Cardiologist wants to transform risk-averse peers
Potential mistakes should be learning opportunities instead of reasons to avoid complex cases.
Every time a commercial pilot encounters a complication, the airline does a root-cause analysis and shares the findings immediately. The investigation focuses not on blame, but on the problem and the appropriate in-the-moment response. Pilots welcome this process because it keeps their skills sharp and because lives are at stake.
No such feedback-improvement loop exists for interventional cardiologists, though stakes are similarly high, says Dr. William Lombardi, clinical associate professor of medicine. Interventional cardiologists perform diagnostic and treatment procedures on the heart and vascular system.
Fear of potential complications during procedures, he said, often results in decisions not to approach complex patient conditions. It’d be akin to pilots choosing to fly only when skies are a calm blue.
“My father was a commercial airline pilot and a flight instructor,” said Lombardi, a UW Medicine interventional cardiologist. “I’m trying to bring lessons from the airline industry into our industry."
To that end, UW Medicine cardiologists are hosting a symposium Aug. 10-11 in Seattle. It will cover managing complications, and taking lessons from them. Lombardi is the event chair.
Cardiologists’ fear of complications stems in part from legal liability, but also from a larger cultural shift that has made self-preservation and finger-pointing a reflexive response in the wake of a medical mistake. That response has given rise to a twisted logic by which doctors simply avoid providing treatment in higher-risk cases, he said.
It’s a self-perpetuating loop: Lack of experience with complex cases fuels doctors’ fear, which results in fewer of the most potentially beneficial cases being done. Most cardiologists’ experience with complications is limited to their own cases, Lombardi said, “which isn’t enough to learn from if you mostly take cases that look easy and straightforward.”
Lombardi directs Complex Coronary Artery Disease Therapies for UW Medicine. He said he feels lucky to work in a practice in which cardiologists are encouraged to try new approaches to treat complex cases, many of which are referrals from practices whose posture is to be more selective.
Lombardi is an expert in treating chronic blockages of coronary arteries, the vessels that supply blood to the heart muscle. He gets patients referred from all over the United States. He achieved that stature by challenging procedural conventions and facing risks.
“I had to break the rules, and most people wouldn’t do that,” he said. "It’s one of the unique things about being here: Our team embraces new technology, new techniques, pushing the boundaries and working cooperatively to come up with solutions – knowing there are potential negative consequences. As long as we’re all thinking about it and critically learning from it, we think it makes sense.”