Wednesday, March 22, 2017

Team Matters


Thanks to the miracle of modern technology, I'm posting this blog from 35,000 feet up over this beautiful country of ours. I'm traveling to attend a course on minimally invasive mitral valve repair in California.

One of my favorite movies is "Up in the Air" with George Clooney. In the film, he loves being in flight, traveling across the country for his job. There is a certain serenity, a time to reflect. I agree. I find it very relaxing, one of the few times I am completely alone with my thoughts, while enjoying the view of God's work below.

Tonight, my thoughts are with my team. At the center of that team are four special women who I have had the privilege of working with for as long as I can remember --Mindy Snyder, Carol Shannon, RN, Pam Olivieri, and Lisa Garloff.

Mindy is our practice manager. Mindy is the heart and soul of our practice. Carol is one of the most experienced and talented cardiothoracic surgery nurse in the country with 35 years of experience! Pam is our office scheduler who manages thousands of patient appointments every year, somehow keeping up with emergencies and constant changes. Lisa is our O.R. scheduler, who ensures that every patient that goes to the operating room is ready and safe to proceed.

Together, they are the core of our practice. They work so hard and rarely get the recognition that they deserve.  I know that whatever success I may have enjoyed over these past 25 years, it is largely due to my team --the entire team-- exemplified by these four amazing professionals. To me, it's more than just a team, it feels like family.

Indeed, what separates our cardiothoracic team at Lehigh Valley Health Network is that we are a family. All of our surgeons, physician assistants, nurses, and staff are truly special. Patients sense this when they come to our office and when they are cared for in our operating rooms and our intensive care units.

Yes, I've been fortunate to travel far and wide for my career, as I am doing tonight. And in all my travels, I know, I'm the luckiest surgeon in the world to have the finest team at home.

"The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don't play together, the club won't be worth a dime." --Babe Ruth

Sunday, July 17, 2016

Patients Need to Do Their Research

Be like Barry...

Barry Kanick Showing His Research on Heart Surgeons

I make it a point to tell all of my patients to get a second opinion. I often wonder why we will visit 4 or 5 car dealerships when when looking for a new car, but we often take on face value the first recommendation we receive when looking for a new doctor?

Of course, there are some important differences.  It doesn't cost you anything to visit car dealerships, whereas it often costs a lot of money to visit various doctors, especially specialists.  Moreover, when you need a specialist, you often don't have the luxury of time.  Specifically, if you need heart surgery, you may not be in an "elective" situation --you may have to make a quick decision based on limited information.  Lastly, your health insurance may not give you many choices.

That last point is an important one.  Your insurance and/or your health network may govern your choices. For example, chances are today that your doctor is employed by a health network.  Recently, many of the best health networks are merging with each other, forming larger, hopefully even better health networks. Many will even offer their own insurance product. The big buzz word in health care today is "Accountable Care Organization" or ACO, which combines the efforts of many physicians and hospitals to share in the care and cost of caring for a population of patients.

Hopefully in the long run, all of these changes will be good for our community, especially if these larger health networks provide more "value" to their patient populations. Most large, high quality programs such as Lehigh Valley Health Network define value as providing higher quality health care at a lower cost.  Therefore, patients should do their research and make sure they are aligned with a health care organization that is focused on providing value for their family's health, not just services.

The problem is... we haven't gotten there yet.  What I mean is that despite a tremendous effort to improve health care by many stakeholders --doctors, hospitals, insurance companies, and the government-- the care we provide in the U.S. remains inconsistent.  Dr. David Nash, Dean of the School of Population Health at Thomas Jefferson University refers to this phenomenon as "unexplained clinical variation."  Simply put, for any given diagnosis or surgical procedure, different doctors or surgeons may approach the exact same problem in significantly different ways, often resulting in significantly different outcome.

So what can you do if you need to find a doctor?  First, when you sign up for your health insurance or align yourself with a hospital network, you need to read the policy carefully and determine what is allowed with regards to obtaining a second opinion or seeking a specialist out of the network.

In many instances, you may have more choices than you think.  No doubt, if you need a specialist, your physician will likely select someone who they trust within their network. And that's fine. We do the same thing at Lehigh Valley Health Network.  The fact is, at LVHN we have very high standards of excellence and a long history of quality outcomes, so it would only follow that our doctors would recommend the colleagues that they trust.

And yet, even if you are at a fine hospital, with trusted, experienced physicians, it is important to do your research and ask important questions.  Moreover, if you are at an institution that doesn't have the volume of experience or the latest technologies, or the recognition for quality that you desire for your family, all the more reason to seek a second opinion.

The Internet has become a great source of information.  There are many very good educational sites, such as Adam Pick's website: www.heart-valve-surgery.com or my own: www.heartlungdoc.com.  Also, you can find a lot of important information from state and national public report cards, such as the Pennsylvania Health Care Cost Containment Council (PHC4): www.phc4.org, or the Center for Medicare and Medicaid Services (CMS) website: www.medicare.gov/physiciancompare/search.html.

