But, just as we don't judge racehorses only by their bloodlines, cardiologists should be judged by the results of their trained efforts, not just their pedigrees. Assessing outcomes in cardiology is considerably more difficult than judging the winner of a horserace, but our peers have now created excellent, comprehensive databases in several important areas of cardiology, including the cath lab, the echo lab, and nuclear cardiology. These objective measures can be appropriately used to judge the quality of our efforts. We need more such databases that are scientifically constructed and validated by cardiologists. Only cardiologists have sufficient training, experience, clinical judgment, and commitment to accurately oversee correlation of measurable outcomes with the complex processes and human interactions that define modern cardiology.
Quality is a moving target with different meanings to different people.
One of the most startling developments in medicine over the past millennium has been the transformation of medicine from a cottage industry into a multitrillion dollar global enterprise. Thus, we use Frederick Winslow Taylor's classic time-motion analysis to improve the care of acute myocardial infarction, and we employ W. Edward Demming's concepts of total quality management to improve management of congestive heart failure. Quality in this industrial context does not comfortably embrace all of the scientific and human uncertainties inherent in medical practice. Rather, these principles focus on producing a product of known dimensions as cheaply and efficiently as possible. Although we might object to being compared to hourly laborers working on an automobile assembly line, we cardiologists are, indeed, part of a team producing a product, albeit an exceedingly complex product, elements of which cannot be measured as precisely as the performance of an automobile.