To illuminate the topic of how difficult it is “to get doctors to quit ordering unnecessary procedures and tests,” NPR’s radio news show All Things Considered set up a discussion between Eric Topol and Paul Teirstein.
Reporter Chana Joffe-Walt used the two Scripps Health interventional cardiologists– “same specialty, same city, same hospital, very different points of view”– to demonstrate that “what seems unnecessary to some doctors is standard procedure for others.”
Topol and Teirstein, who have been engaging in a series of “light-hearted discussions” on TheHeart.Org (click here to read the CardioBrief summary of their most recent show on percutaneous aortic valve procedures) disagree about all but one point in the 5 minute segment.
Topol says that cardiologists use too many stents: “there is unquestionably more procedures that are being done than need to be done.”
Teirstein responds: “I definitely have a bias toward stents because I have a lot of experience with stents and I’ve seen patients do so much better.”
The NPR reporter spends a day with Teirstein in the cath lab and watches him perform six procedures and implant 10 stents. Watching one procedure, she observes: “you can watch right away on the screen, the artery opens” and then the audio track picks up her astonished “wow,” a perfect aural encapsulation of the thrilling satisfaction that is achieved when the itch of the oculo-stenotic reflex is scratched.
Teirstein encourages her response: “you see the difference, right? It’s not a subtle difference. Here exactly is the allure of stenting: it’s an instant fix, and she should feel a lot better…”
Topol responds with a different perspective: “sometimes there’s a tendency to believe in your procedures too much… most of the time interventional cardiologists are like that, they are going to say, well I can fix the artery. The question of course is, in some cases, should you?”
Teirstein denies there is overuse: “I just haven’t seen that.” Topol responds: “I think you have a rose-colored glass view.”
The reporter asks about financial considerations. Topol agrees to answer “because I’m not trying to be a hero to my fellow physicians, I’m trying to tell it like it is: some of it is financially motivated but at a subconscious level.”
“I strongly disagree with you on this,” replies Teirstein, “I really do. Financial incentive is the last thing you think about.”
The segment ends with a final note of agreement. Both Topol and Teirstein agree that medical decisions should be made by physicians, not government or insureers.
You can read Chana Joffe-Walt’s news story here, but it doesn’t capture the flavor of the audio debate. Fortunately the page also contains a link to listen to the entire segment.