The most painfully overused word in undergraduate English college papers holds an important role in academic medicine and clinical practice. Often, physicians are forced to weigh the gold standard or the current norm compared with a new alternative to assess which will serve their practice or patients in a superior manner.

For instance, MedAxiom surveyed about 155 cardiology practices—22 of which had recently integrated with a hospital and 70 of which were considering the option—and found all 22 would recommend integration. In evaluating the process, those practices which chose to integrate mainly did so for three reasons: the belief that reimbursement trends favored hospital-based environments, that they would gather better capital growth for the cardiovascular service line and that they would have a better ability to reach goals.

Pat White, president of MedAxiom, told Cardiovascular Business News that while in the process, practices are most concerned that the integration could change the way they practice medicine through management and governance. However, he stressed that the importance of weighing the alternatives, as all members need to be “willing partners” once the decision is made.

Clinically, cardiologists are often forced to examine observational studies, instead of gold-standard randomized, controlled trials for alternatives in the practice of medicine. A recent American Journal of Cardiology study, which compared the safety and efficacy of CABG to angioplasty with drug-eluting stents (DES) in patients with left main coronary artery disease, found that the risk of death or MI at one-year follow up did not differ significantly between CABG and angioplasty with DES, but stroke was lower with stenting and restenosis was significantly higher with stenting.

Until more definitive evidence is published, clinical decisions will have to continue juxtaposing the risk/benefit analysis, which is particularly dependent on an individual’s operator experience and an individual’s patient risk

Sadly, a Circulation study emerged this week indicating that concerns about malpractice suits often influence how cardiologists order some potentially unnecessary tests, instead of being influence by the true clinical appropriateness of the test.

Physicians, as decision makers, are often forced to weigh many options throughout their days, and some may revel that role, in a way that all undergraduate English majors and American guitarist Charlie Sexton appreciate: “I love the word juxtapose. I like balancing words together…Life is not all black and white -- it's shaded.”

On these topics, or any other, please feel free to contact me.

Justine Cadet
jcadet@cardiovascularbusiness.com