“It’s About Time!”, noted Ruben Navarrette, Jr., a CNN contributor and a columnist for the Washington Post, in an article announcing the election of Argentinian Cardinal Jorge Bergoglio as the “first Latino Pope.”  His article explained that it was “about time” that the Roman Catholic Church had recognized the “importance of Latinos” in the church and elected a Pope to represent them; further expounding in great detail that he is a “cafeteria Catholic,” a normally derogatory term meant to imply someone of the Roman Catholic tradition who picks and chooses which parts of Catholicism they wished to embrace a sort of moral relativism.  In practice, however, there is a core set of inviolate tenets which are not “pick and choose” just as most assuredly Bergoglio was not selected to cater to a subset of the Catholic demographic.

Here at the American College of Cardiology, we face a somewhat analogous situation.

The inviolate tenet of the College is the unwavering commitment to continuously, unabashedly, and with zeal focus on providing the highest quality patient care.  Quite simply, our every effort to append, fix, modify or change our health care system must have as its central theme improving the care of our patients as well as the comfort of their families.

In some instances, this is easy.  We have many tools and resources to help us accomplish this core mission, such as CardioSmart, which works to engage our patients via education and through endeavors that focus on shared decision making and patient-centered care. We have guidelines and appropriate use criteria that help define the appropriate use of therapies for the betterment of our patients.

In other areas, we make changes to the system in order to improve our working situations, and in most instances these are business decisions which have a neutral effect on patient care.  Changes in affiliation within different medical centers, merging of practices, changes in services provided to patients, and changes in staff levels all come to mind. Sometimes, however, these system changes can inadvertently cause a negative impact on patient care.  An obvious example is a situation in which a practice integrates with a medical center and provider-based billing is initiated, which in return causes the patient’s expense to dramatically increase. Although this is certainly an acceptable business practice, it may reduce the access of those who are unable to afford treatment, and the patient might avoid receiving needed care or diagnostic evaluation due to such changes.  We must work to mitigate these detrimental effects.

In its most egregious manifestation, it takes the form of a decision by physician to ignore proven therapies and treatments, applying their own self-serving rules to an otherwise straightforward medical decision.  All of us have seen the patient who undergoes nuclear exercise testing every six months following an angioplasty, symptoms having been absent for five years, told by the physician that they are going to “prevent a heart attack” by testing them.  There are many other examples.

It is our professional responsibility to sight our way forward using a strict moral and ethical sextant focused on the prize of outstanding patient care and service to humanity rather than the “medical moral relativism” that allows us to pick and choose what we would like to do.

Let us not be “cafeteria cardiologists” drifting in ethical relativism for our own gain, but let us embrace the highest standards of our profession, never losing our way amidst the difficulties of health care reform.

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