Of course, the Internet is not perfect and although you can acquire a ton of information, some may be misleading or incorrect.  That's why whenever possible you should try to get a second opinion in person. You should write down a list of questions for your doctor.  For example, if you are meeting a surgeon to discuss having an operation, some things you may wish to ask include:

1. How many years have you been doing this procedure?

2. How many of these procedures have you performed in the past two years?

3. What is your success rate?  Your complication rate?  Your mortality rate?

4. Will you be taking care of me after the surgery?

5. What are the alternatives to this surgery?

6. What are the long-term expectations?  For example, will I need another operation down the road?

Two final thoughts.  It's important to "ask around."  When you find out that you need a doctor, you will be surprised to learn how many of your friends already have experience or knowledge that may help guide your decision.  And, here's a little inside tip... in addition to asking friends who may have been patients, ask friends who are doctors and nurses.  Often the best advice will come from them.

Barry Kanick was one of the most informed patients that I have ever met.  The picture above was taken the day he was discharged from Lehigh Valley Hospital after his heart valve surgery. He gave me permission to post it on my website.  Barry first came to my attention after he emailed me from my website.  He had read Adam Pick's book and had scoured the Internet but requested to see me for a second opinion.  I called him on the phone after he emailed me and we talked for quite some time.  Then we met in my office and we continued to email each other back and forth.

To be honest, I don't think Barry decided to have me do his surgery because he necessarily thought my skills were any better than the fine surgeons on his list, but rather that I was the most responsive and transparent with my experience and results.  How a doctor communicates does matter, as does bedside manners and trust.  After literally months of research, Barry felt most comfortable with me.

His surgery went very well and he was ready for discharge to go home after only a few days.  He had little to no pain and was of course the ideal patient, very motivated to get better.  He was walking the halls on the first day!

He didn't bring out his "scorecard" on surgeons until the day he went home. I had not seen it before that day. I must admit, I almost fell over when I saw his chart.  The names on that list are among the most well known heart surgeons in the country.  I was truly honored to see my name on the same page as Dr. Joseph Bavaria, Dr. Marc Gillinov, and Dr. David Adams, to name a few.  No doubt, Barry would have done just as well if he had his surgery with any of these great colleagues.

In the end, Barry had narrowed his research to a very good short list of options. True, because his condition was stable, he had the luxury of taking his time in order to make the best decision for him.  But there still is an important lesson to learn.  That is, whenever there is a question about your health, please do as much research as you can before selecting a physician.  And, even if your insurance policy or health network governs your choices, it is still equally important to do your research and ask important questions.

Be like Barry...

Friday, October 23, 2015

Beyond the Billboards: Medical Marketing Can Help Patients Decide

 

 

 
It has certainly been an interesting year for me.  It started out with a phone call from my sister.  I thought something was terribly wrong because she was crying.  Instead she was calling to say how proud she was of me, having just passed a billboard featuring our heart surgery program at LVHN.

Fast forward a year later and my billboards are coming down as the hospital continues to highlight other physicians and topics.  Alas, my time on the side of the road, the mall, and the movies will soon fade.  But what to make of all of this marketing stuff?  Sure, it is nice to see your name and hospital proudly displayed, but what does it mean for patients in our community?
 
The fact is medical marketing is playing an increasingly important role in the decision making process for patients and their families.  As just one example, due to the ongoing healthcare reforms more and more patients are being faced with high-deductible health plans.  A concern is that this may lead to some patients delaying necessary care which in turn can adversely impact their health.  On the other hand, hopefully these patients will choose instead to simply do more research and be more selective of the care they need to receive.  Put differently, patients need to become more careful consumers.

Puman Anand Keller, a professor at the Tuck School of Business at Dartmouth, published an article in Forbes in 2014 called “What marketing can do for hospitals.” Keller pointed out that hospitals are now facing the same world of transparency and competition that hotels and other service businesses have faced for years.  Just as a consumer may go to TripAdvisor to review a hotel, patients are scrutinizing hospital ads, going to their web sites, and searching doctors’ results in Consumer Reports, US News, Healthgrades, and a growing list of other sources.

Sam Kennedy of The Morning Call published a related article on July 16, “New websites rate surgeons.” What struck me about the Call article was that it was in the “Your Money” section of the newspaper. And yet, that is exactly the point. As Kennedy states, choosing a surgeon is one of the biggest decisions you can make and often patients (consumers) are not very well informed.  Websites such as surgeonratings.org look at Medicare data to determine mortality rates, complications, length of stay, readmissions, and costs. We should expect more of these websites to appear in the future.

No doubt all of this can still be very confusing for patients.  Most hospitals tout that they are “tops” in their field for certain procedures, based upon the many different report cards available to assess doctors and hospitals.  If a hospital gets an “A” grade on a particular report card, you can be sure you will see it in an ad. As a consumer you need to look beyond the billboards and do your own research to learn more about that rating and that hospital.

Way back in 1999, I saw some of this coming.  I was sitting across a retired couple, providing a second opinion for heart surgery. After an hour of what I thought was a very complete discussion, the gentleman asked me if I had a website!  Keep in mind 1999 is ancient for the Web.  Google only started in 1998, Facebook not until 2004 and Twitter in 2006.

