By Todd Neal, Senior Staff Writer
MedPage Today, Dec. 5, 2013
What’s the biggest barrier to practicing medicine today? That’s just the first of 10 questions the MedPage Today staff is asking leading clinicians and researchers to get their personal views on their chosen profession. In this series we share their uncensored responses. Here, answers from Steven Nissen, MD, of the Cleveland Clinic.
There, Nissen is chair of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine. A past president of the American College of Cardiology and former chair of the FDA’s Cardiovascular Renal Drugs Advisory Committee, he has had a leading role in highlighting potential risks associated with certain drugs, including rofecoxib (Vioxx) and rosiglitazone (Avandia). In 2007, Nissen was included on Time Magazine‘s list of “100 men and women whose power, talent, or moral example is transforming the world.”
1. What’s the biggest barrier to your practicing medicine today?
The lack of a single-payer system. We waste enormous amounts of time and energy dealing with insurance companies, whose major goal is figuring out how not to cover patients.
2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds or tests, etc.) and how did you respond?
There are too many to count. I remember a patient who could not afford clopidogrel (Plavix), so he split his pills to stretch the prescription, but subsequently had a catastrophic in-stent thrombosis leading to cardiogenic shock and eventually heart transplantation.
3. What do you most often wish you could say to patients, but don’t?
If you continue to smoke, I would prefer that you see another physician.
4. If you could change or eliminate something about the healthcare system, what would it be?
Fee-for-service medicine. It drives overutilization and leads to poor outcomes.
5. What is the most important piece of advice for med students or doctors just starting out today?
Consider a career in academic medicine. It provides greater diversity and satisfaction than limiting your career to clinical practice.
6. What is your “elevator” pitch to persuade someone to pursue a career in medicine?
I have never regretted my decision. The relationship to patients as well as science makes medicine a unique career choice.
7. What is the most rewarding aspect of being a doctor?
The appreciation we receive from patients and their families. It’s always very special.
8. What is the most memorable research published since you became a physician and why?
I actually think the CAST Trial was most memorable. It continues to resonate. Drugs that suppressed arrhythmias increased the rate of death. It began the ongoing movement away from surrogate endpoints.
9. Do you have a favorite hospital-based TV show?
I don’t watch TV (except the NewsHour on PBS). Television lowers your IQ substantially. There’s a dose-response curve. The more you watch, the more stupid you become.
10. What is your advice to other physicians on how to avoid burnout?
If you can, do what you really enjoy. Then work becomes a pleasure.
Todd Neal is senior staff writer at MedPage Today. http://www.medpagetoday.com/PracticeManagement/PracticeManagement/43257?isalert=1&uun=g441580d398R5538349u&utm_source=breaking-news&utm_medium=email&utm_campaign=breaking-news&xid=NL_breakingnews_2013-12-05
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