I've been shadowing a Cardiologist, and had some questions. Could you help me out by chance?

[Alakazam123]

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I had a couple questions, but I didn't wanna annoy the cardiologist or his staff, so I just noted them down.

1. He told me that he regularly collaborates with CT surgeons on many procedures, and said that the residency program at their institution included interventional cardiology collaboration. What I did not understand, was whether the CT surgeons were actually taught interventional techniques? Is this a thing?

2. Is interventional cardiology limited to actual endovascular procedures? The cardiologist I shadowed TEEs multiple times and also oversaw some procedures in the cath lab, so I was very confused what the scope of the field is, because he is not an IC...

3. He told me that when I apply, to not shy away from DO schools, because a couple of the fellows at his institution that he was training, were DOs. How common is this across the board? Are there DOs accepted into cardiology fellowship as long as they can get into a decent IM program, or will there still be a bias against DOs in the admission process?

4. What is the advantage of a TEE over a catheter-based angiogram?

5. Many of the patients he saw were obese and had high blood pressure. Often times, I found him approaching the problem from a medical standpoint, meaning, he'd prescribe a different medication, adjust dosage, etc. However, lifestyle was not brought up as much barring extreme things like smoking...there was no deep discussion about exercise regimen or dietary regimen. Why is this?

 

[lalalallala]

5. It is extremely likely that diet and exercise were brought up at some point by at least one of the patients' doctors whether it be the cardiologist or primary care provider. However, that is not something that the doctor can change because he is not there every day with them nor can he force anything upon them. It seems reasonable for him to treat patients with how they are now.

3. If you can get into an MD school then you should go, but if you cannot then cardiology is a possibility through the DO route. Whether there is bias likely varies between programs and physicians, but there are definitely cardiologists out there who are DO. There has been a change with DO residency matching so perhaps you should look at threads more specific to that for an idea of how your likelihood may change with time.

2. This doesn't seem like an annoying question to ask him.

 

[LizzyM]

I had a couple questions, but I didn't wanna annoy the cardiologist or his staff, so I just noted them down.


5. Many of the patients he saw were obese and had high blood pressure. Often times, I found him approaching the problem from a medical standpoint, meaning, he'd prescribe a different medication, adjust dosage, etc. However, lifestyle was not brought up as much barring extreme things like smoking...there was no deep discussion about exercise regimen or dietary regimen. Why is this?

I'll take on this last one.... it takes time to do it right, the physician is neither well trained or well compensated to provide that type of treatment advice and it is most often a losing battle (or not losing, if you'll pardon the pun). If controlling weight and getting more physical activity were easy, people would be doing that to successfully control their blood pressure. But it isn't easy and many people find it very difficult to make changes in behavior and so the next step is to lower blood pressure using medication.

 

[Alakazam123]

5. It is extremely likely that diet and exercise were brought up at some point by at least one of the patients' doctors whether it be the cardiologist or primary care provider. However, that is not something that the doctor can change because he is not there every day with them nor can he force anything upon them. It seems reasonable for him to treat patients with how they are now.

3. If you can get into an MD school then you should go, but if you cannot then cardiology is a possibility through the DO route. Whether there is bias likely varies between programs and physicians, but there are definitely cardiologists out there who are DO. There has been a change with DO residency matching so perhaps you should look at threads more specific to that for an idea of how your likelihood may change with time.

2. This doesn't seem like an annoying question to ask him.

Thank you very much!! For my first question, do CT surgeons increasingly learn any interventional procedures due to these collaborations that he describes? Or is the turf still lost?

 

[lalalallala]

Thank you very much!! For my first question, do CT surgeons increasingly learn any interventional procedures due to these collaborations that he describes? Or is the turf still lost?

I don't know

 

[Alakazam123]

I don't know

No problem, thank you again for your informative answers previously!!

