Nuclear cardiology, patient care, and the humanities

Abstract

Nuclear cardiology is clearly a well-recognized and established clinical discipline and has been so for at least 40 years. The clinical discipline emerged from the research domain in the late 1970s and has been utilized worldwide for decades. Parallel with nuclear cardiology’s growth has been the evolution of the American Society of Nuclear Cardiology as a distinct and important entity, as well as the growth of the Journal of Nuclear Cardiology as a superb medical publication. Having had the opportunity to observe this evolution from its inception has been extremely satisfying. Nuclear cardiology draws the vast majority of its practitioners and investigators from the cardiology domain, with a smaller pool of participants coming from the pure imaging fields of diagnostic radiology and general nuclear medicine. The cardiologist practicing nuclear cardiology may do so in the setting of noninvasive cardiac imaging, which also may include other imaging modalities such as echocardiography, computer tomography, or magnetic resonance imaging, in association with patient care. Alternatively, the nuclear cardiologist may work exclusively or predominately in the laboratory, supervising and interpreting studies, with no, or relatively little, direct patient care. The latter individuals may have excellent technical backgrounds, inciteful understanding of potential errors and artifacts, and outstanding computational skills. However, such individuals, after initially trained as clinicians and cardiologists, run the risk of immersion in the technical and statistical issues of the laboratory to the extent that they professionally experience a loss of empathy and clinical emotional intelligence as a result of the absence of meaningful direct patient interaction. To my mind, imaging at its best requires an ongoing interaction of both the imager’s interpretative skills and the clinician’s interactive and interpatient skills. There should be symbiotic balance between these two poles of the clinical spectrum. As imagers, it is easy to fall into a pattern where, over time, patients become mere statistics, represented by images and pixel densities. If this occurs, there is a dissociation from basic patient concerns. Then nuclear cardiologists and imagers may become hardened and insensitive to the patients they seek to serve. For example, it is important to consider what psychological stress is placed on patients by the studies performed and their results. How long should a patient have to wait before test results are available? Is the patients’ family present during the study? Do they need to be spoken to as well? Will the patient be a candidate for surgery, stenting, or medical therapy and how much anxiety will each of these decisions produce? What is the social background of the patient undergoing the study? Are there any issues specifically resulting from ethnic diversity? What is the impact of calling a study equivocal as opposed to either positive or negative? How important is physical activity to the wellbeing of the patient? In short, when studies are interpreted what is known about the patient behind the image? Clearly it is impossible to deal with all these issues in each patient Reprint requests: Barry L. Zaret, MD, MASNC, Division of Cardiovascular Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, PO Box 208017, New Haven, CT 06520-8017; [email protected] J Nucl Cardiol 2019;26:353–4. 1071-3581/$34.00 Copyright 2019 American Society of Nuclear Cardiology. Barry L. Zaret, MD, Founding Editor, Journal of Nuclear Cardiology