EP72: We Can Do Better

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop is a practicing cardiologist and author dedicated to improving patient care through heart health education. In this episode filmed from the Maldives, Dr. Bishop shares two case studies that illustrate gaps between optimal cardiac care and current clinical practice, highlighting the importance of patient advocacy in healthcare decisions. Key Takeaways: Stress tests alone are insufficient for assessing arterial health; they only detect significant blockages that are already late in the disease process and may miss early plaque buildup. Patients with family history of heart disease should advocate for direct imaging of their arteries rather than relying solely on functional tests like treadmill assessments. Performing stress tests on asymptomatic patients who are clearly fit may reflect business interests rather than genuine clinical necessity. CT coronary angiography (with contrast) provides valuable information about plaque presence and quantity, enabling better risk stratification and treatment intensity decisions. A 30% arterial narrowing on CT imaging is non-flow-limiting and will not cause symptoms, as approximately 70% narrowing is needed to produce hemodynamic obstruction. Proceeding to invasive coronary angiography after a non-flow-limiting finding on CT without symptoms constitutes over-servicing and carries unnecessary risks to patients. Invasive coronary angiography cannot show greater detail than CT for a 30% lesion and is therefore an inappropriate follow-up test in asymptomatic patients. Over-servicing wastes community resources and increases individual patient costs while exposing patients to unnecessary procedural risks. Patients must actively ask questions and seek appropriate imaging to ensure they receive evidence-based care aligned with their actual risk profile. Healthcare technology must be used with integrity and clinical judgment to serve patient outcomes rather than financial incentives.