 

[Alakazam123]

I'll take on this last one.... it takes time to do it right, the physician is neither well trained or well compensated to provide that type of treatment advice and it is most often a losing battle (or not losing, if you'll pardon the pun). If controlling weight and getting more physical activity were easy, people would be doing that to successfully control their blood pressure. But it isn't easy and many people find it very difficult to make changes in behavior and so the next step is to lower blood pressure using medication.

Thank you very much!!

 

[Alakazam123]

Anyone have anything on my first question?

 

[getdown]

Anyone have anything on my first question?

1. No, the CT surgeons are not actually taught interventional techniques as this is not necessary. The reason the collaboration exists is because at some point interventional cardiology can only do so much without actually needing a surgeon to do something. Depending on the patient's anatomy some areas cannot be reached via endovascular route. In a patient with bad coronary disease they need to refer the bad cases for an actual open heart surgery. Same with end stage heart failure patients can be refered for LVAD placements and even cardiac transplant. Who do you think does these?

 

[Alakazam123]

1. No, the CT surgeons are not actually taught interventional techniques as this is not necessary. The reason the collaboration exists is because at some point interventional cardiology can only do so much without actually needing a surgeon to do something. Depending on the patient's anatomy some areas cannot be reached via endovascular route. In a patient with bad coronary disease they need to refer the bad cases for an actual open heart surgery. Same with end stage heart failure patients can be refered for LVAD placements and even cardiac transplant. Who do you think does these?

Thank you. Good to hear from you again!!

 

[getdown]

I had a couple questions, but I didn't wanna annoy the cardiologist or his staff, so I just noted them down.

2. Is interventional cardiology limited to actual endovascular procedures? The cardiologist I shadowed TEEs multiple times and also oversaw some procedures in the cath lab, so I was very confused what the scope of the field is, because he is not an IC...

3. He told me that when I apply, to not shy away from DO schools, because a couple of the fellows at his institution that he was training, were DOs. How common is this across the board? Are there DOs accepted into cardiology fellowship as long as they can get into a decent IM program, or will there still be a bias against DOs in the admission process?

4. What is the advantage of a TEE over a catheter-based angiogram?

5. Many of the patients he saw were obese and had high blood pressure. Often times, I found him approaching the problem from a medical standpoint, meaning, he'd prescribe a different medication, adjust dosage, etc. However, lifestyle was not brought up as much barring extreme things like smoking...there was no deep discussion about exercise regimen or dietary regimen. Why is this?

2. The field itself involves a lot of minimally invasive interventions: arrhythmia ablations, electrophysiologic studies, closure of PFOs, pacemaker/AICD placements etc. But these guys are still cardiologists and are able to do TEEs, pacemaker checks, clinic. But this is something you should have asked the cardiologist since it's his field.

3. There will always be bias towards DOs in any of the competitive fields in medicine and IM subfields in general. Impossible? No. Very hard? Yes. There's even a urology fellow at my hospital who's a DO.

4. Again, this is a question you should direct to the cardiologist. But generally speaking the indications for a TEE and an angiogram are pretty different. With echos you're looking at the structure of the heart, valves, wall motion etc. Angiograms you're looking at the coronaries to identify blockages that you can't see from a TEE.

5. While it would be nice to do this holistic thing, you don't have enough time in the day to talk to patient's about their habits. They're there to have their specific cardiac issues addressed. Plus if they're seeing a cardiologist already that means their issues have gone past easily modifiable lifestyle changes. The patient's PCP should be the one addressing the lifestyle stuff anyway.

 

[Alakazam123]

2. The field itself involves a lot of minimally invasive interventions: arrhythmia ablations, electrophysiologic studies, closure of PFOs, pacemaker/AICD placements etc. But these guys are still cardiologists and are able to do TEEs, pacemaker checks, clinic. But this is something you should have asked the cardiologist since it's his field.

3. There will always be bias towards DOs in any of the competitive fields in medicine and IM subfields in general. Impossible? No. Very hard? Yes. There's even a urology fellow at my hospital who's a DO.

4. Again, this is a question you should direct to the cardiologist. But generally speaking the indications for a TEE and an angiogram are pretty different. With echos you're looking at the structure of the heart, valves, wall motion etc. Angiograms you're looking at the coronaries to identify blockages that you can't see from a TEE.

