After years of cardiology consultations, Dr. John P. Higgins realized that many of the same questions were constantly raised, yet the answers were changing as new medical research accrued. He also noted that many students, residents, fellows, and attending physicians had difficulties translating the up-to-date knowledge into practical diagnostic solutions. The truly useful data, while not inaccessible, was tucked away deep in many papers and research reports. In addition, many of the guidelines, books, or software available to assist diagnosis were topic-driven rather than the Frequently Asked Questions (FAQ) format as followed in this text. The vision for the book was to change the approach to diagnosis problem solving by using a simple tool that organized, synthesized, and hence provided a comprehensive epiphany in the form of a point-of-care tool.
Dr. Asif Ali collaborated to bring his expertise in medical animation education and information technology to help develop the format and layout of the book. Dr. David M. Filsoof added to the questions along with chapter revisions and development.
The team holds firmly to the belief that the application of comprehensively collated information is the pivot on which all good diagnostic decisions are made. The process to accomplish this followed the following flow path:
The platforms for the practical application of this work will be book, computer, and handheld pocket digital assistant formats. Nine areas have been collated for this text, namely:
This book and its chapter selection evolved as a major collection of clinical questions in cardiology (along with their answers), based on the frequency of consult questions the authors were asked over the past few years in Boston (veterans administration and private teaching hospital) and three Texas hospitals (private teaching hospital, county hospital, and a specialist cancer hospital). While the book outlines several cases where specialized referral and corrective surgery is required, it has a strong bias toward using noninvasive gold standard diagnostic strategies and available medications. The goal is to empower the doctor to get his or her patient to the best solution as efficiently and effectively as possible. The authors seek to take a plethora of information, form it into something useful, and pare down information overload. In 1995, Harvard Business School Professor Clayton M. Christensen and Joseph Bower coined the term disruptive technologies. In 2003, Christensen revised this term to disruptive innovation. We believe this book takes on the spirit of a disruptive innovation for it projects a business model that seeks to provide a new improved service, in a way the market does not expect, for a new larger customer audience, and it threatens the status quo with its disruptive impacts. Our model seeks to simulate the consultation process and proceeds directly from an alchemy of questions toward the critical data that must be obtained, and outlines the procedure to reach solutions to the questions.
Relative to each chapter the "Key Concept" section describes and defines the major decision factors impacting the goal of the consult question. This sets the stage to gather pertinent information. The "History" and "Physical Examination" sections focus on important historical data and the signs to look for pertaining to the consult question. The "ECG," "Imaging," and "Lab" sections aim to focus on findings that help narrow the differential based on results and diagnostic tests performed to make the diagnosis. The "Synthesis" section organizes the information into the core components that will be required for the equations that follow. The "Epiphany" section provides the equation into which the synthesized facts are inserted and the resulting solution is clearly stated in a manner that allows point-of-care management. The "Pearls" section provides factual information that is related to the consult question assisting consultants in educating personnel on key teaching take-home points. The "Discussion" section goes over some key items related to the equations that are often asked. The "Contraindications" section alerts the consultant toward signs to watch for when making their recommendations. The "Evidence and References" section offer evidence-based medicine resources pertaining to the consult question. The objective of this organization of sections is to provide a step-by-step effective approach to answering the consult question. It provides clear and present solutions by incorporating up-to-date evidence-based medicine that adheres to the most current guidelines and consensus statements. In addition, by informing the physicians of the precise pieces of information required to answer the question, it helps them save time by obtaining just those key information, and then plug them into the equations ("Epiphany" section) resulting in a speedy answer. The analogy we use is that imagine there are 100 pearls on a beach regarding the topic the consult question addresses. Rather than pick up all 100, we point out what 10 crucial pearls you need, and help you retrieve them. Then, we tell you how to string these 10 pearls together into a "pearl necklace"—the solution to your question. You save time by using only those critical data in the decision process, and also avoid being inundated with less relevant information.
We believe that this book will enable students, interns, residents, fellows, mid-level providers, physician extenders, and attending physicians to better find correct diagnostic solutions to common cardiology questions that arise, especially while they are rotating on inpatient medical services. We sincerely hope it will lead to faster and quality patient care.
Dr. John P. Higgins
Dr. Asif Ali
Dr. David M. Filsoof
28 June 2011