He seeks me out for another opinion about his atrial fibrillation. This is good.
“Doc, you know I had one of those ablation procedures (at another hospital) last year. It hasn’t seemed to work, as I am having lots of AF.”
About that time, my MA comes in the room with a copy of the procedure note. I’ve underlined some of the key phrases.
“Dabbling,” in AF ablation is a “real-world” problem.
Pulmonary veins are either isolated or they are not. Leaving the right inferior vein electrically connected is like loading the dishwasher, and not turning it on. The rhythm “resembled” atrial flutter? Bi-directional block was not assessed. Oh my.
Of course, this patient still has AF. What do I tell him, other than I think it is worth another try? Fortunately, he does not ask me to comment on the previous procedure. It is true that AF ablation, even when done right, often requires a second procedure for ultimate success. I can offer that fact and move on.
It is ironic that this procedure was done at a huge hospital, endowed with much treasure, which they put to use aggressively in their marketing campaign. Billboards, radio spots and TV ads all proclaim this hospital’s superiority in cardiac care.
The problem is that AF ablation is delivered primarily by physicians, who possess varying degrees of experience and skill.
The dabblers still get referrals. This is so for many reasons: the primary care doctors–most of whom are not in the hospital anymore–do not know the experience level of the specialist, patients don’t know it either, and now, many referrals are made solely on the fact that the specialist is owned by the same hospital as the primary care doctor.
It takes a very savvy patient to navigate this complex health-care maze. My guess is navigation to the non-dabbling doctors will become even more challenging in the future.