A Cardiac Model for Resuscitating Health Care

A heart attack can have salutary effects. In some instances, it helps us to reexamine our lives and reorder our priorities. The same is true for medicine.

RTR34SMFmain.jpgPetr Josek Snr/Reuters

The best and most beautiful things in the world cannot be seen or even touched. They must be felt with the heart. 
-Helen Keller

One of medicine's greatest challenges is heart failure. Nearly all of the human body's tens of trillions of cells depend on a constant supply of blood, and failure of the heart to meet this demand represents one of the gravest threats to health and life. It is estimated that heart failure afflicts over 5 million Americans, and it represents the most common reason for hospital admission in patients over 65 years of age.

We can live without a hand, an eye, or even a kidney or lung, but the heart is absolutely indispensable. It reliably contracts 100,000 times each day, for a total of 2.5 billion beats over the course of a life time. It pumps blood through a network of vessels that, if each were stretched out and laid end to end, would measure over 60,000 miles in length. Cessation of cardiac function remains one of the most important indicators that life has ended.

The scientific and rhetorical proof of the heart's role in circulating the blood constituted one of the greatest triumphs in the history of medicine. William Harvey (1578-1657), perhaps the greatest English-speaking physician who ever lived, was not the first to suspect that the blood moves in a circuit, but he was the first to provide rigorous experimental proof. Yet even Harvey's demonstration had holes. Lacking a microscope, he could not explain how the blood finds its way from the arteries to the veins.

Physicians are not immune from heart failure. Like our patients, we too develop coronary artery disease and hypertension, two of its principal causes. Over time, these conditions can force the heart to work too hard or deprive it of too much blood flow, causing it to wear out. Inspecting an electrocardiogram, a chest radiograph, or a heart muscle biopsy specimen, we can determine if the heart is diseased, but we cannot tell whether or not the patient from whom it was taken happens to be a physician.

There are, however, other forms of heart failure that pose a special threat to physicians. These ailments lie completely beyond the reach of our high-technology diagnostic tests and therapies. A physician might receive a completely clean bill of health from a colleague in cardiology yet still suffer from a profound sickness of the heart. The heart is not only the pump that circulates the blood but also the foundation of our life and practice. To forget this elemental truth is to lose heart.

One such form of heart failure is exemplified by a physician who has provided his office staff with clear instructions: "If I am in the room with a patient for longer than two minutes, come and get me." This colleague suffers from cardiosclerosis, hardening of the heart. In his practice, attention and compassion have given way to throughput and revenue. He provides health care as a means of making money, but he no longer cares for his patients.

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Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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