I decided to take night classes at Penn State on web design and started my own website www.heartlungdoc.com.  It is a personal site that mixes everything from my training, surgical experience, types of operations, and most of all, my outcomes and my personal philosophy on patient care.  Sixteen years later my website gets many hits daily from all over the world and almost every new patient has found my personal website on the Internet.
 
Of course, when it is all said and done, the best advice is to stay healthy.  But if you do need guidance, think of yourself as an informed consumer, not only as a patient.  Do not rely on just one doctor’s recommendation or one source on the Internet.  Ask questions.  If able, ask for a second opinion.  Know your doctor’s results and what other patients think of that doctor’s bedside manners, responsiveness, and empathy.  You do have choices.  When it comes to your health and your healthcare, make good ones.

 

Tuesday, April 8, 2014

Aortic Valve Root Reconstruction and Aneurysm Repair

I am excited to post this new video of a complex aortic aneurysm and valve replacement operation.

This patient is 64-years old who was found to have a large aneurysm near the heart.  We often refer to these proximal ascending aortic aneurysms as "root aneurysms" meaning that they occur at the very beginning of the aorta.

In this instance I did not feel the patient's aortic valve could be saved and therefore I replaced the valve and root using a Medtronic Freestyle Porcine (Pig) Valve Conduit.

Turn on your speakers and listen as a describe the procedure as you watch the video!

 


Saturday, August 24, 2013

We are all the same on the inside!


One of the great ironies of human diversity is that fact that for the most part, humans are less diverse as a species than most other animals on the planet.  In fact, if we compare ourselves to the other 8 million species that live on the land or beneath the seas, Homo sapiens –Latin for “wise men”—have among the least amount of genetic variation.

For example, a 2012 Oxford University study showed that groups of chimpanzees living in a relatively small area of central Africa have more genetic diversity than human beings living on different continents.  Needless to say, man’s best friend –the dog, or the cat for that matter—have a tremendous greater amount of genetic diversity than humans.  Penguins have twice the genetic diversity as humans. Fruit flies have 10 times as much, and so on.

Sure, we humans look remarkably different on the outside. Some are tall, some short. Some have blue eyes, some brown.  But these different traits are minor from a genetic standpoint and, more importantly, they are discordant, meaning they don’t match up.  You cannot tell a person’s eye color from their height and you cannot tell a person’s blood type by their skin color.  Perhaps most importantly, you cannot tell a person’s IQ, athletic abilities, or future leadership potential from any external physical characteristic because in fact beneath the skin, we are all genetically similar.

As a heart surgeon, I have had the privilege of knowing firsthand what lies beneath the skin.  After 21 years in practice and nearly 6,000 operations, I can assure you that we are all the same on the inside.  Your heart, your lungs, and your bones are all indistinguishable from race to race, person to person, man or woman.

And yet, wars continue to be fought, fences continue to be built, and children continue to die unnecessarily in the name of race, creed, ethnicity, nationality, religion, and even sexual orientation.  How can this continue to happen?  How is it that we continue to see only our superficial differences and not our human similarities?  These visual differences that we see on the surface of our bodies tell us nothing about what lies beneath the skin, nor what lies within our hearts or in our souls.

I am in awe every time I step into the operating room.  To literally hold a heart in your hand is an experience that is like no other.  No matter how many operations I perform, I will never cease to marvel at both the complexity and the efficiency of the human heart.  And, of course, even beyond the splendor of its anatomy, the heart has always represented the very essence of our thoughts –love and hate, strength and fear, passion and calm.  These metaphors are perfect. Just as our hearts are genetically similar, so are our human needs.  We all just want to survive, love our families, and live in peace.

Mother Teresa once said, “If we have no peace, it is because we have forgotten that we belong to each other.” It is undeniable that we belong to each other, not only from a philosophical or spiritual standpoint, but also because of our very DNA.

I often wonder how different things would be if everyone in the world could see into each other’s hearts as I do each day in my profession.  Imagine if we no longer saw each other as different races or countries or religions… just people, all the same on the inside.  If we all begin to see each other as one and the same, perhaps someday we can all finally live together in peace.

“You may say I’m a dreamer, but I’m not the only one. I hope someday you will join us.  And the world will live as one.” –John Lennon


 

Friday, February 8, 2013

PBS Channel 39 Tempo In-Depth on Heart Disease

This week, WLVT PBS 39 dedicated their Tempo In-Depth show to heart disease.  Below is a video of the show.  The show features a number of heart health issues such as women's health, the new trans-catheter heart valve replacement technology, and the new implantable left ventricular assist devices (LVAD) --all available at Lehigh Valley Health Network.
 
 
 

Tuesday, February 5, 2013

HeartMate II LVAD Implantation at LVHN --First In Region

Lehigh Valley Hospital's collaborative team of heart failure cardiologists and heart surgeons implanted the first Thoratec HeartMate II Ventricular Assist Device in our region. Our Mechanical Heart Assist Device Program is affiliated with the Hospital of the University of Pennsylvania Heart Failure and Transplantation Team. We are pleased to provide this advanced technology to our region and we are honored to be affiliated with Penn's nationally recognized transplant center.