Winter 2007

Forces Tear Apart, Unify Heart and Vascular Medicine

There are huge centripetal and centrifugal forces at work in heart and vascular medicine. These forces will either bring us together or tear us apart.

The centripetal forces are the changes in technology and training that are pulling everyone together. Cardiology, radiology and vascular surgery — specialty areas that once had very different duties — are each now acquiring the skills to perform jobs that before were the exclusive domains of the others.

Whereas radiologists long ago simply took and interpreted X-rays, interventional radiologists now treat patients directly. Vascular or thoracic surgeons now may be just as comfortable using a catheter as they are a scalpel. Interventional cardiologists want to hold onto and treat patients they previously would have handed off to the surgeons or interventional radiologists. Each specialty is now more like the others than ever before.

Ironically, the forces that are bringing these fields together are giving rise to centrifugal forces that are tearing them apart. Once, each specialty had a role to play in the treatment of cardiovascular patients. More and more, though, those in each of these medical departments desire — and have the capability — to do everything themselves.

This changing clinical landscape has created serious competition for patients and discord among physicians in medical centers across the country. The situation is most intense and furthest along in academic medical centers. At some centers, whole divisions are in danger of vanishing. But inevitably, the trend will filter down to private and community hospitals.

Medical centers are not the only losers. When specialties become separate silos of clinical care, patients are denied the insights and knowledge that have historically been contributed by physicians trained in the other disciplines. Research and clinical advancements are also affected detrimentally when cardiologists, radiologists and surgeons have fewer reasons to interact. Dramatic research advances usually come at the interface between disciplines. But with little interdisciplinary interaction, there is no interface.

The UCSF Heart and Vascular Center was formed to foster positive and collegial interaction between cardiologists, radiologists and surgeons in the interests of our patients. We have forged agreements that promote the kind of cooperative and dynamic relationships that have already produced dramatic research advances and the best clinical care possible.

Karen Rago, R.N., M.P.A.
Administrative Director
UCSF Heart and Vascular Center

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