5. While it would be nice to do this holistic thing, you don't have enough time in the day to talk to patient's about their habits. They're there to have their specific cardiac issues addressed. Plus if they're seeing a cardiologist already that means their issues have gone past easily modifiable lifestyle changes. The patient's PCP should be the one addressing the lifestyle stuff anyway.

Thanks again man!!

As for why I didn't ask the cardiologist directly... I didn't want to make him feel as though I was trying to sound smart.

 

[getdown]

Thanks again man!!

As for why I didn't ask the cardiologist directly... I didn't want to make him feel as though I was trying to sound smart.

He knows you're shadowing therefore these are type of questions he'd expect you to ask him. Not asking him questions actually make it seems you're either disinterested or bored.

 

[Alakazam123]

He knows you're shadowing therefore these are type of questions he'd expect you to ask him. Not asking him questions actually make it seems you're either disinterested or bored.

Will do from now on, thanks!!

 

[seanm028]

Thanks again man!!

As for why I didn't ask the cardiologist directly... I didn't want to make him feel as though I was trying to sound smart.

I've run into this same problem in the past, but you have to gauge each individual physician. Some are only allowing you to shadow begrudgingly, but I think most physicians agreed to take a shadow because they are genuinely interested in helping.

For example, I recently shadowed the same physician on two 12-hour shifts. The first time I tried to keep a respectful distance as I didn't want to get in the way or slow him down. I asked a few questions here and there, but mostly tried not to distract him while he was charting or entering orders. A few times he asked me if I had any questions, but I usually responded that I had already asked him all of the questions I had. At the end of the shift he said, "Come with your questions next time." It wasn't rude or anything, but it seemed like he was trying to hint that I was too reserved. So the next shift I was a little more assertive (while still being respectful of his time and his need to chart). I asked questions ranging from medical care ("Why did you order that medication?" "When would you want to order this test?") to medical school admissions ("When you helped out with admissions, did you see any common pitfalls in applicants' personal statements?" "How would you suggest I approach the issue of my low GPA prior to my postbacc?") to life on the wards as a med student/resident ("Do you have a system for presenting a case to your attending?"). He was extremely receptive and helpful, and while I enjoyed both of my shifts with him, the second one definitely left more of an impression on me.

 

[Alakazam123]

I was also wondering about something related to call schedule. He told me he would be on call for an entire week, next week. I've seen many on this forum discussing how they take call, etc.

I've been curious about what happens if a doctor does not pick up the phone while they are on home-call? Are there penalties of any sort?

 

[LizzyM]

I was also wondering about something related to call schedule. He told me he would be on call for an entire week, next week. I've seen many on this forum discussing how they take call, etc.

I've been curious about what happens if a doctor does not pick up the phone while they are on home-call? Are there penalties of any sort?

My understanding of being "on call" means that you are responsible for the patients during your period of being on call. In a teaching hospital, it means that you are responsible for hearing morning report from the residents, seeing the patients with the residents in the morning (rounds) and helping to outline the care plans and reviewing things at the end of the day. Residents and fellows care for the patients routine needs overnight but if something goes wrong, you'll get a phone call and be expected -obligated- to pick up and take the call. You may be able to handle it by phone or you may need to go into the hospital. not to pick up would be negligence and could cause a heap of trouble.

Many places now have "hospitalists" that take care of patients in the hospital so that doctors in ambulatory care setting can focus on patients in that setting without worrying about running back and forth to the hospital.

For some specialties, being "on call" can mean that you'll be tapped by the emergency department staff if someone comes in and needs someone in your specialty for an intervention or procedure. You may not get called, but you need to be in the area and available if you need to come in overnight. In some specialties where time is of the essence, you may need to sleep in the building as an attending to be available at a moment's notice (I'm thinking of trauma surgeons and interventional cardiologists -- door to balloon time is a big deal for heart attacks and trauma centers need trauma surgeons on the premises 24/7).