Why your Cardiologist is not my Cardiologist

I was at my church’s monthly Senior Citizens Fellowship today. (No, I’m not claiming to be a Senior Citizen; I was there because I’m in the group that prepares the food!) The Worship Service was over and we had moved into the Fellowship Hall for the meal.

In the course of the conversation the fact that next week I have a doctor’s appointment at Emory University Hospital in Atlanta was mentioned. Sitting at the table across from me was a distant relative of mine.

“You got a doctor’s appointment in Atlanta?!?!” he asked, in the same tone of voice you would use if I told you my doctor ran a clinic on the moon. Yes, I answered, I have local doctors but I go to Atlanta for major checkups.

“How often you go down there?”

“Usually every four months, more often if there is a problem.”

He shook his head slowly. “I don’t see why.”

“I need a specialist, and that’s the closest hospital that does what I need.”

Another head shake. “I don’t see why. When I had my heart attack, I had a doctor in Columbia. He did me right. I’ll give you his number if you want it.”

Thanks, but no thanks. Like a lot of people unfamiliar was Congenital Heart Defects, he believes that a heart is a heart is a heart. Despite what the Declaration of Independence states, all hearts are not created equal. Mine is different, and I need a whole different set of doctors.The doctors I need are Adult Congenital Heart Defect (ACHD) doctors. ACHD is not a recognized medical specialty; you can go to medical school to be a Orthopedist or a Proctologist, but not an ACHD Cardiologist.

Most of the original group of ACHD doctors (some of whom are still practicing medicine; the field is that young) started their careers as Pediatric Cardiologists. As time passed and their young patients began to see Adult Cardiologists, some of those patients started coming back to them. The adult Cardiologists seem to be lost, they complained. They didn’t understand a defective heart nearly as well as they understood clogged arteries and cholesterol, and these patients just felt more comfortable and “safer” with their childhood physicians.

Suddenly these doctors had a problem – their patients still had heart defects, but they were showing the usual signs of aging, in certain cases they needed more surgery or new medical procedures, and they were asking questions that Pediatric Cardiologists usually don’t have to answer. Hey doc, if I find the right person and we get married, should we have children? Doctor, can you call the HR department at my work? Because of my heart, they are giving me a hard time about insurance.

All of this was uncharted territory. But a trend quickly developed: this phenomena was happening more often in large urban areas than anywhere else. The reason was numbers: 1 out of every 125 people (0.008 of the population) are born with a heart defect. With the greater population of a city, the more people with a heart defect who are potentially living in the area.

So the first clinics set up to treat Adults with heart defects sprung up in major hospitals in cities. Johns Hopkins in Baltimore, UCLA in Los Angeles,  Philadelphia, and several programs in Boston are prime examples. The major exceptions to the “big city” rule are The Mayo Clinic in Rochester, Minnesota (population 100,000) and Duke Medical Center in Durham, North Carolina. (Population 220,000) – hospitals known for quality care long  before Adult Congenital Cardiac Care became an issue.

So for high quality medical care for my funky heart, I have to travel to a large medical center. I’m glad he was able to help my kin, but that heart doctor in Columbia is not the guy I need.


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