Cardiology vs. The World

One difference I noted between my cardiology and medicine rotations is the scope of treatment. While in cardiology, we have an intensive focus on issues related to the heart, on general medicine wards, we have a comprehensive look at all medical issues. Many of our patients, especially older ones, come with a host of chronic medical conditions. Although patients come in with a specific chief complaint, we try to address all their problems, which can be over a dozen. A typical medicine patient might not only complain of shortness of breath, but also have diabetes, lupus, chronic kidney disease, headache, anemia, and leukocytosis. A problem list for these patients must make an assessment for all these issues and propose a diagnostic and treatment plan.

On cardiology, we are very good with certain issues. We manage blood pressure, cholesterol, thyroid problems, and diabetes closely because those are such pertinent factors in the management of heart disease. But we often gloss over chronic medical problems like arthritis or COPD. As I gain more independence and insight as an intern, I begin to address other medical problems even if they are not the primary problem. On one of my patients, I noticed a chronic anemia. It'd be easy enough to ignore this and defer to outpatient work up - after all, it's been going on for a long time and unrelated to the chief complaint. But I went ahead and sent an iron panel which lead to a diagnosis of iron deficiency anemia.

Should cardiology attendings worry about general medical issues? Of course they should; we must provide comprehensive care for our patients. But the reality is that they are much more interested and skilled at resolving issues of the heart. That is why these patients go to a cardiology service rather than admitting them to the general medicine wards with a cardiology consult. But one of the wonderful things I can do as an intern is to make sure small issues do not fall through the cracks.