Coping with a sea of data a challenge

Integrating new technologies, concepts and data into practicing contemporary CV medicine is an ongoing challenge.

Cardiovascular medicine is a fast moving field, and our practice of it continues to change each year.

As scientists and researchers strive to unravel the mysteries of human pathology, clinicians must try to apply their discoveries to the every day practice of medicine.

A sea of data storms into our mailboxes on a monthly basis, claiming to represent the ever-changing concept of evidence-based medicine. We do our best to keep up with the new literature, and off we go to fight disease with data while searching for statistical probabilities in our limited history and physical exam.

Juan Rivera

Technological innovation is directly proportional to scientific progress. Biotechnology quickly works its way into clinical medicine introducing novel procedures, therapies and diagnostic possibilities that bring a new perspective to our ongoing fight against CVD and, ultimately, against death.

This technology, of course, is not cheap. It is also not infallible. After it is available for clinical practice, we tend to overuse it as part of our quest to deliver state-of-the-art medicine. Do we really have an indication? Are we using it as a substitution for our clinical judgment? Is defensive medicine altering our practice to the point that we order extra diagnostic tests and have patients undergo unnecessary procedures just so we can be safe rather than sorry? How much longer can our health care system resist this abuse before it collapses?

Physicians must multitask

Keeping up with the latest advances in medicine is difficult and time consuming, but understanding how and when to integrate these new concepts, technologies and ideas is even more challenging. We don’t want a clinical trial to be the sole dictator of the care delivered to a patient. Our job as physicians is to practice medicine, the art of medicine, and not to reduce our role to mere statistical- and trial-memorizing analysts. I am a firm believer in practicing evidence-based medicine and in the development of new technologies, but I am against the indiscriminate and at times naive way in which we apply them to patient care.

We should be physicians and managers, using our skills and training to guide our diagnostic approach and patient care while effectively using the data, statistics and technology available to us to complement our therapeutic goal. When advanced imaging studies, published trials that sometimes are not even representative of our patient population, and seemingly uncomplicated invasive procedures govern our clinical impression, we are destined to economically overload our health care system.

The ultimate purpose of our profession should be to heal human suffering through the practice of that trained and skilled art we call medicine. To achieve our goal, we have to understand the human body, how it works, and what can disturb its equilibrium. Scientific research is the cornerstone of that effort. Clinical research also plays an integral role by searching for a uniform and more standardized way of practicing medicine, with the underlying goal of providing better and less harmful patient care treatments. Technology stems from the above mentioned fields as the next logical step, and as a mean to the overall greater end.

It is imperative that we comprehend these different but interrelated professional dimensions for us to practice contemporary CV medicine.

As cardiologists, we must be aware of the scientific, clinical and technological research that relates to our field. Our responsibility is to individualize each clinical case by combining clinical judgment with medical literature to provide balanced care. Not being up-to-date with the latest discoveries would be irresponsible. Relying only on clinical trials and on fancy and expensive noninvasive or invasive imaging modalities to formulate our clinical opinion would be practicing robotic medicine.

Juan Rivera, MD, is a Fellow at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and a member of the Today in Cardiology Fellows Advisory Board.