition of quack and that of quackery and in a  subsequent post I will delve further into the miasma of quackery, quacks and quacking,

Anatinely Yours,

-ACP

N.B. While researching this post I came across a fantastic article on Gwyneth Paltrow’s goop Doctors from David Gorski at Science-Based medicine. I highly recommend reading the entire piece (gwyneth-paltrow-and-goop-another-triumph-of-celebrity-pseudoscience-and-quackery) for your edification and pleasure.

Gorski’s paragraph on Gundry begins

  • Dr. Steven Gundry, a cardiothoracic surgeon very much like Dr. Mehmet Oz who, as he took incredible pains to lecture Dr. Gunter in his section of Goop’s hit piece on her, who once was a very respectable academic surgeon and, even better than Dr. Oz, served as Chairman of Cardiothoracic Surgery at Loma Linda University for a number of years, before leaving academia to undertake his private practice. (No wonder he and Dr. Oz seem to have an affinity for each other!) These days, he devotes his time to his practice, writing books, giving talks, and selling expensive supplements like Vital Reds (a bargain at $69.95 for per jar, discounted to $377.73 if you buy six jars) and Lectin Shield (a slightly more expensive bargain at $79.95 a jar, $419.70 for six), while bragging (as he did in his response to Dr. Gunter) about how so very, very hard he works and even—gasp!—accepts Medicare and Medicaid patients. His most recent book is The Plant Paradox: The Hidden Dangers in “Healthy Foods” That Cause Disease and Weight Gain. (Spoiler: That “hidden danger” is lectins.)

 

Featured image Photo by Ravi Singh on Unsplash

Six Things a Cardiologist Loves About Apple Watch Series 1 – None of Which Involve Health

The skeptical cardiologist stopped wearing his initial wearable piece of technology (a Garmin device that constantly prompted him to move, described here), within 6 months of purchasing it; it just wasn’t worth the effort of charging and putting on the the wrist.

I am not alone in finding FitBit type devices not worth wearing after awhile. ConscienHealth points out that sales and stock price of FitBit are down significantly.  Part of this is competition, part saturation of the market, but part must be due to individuals going through a process similar to mine.

The great promise that wearable fitness/sleep/activity tracking devices would make us healthier has not been fulfilled.

A recent study showed that among obese young adults, the addition of a wearable technology device to a standard behavioral intervention resulted in less weight loss over 24 months.

Taking the Apple Watch Plunge

However, knowing I was a fan of all things Apple, the eternal fiancee  bought me a Series 1 Apple Watch, which I have come to love. This love has little to do with how the device tracks my steps or my sleep or my pulse or my movement.

Let me count the ways I do love my Apple Watch…

  1. I can answer my phone without touching my phone or
    If I see a call is coming in from Hackert, my home security company, I have to take it no matter what I’m doing. Here I’m having a conversation about what set off my home alarm just using the Apple Watch

    having it near me or even knowing where my phone is.

    Since I’m constantly misplacing the damn thing, this is a surprisingly helpful feature. There is also the really cool aspect of walking around and having a telephone conversation  using my watch.

During a busy day of seeing patients in the office I typically will receive multiple calls from the ER or other doctors I have to talk to immediately.  Now, I can rapidly screen my calls with a tilt of my wrist and excuse myself to take the call. If I’ve been trying to get ahold of Dr. X to discuss a mutual patient, and he calls while I’m doing a transesophageal echocardiogram, I can have someone touch my watch instead of reaching into my pants for my iPhone, or searching in my office for it, or missing the call altogether.

 I’m missing much less important calls these days.

And although previously I would take calls while driving, the watch makes this process much simpler and therefore much safer.

2. Receiving and responding to text messages does not require accessing my iPhone.

Responding in detail to texts is as simple as touching the microphone icon on the Watch, speaking, then touching SEND. The translator works pretty well.

This doesn’t seem like that big of a deal, but again, the ability to rapidly scan incoming texts with just a tilt of the wrist greatly facilitates expeditious screening and processing.

The Apple Watch allows response via either audio recording (translated seamlessly and quickly to text) or pre-set standard responses or emojis.

 

3. “Hey Siri” function simplifies and makes hands-free and iPhone-free many useful tasks. For example:

  • To set a timer for my (heart-healthy) boiled eggs, I say “Hey Siri, set timer for 11 minutes.” Normally in this situation I avoid setting the timer because I’m too busy to grab my phone, open it, and find the timer app (I know I could use Siri on my phone, but that requires more effort).
  • If I suddenly remember I need to call someone while driving, the “Hey Siri” function allows making the call without taking my hands off the steering wheel.
  • If a brilliant idea for a blog post occurs to me while driving or walking through the hospital corridors, “Hey Siri” can take a note with ease.

4. Checking the time is a lot easier (I know, all watches do this, but I’ve haven’t worn a watch for about 20 years).

The lower left icon triggers the pinging of iPhone. Watch and iPhone must be “Connected” via either bluetooth and proximity or via being on the same WIFI network.

5. If I misplace my iPhone (this happens roughly once per hour when I am at home), I can “ping” it by pushing a button on my Apple Watch: follow the ping and “voila!” I have found my iPhone. Most of the time it is lying under a piece of paper or article of clothing within a few feet of where I’m working, but sometimes it is in an obscure corner for obscure reasons.

Here’s a true story which illustrates my tremendous absent-mindeness and the value of the “ping.”

I haven’t figured out how the Apple Watch knows this but when I’m getting ready to drive to work in the morning it automatically shows me something like this, advising me on the best route to take. Likewise, when I’m getting ready to leave work, it alerts me to best route home. It’s somewhat creepy. Is it keeping a log of my driving patterns?

I left my office Friday evening and after stepping outside I realized I did not have my iPhone in its usual location, the left front pocket of my pants. I searched the pockets in my pants and in the jacket I was wearing to no avail. I began heading back to my office believing that I had left it on my desk but then realized that I might have put it in my satchel. Not in my satchel. A bright idea then occurred to me: ping the iPhone to see if it was in the satchel, but hidden.

Sure enough I heard the iPhone ping. But it was not in the satchel; it was (for obscure reasons) in my shirt pocket (a place that apparently makes it undetectable to me).

6. Information on local weather is immediately available. I have configured my watch “dial” to show me the local temperature. Right now with a flick of my wrist I can see that it’s 17 degrees outside and I’m going to have to dress warmly. I’ve also configured my watch dial to tell me when sunrise/sunset is and what my heart rate is.

These last two things, although immensely interesting, are not that helpful.

Oh, excuse me, my watch timer is telling me my eggs are done.

Pingophilically Yours,

-ACP

P.S. I’m still in the process of evaluating the work-out/sleep/move/mindfulness features of Apple Watch and hope to write about it in the near future.

Feel free to share the things you love or hate about your Apple Watch below.