PulseDoc: The Heart of the Matter

The NY Times
Re: Many Doctors, Many Tests, No Rhyme or Reason

(Health Section March 11)

Citing the case of a 50 year old man who was seen by 17 doctors as an example of the excesses we face today in medicine is disingenuous and only serves to vilify physicians. We are not provided with any information about the patient nor his outcome. There are many causes for shortness of breath including asthma, chronic obstructive pulmonary disease, congestive heart failure, pneumonia, pulmonary embolus to name some. Sometimes the cause is not immediately apparent.

The hyperbolic statement “The Man Complained of Shortness of Breath. He Saw 17 Doctors” is is clearly designed to inflame. I agree that doctors do too many procedures & there may be too many consultants involved in a case. By omitting crucial clinical data, however, we do not know whether this patient might have warranted all the physicians and procedures involved. It is irresponsible to make a case for “…..No Rhyme or Reason” without the facts. Now why were there so many physicians involved in this case? Did the patient have an echocardiogram &/or a nuclear stress test to help evaluate the cause of his dyspnea? Since no information is supplied regarding the results of his echocardiogram &/or nuclear stress test the reason for his cardiac catheterization presumably was because these tests revealed information that required further investigation. His pacemaker implantation must have been prompted by a significant cardiac arrhythmia requiring the services of the cardiac electrophysiologist and thoracic surgeon. Both appropriate and justifiable. Since Dr Sandeep Jauhar was the cardiologist responsible for this patient I assume he was responsible for ordering the echocardiogram, the nuclear stress test, the cardiac catheterization, the electrophysiologist and the thoracic surgeon.

What are the motivations of a physician who writes an essay such and this? To enhance his reputation beyond what is justified by the facts? To presume to have such wisdom that he is compelled to share it with the masses? Or to serve as example to his fellow physicians what comprises the “proper” way to practice. Whatever it may be I do not believe it deserved publication in a newspaper that boasts “All the News That’s Fit to Print.”

My name is Sanford S Zevon a retired physician/cardiologist. I was born in Brooklyn, NY and was in practice for 45 years and certified in both internal medicine and cardiovascular disease.

In 1954 I was graduated Phi Beta Kappa from the University of Illinois. I received my medical degree from State University of New York, Downstate Medical Center and my Internship and first year medical residency at the Jewish Hospital of Brooklyn.My second year residency was at Mt Zion Hospital in San Francisco. I completed my residency training and cardiology fellowship at Montefiore Hosp in the Bronx, NY.

I was affiliated with White Plains hospital for 44 years where I served as Chief of Cardiology. I was an assistant clinical professor of medicine at the Albert Einstein College of Medicine.

I was a Fellow of the American College of Physicians, American College of Cardiology, Fellow of the Council on Clinical Cardiology of the American Heart Association and Fellow of the New York Cardiological Society.

Writing from the perspective of a retired clinician, my intention is to comments on pertinent issues facing the declining state of health care in America today.