Off to the Land of Make Believe

Tomorrow I head off to Land of Make-Believe: The 2011 American College of Cardiology Scientific Sessions in New Orleans, Louisiana.

I say this not out of spite for the organizers who have toiled to streamline the registration process and prepare the display hall, nor because I have anything against the presenters who have spent hours perfecting their talks and preparing their slides, nor because I won't learn anything there, nor because I don't have faith in the incredible will and wonder of the people of New Orleans. Seriously, it's a huge, fun, informative conference in a warm, welcoming, and conference-friendly city.

Rather, I say this because I fear these meetings will have less and less influence on how health care delivery will occur going forward as limits to how and how much care is delivered - at least as far as technology and innovation are to be used in the years ahead.

The sands are shifting beneath our feet. Every doctor I speak to knows it - some with more foreboding an outlook than others - but no one dares to show it lest they not appear to be a "team player." Instead, most of us act on the outside as though we are stalwart stewards of the status quo marching ahead to our future Land of Make Believe.

As such, we’re elated at the prospect that percutaneous aortic valve replacement will be available to all of our patients over eighty years of age with multiple severe co-morbidities soon (at least those are the only patients studied so far) and that all us who are fantastic interventionalists will soon be able to perform the procedure for all of our patients to meet the overwhelming demand. After all, the data at this meeting will show how safe the procedure is for them, right? Surely CMS would never drag it's feet toward approval of this expensive technology, would they?

Make Believe.

We watch the Stent Wars between companies and clinical investigators like a good Ultimate Fighter match: each company sparing for the right to claim a hair-thin victory over their competitor. And those bio-absorbing stents? Rock on! Surely the winner hear will take the sales prize, right? Especially since doctors have such influence over purchase orders these days. Everyone will be watching when a p value gets low enough and the legions of Press Corps spring to action as willing sycophants to the marketing hype so critical to promotion and adoption by the cardiovascular community at these meetings. As if it will soon really matter.

Make Believe.

We urge our medical students, residents, and fellows to attend these meetings and offer cash rewards to our best and brightest Young Investigators as if to suggest that most of them can still become entrepreneurs in the medical device arena in the years ahead. After all, regulatory approval hurdles for new technology aren't prohibitive, right? And those fees to the FDA, they're not too high, are they? Profits surely will be showered upon our young employee-inventors, too, right?

Make Believe.

And then there will be the transparency about how much all this stuff displayed costs, like the hybrid cath-lab/operating rooms (being developed now to install all those percutaneous valves in our elderly patients). Better to ignore this in favor of the bright, the shiny, and the new. Never mind that doctors and hospitals will soon be paid in lump sum payments from Medicare. Never mind that those payment amounts will be about 20% of where they are now. The sky's the limit for these purchase orders, right? Hospitals will get their return on investment quickly and doctors will still get their fare share of those bundled payments. Finally, look for these issues to be discussed front and center every single day at these Scientific Sessions.

Make Believe.

But I still can’t stay away. It will be a welcome respite from the cold to enjoy some nice warm weather. There’ll be nice people from all over the country and all over the world there. I enjoy speaking at these events, too: you realize the depth and breadth of commitment of today's doctors despite the forces that are changing. There’s a unique camaraderie that's developing, I feel, despite all of these changes. No matter what happens ahead, so far we are still afforded the luxury of meeting face-to-face to share our stories of patient care – both good and bad. And once in a while those stories can sometimes be shared nice glass of self-bought wine.

Better yet: it’ll be my excuse to leave those insidious Electronic Medical Record communications, office and patient e-mails, and results-reviewing behind for a few days.

Oops, I forgot.

Make Believe.

-Wes

P.S.: Anyone who wants to share some stories and a good glass of wine between e-mails at the ACC 2011 Meeting can reach me via Twitter at @doctorwes. If you're still not on Twitter, here's how and why you should consider signing up.