A recent New York Times article reported that a hospital system in Florida is being investigated for possible overuse of cardiac procedures and percutaneous coronary interventions (PCI). Although the facts currently available to the public are limited, the mere possibility of inappropriate procedures with little regard for patient well-being evokes feelings of incredulity, shock, and dismay. The kind of clinical practice depicted in the article flies in the face of all of our ACC core values and mission?values that?are?wholeheartedly embraced by the vast majority of cardiologists. Unfortunately, unprofessional behavior can arise anywhere in society, through myriad circumstances. In medicine, however,?even a single occurrence that puts a patient at risk is one too many. Beyond the effect on the individual patient, unprofessional behavior betrays patient trust and, when portrayed at the national level, sends shock waves into good patient-physician relationships.
The College has always emphasized professionalism and quality of care. As new discoveries are applied to practice and our knowledge increases, the ACC updates?an extensive array of educational and quality improvement tools to help guide appropriate care: educational programs,?comprehensive?guideline and quality standards, Appropriate Use Criteria (AUC), the National Cardiovascular Data Registry (NCDR?) and more. These tools provide a source of information to the health care team on the latest science and evidence-based medicine as well as a means to evaluate and measure quality parameters of the care rendered. Ultimately, the best care is accomplished in the context of an enduring relationship between a patient and the physician/health care team.
In recent months I?ve highlighted the importance of involving patients in their care and rekindling the patient-physician relationship. The ACC?s desire to encourage patients to take an active role in their own care is evidenced by resources such as CardioSmart. We have also invested a great deal of time and effort developing tools for physicians, such as the College?s AUC. The criteria define ?when to do? and ?how often to do? a given procedure based on a patient?s profile and evolving scientific evidence, combined with a physician?s seasoned judgment (click here to view a recent blog series on AUC, and check out the current issue of Cardiology magazine for a story on the purpose behind AUC).? Over the past few years, these documents have tackled a variety of diagnostic procedures and therapeutic interventions. An AUC document on coronary revascularization was published in 2009 and more recently, one on cardiac catheterization.
An independent program, Accreditation for Cardiovascular Excellence (ACE), sponsored by the ACC and Society of Cardiovascular Angiography and Interventions (SCAI), was started a few years ago to provide accreditation and continuing quality improvement services for cardiac catheterization, PCI and?carotid artery stenting,?as well as external peer review for coronary angiography and appropriate use. Through its external cath lab evaluation, the program can assess cath lab quality, appropriateness and angiogram film reviews to evaluate accuracy of coronary assessments.
As ACC Past President Ralph Brindis, MD, MACC, said in an ACC in Touch Blog post on the overutilization issue in 2011, ?how we react to this overutilization storm will determine our future.?? ?The ACC?s Maryland Chapter, who at that time was faced with a similar situation, was exemplary in the way they tackled their own crisis and worked tirelessly with SCAI and state officials to advocate effectively for oversight and guidelines for cath labs performing PCI.
A medical professional carries two primary levels of responsibility: toward our profession and toward our patients. The majority of physicians are caring, competent and good-natured. Incidents that cast doubt on our collective integrity may distort our practices and relationships in numerous ways, but they also present an opportunity for each of us to reaffirm, in the strongest terms, our fundamental ethical commitments.?
supreme court justices 19 kids and counting danny o brien alicia silverstone park slope food coop anchorman sequel safety not guaranteed
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.