Physician’s distortion of professional priorities may be bad for the patient

Nonfiction book highlights the relationship between medical profession, the health care system, corporate America and patients.

In this rapidly evolving era of technological advances, pharmaceutical empires, cutting edge scientific research and insurance companies’ influence on medical care, a physician’s intent may conflict with the best interest of his or her patient.

Individuals seek our counsel to cure their illness and alleviate pain and suffering. However, our patient care decisions may be driven by more than our desire to help another human being.

The need to enroll patients in a research trial, the pressure of having to generate a significant income (eg, for a private group or an academic institution), and relationships with the pharmaceutical industry may influence a physician’s decision regarding the best course of action for a given patient. These factors play an important role in the practice of contemporary medicine.

Doctors who balance these conflicting aspects of medicine and follow the basic principle “Primum non nocere,” or “First, do no harm,” have the most successful outcomes for both patient and physician.

Skepticism a savior

Several years ago, Chae Hyun Moon, MD, an interventional cardiologist and chief of the Redding Medical Center, Redding, Calif., cardiovascular division, and Fidel Realyvasquez, MD, a cardiovascular surgeon, were involved in a horrendous medical scandal. These two doctors performed unnecessary angiograms, IVUS and bypass surgeries on a significant number of their patients, many with normal coronary arteries.

Juan Rivera

Stephen Klaidman, a former editor and reporter for the New York Times and The Washington Post, details the story in his new book titled “Coronary.” A 55-year-old Catholic priest named John Corapi first met Moon when he visited Moon’s clinic complaining of chronic fatigue. Moon listened to Corapi’s complaints, performed a physical exam, and ordered a coronary calcium scan that showed minimal coronary calcification. He did not perform a stress test. Instead, he was quick to deliver his final verdict, “You need a cardiac catheterization.”

Corapi took Moon’s advice and underwent a cardiac catheterization. Moon not only performed an angiogram, but he also performed a “diagnostic” intravascular ultrasound procedure. As soon as he finished, he delivered the second blow: “You need bypass surgery.” The priest was scared, but also skeptical. Several months prior to his encounter with Moon he had undergone a stress test that was interpreted as a normal study. As it turned out, skepticism may have saved his life.

Unjustified procedures

Corapi sought medical advice from at least three other board certified cardiologists, all of whom agreed that his coronaries were completely free of disease and that having bypass surgery was not only unindicated but also outrageous. Corapi was disturbed that a cardiologist would recommend cracking his chest open for no apparent, clinically justifiable reason. Redding’s cardiovascular center was performing an inordinate number of coronary angiograms and bypass surgeries. How many of these were unjustified, similar to the case with John Corapi?

This incident led to a three-year FBI investigation as well as hundreds of civil law suits. The doctors, although it was clear that they were performing procedures and surgeries on healthy people, never had to face criminal charges. The civil suits were ultimately settled for $450 million, most of which were covered by Tenet Health Care, the company that owned the hospital.

Reading Klaidman’s book was almost like reading a John Grisham novel, one in which an unscrupulous moneymaking company was manipulating physicians into performing procedures on healthy people to derive a substantial profit. This in turn would lead to a controversial, media-frenzy mass tort lawsuit and the company’s bankruptcy.

“Coronary” is a nonfiction book that stresses the complex relationship between the medical profession, the health care system, corporate America and the people at the receiving end: those who seek medical attention. Doctors are directly responsible for delivering the best possible care to their patients; at least that is how patients feel when they put their lives in our hands.

When we put them in harm’s way due to a distortion of our professional priorities, we violate the true essence of medicine.

Juan Rivera, MD, is a Fellow at the Johns Hopkins Ciccarone Center for Prevention of Heart Disease and a Member of the Cardiology TodayFellows Advisory Board.