In era of precision medicine every patient must be evaluated by a multidisciplinary team of top-notch experts. This is the only way to ensure unbiased, correct, precise diagnosis and best treatment for each patient. Leading intensive care and heart failure expert illustrates:
– Is there anything else you’d like to discuss? Is there any topic that you would like to expand upon? I think the biggest issue about my observations in medicine are that what we sort of touched on earlier – is the whole silo approach to medicine today. I think it is probably one of the biggest limits to innovation, and I think one of the wonderful things about here is the sense of a multidisciplinary collaborative approach, setting up these centers. And when I was asked to take over or at least develop the center for pulmonary heart disease, and the concept being that we’d bring in surgeons and we’d bring in internists and we bring in radiologists who purely have interest in the area that we’re focusing on. And then really within that we have subsets of interested parties, including interventional cardiologists, pediatric cardiologists, pulmonologists, intensivists, pulmonary vascular-focused physicians, surgeons who focus on both thoracic and cardiac disease – everybody has a common overlap at some point. And when you bring all these people into a room together and you start talking about topics – you come up with ideas of novel approaches. And one thing that came out of that is we developed an approach to do a percutaneous Potts shunt [to treat pulmonary hypertension]. So we took several patients who had advanced pulmonary arterial hypertension and had really gone to the limits of any treatment option. So there was nothing more we could offer other than transplant. And transplant for pulmonary hypertension is a complicated process. So working with our colleagues at Children’s Hospital and here, we developed an approach, where we could go take these patients in the cath lab and create a bridge from the aorta into the left main pulmonary artery percutaneously and put a stent across that bridge, and create a variable shunt that essentially worked as a blow-off valve, without doing an atrial septostomy, which, by doing it in the aorta to the left main pulmonary artery, you left the upper half of the body with normal oxygenation and the lower half of the body had hypoxia. And the result of that was obviously the kidneys kick in and you started to produce more red cells. But it wasn’t a problem and it did help in the sense that it created a bridge that we could keep working on these patients and give them time to get transplanted. There’s still lots of opportunity for improving something like that, but it just is an example of how, if you get rid of the silos, you let people start interacting together and thinking freely – you come up with approaches that people wouldn’t have thought of on their own. Well I think this is very important, clearly. But also from a patient’s perspective, another aspect of silos is something that is probably structurally in the way that healthcare is set up, at least today, it is very hard to get rid of the silo – the silo of any single institution or a hospital. Because when a patient walks into the hospital, that hospital says, “Okay, well, we will treat you, we are the best for you” and often times the larger hospitals acquire physician group practices and their referral patterns become fixed, and it sends somebody who walks into a physician’s office on a certain path, which may be excellent, but may not be an optimal path for that patient. – I think you want certainly as a patient – I mean I’ve never had obviously a bad disease, but I’ve been a patient in a hospital for minor stuff. But I would want a place that could think outside the box, especially if I had a rare disease or a difficult disease. I’d be wanting someone to think about, what else can I do here to try to improve the quality of life for that person? And it may not mean that I’m going to change survival dramatically, but at least improve upon things. Because the truth is in medicine, and I’m not talking about internal medicine, we rarely cure things. I mean, sure, we cure infections and we cure some cancers. But most disease – we manage, long term. So the better we learn how to manage with a goal towards finding a cure, the better off that patient’s going to be. And I think you get into a place like here, where we have this multidisciplinary, open minded, out-of-the-box thinking processes going on, I think it serves a great purpose. And worldwide also, modern technology allows us to go beyond any single institution and look at what’s available, where the experts are located, and transfer valuable information to them without perhaps even traveling. And it’s interesting, because, obviously, with the internet now patients become often their best advocates and they’ll find the programs. And as a result our dyspnea program is an example. We have had patients on their own find us and come from all over the world. And I would say now pretty much every month we’re seeing someone who has come a long distance to get an answer as to why they’re short of breath. And airline travel is not that expensive, of course, sometimes treatments are expensive, but compared to missed diagnosis and wasted money, the symptoms and the aggravation of the wrong treatment – that certainly is a much better solution. And getting an answer is usually very important to the patient, even if you can’t make them better, they want to know “what’s wrong with me?” That is very important, getting the right diagnosis, the precise and complete diagnosis. Dr. Waxman, thank you very much for this very interesting conversation about lung disease and heart disease and lung vasculature. We hope to see your continued research and stem-cell research, and come back to you in the future. – Thank you very much! – Thank you, it was fun!