A few months ago I posted a lengthy piece about Mark Midei, the interventional cardiologist from Maryland who had his medical license suspended last year following a lengthy scandal in which he became the poster-boy (or scapegoat, depending on whom you ask) for all that’s wrong with interventional cardiology in the US. Although I was highly critical of Midei in my piece, I also expressed sympathy for his situation. Now a reader– Ohio MD– has written a response on the Forbes CardioBrief feed to my original post, taking me to task for being “entirely too sympathetic” to Midei. I think his position is worth bringing to more general attention, though I continue to believe that it is possible to simultaneously believe that Midei is guilty as charged and yet feel sympathy for his situation.
Here is the comment by Ohio MD:
I think the article is entirely too sympathetic to the doctor. As a physician myself, I am absolutely appalled at the acts perpetrated by this man upon his patients. It is all too easy to point at rates of success in terms of claimed lives saved and numbers who survived the intervention. Realistically, many of those who underwent procedures were destined to do well without cardiac interventional procedures. Testimony and review of the Maryland Board of Medicine and a review by Midei’s own institution suggest a systematic process of overstating severity of coronary disease to justify needless interventions. One must also consider that these interventions carry with them not only substantial cost, but the burden of carrying a needlessly implanted device, potential need for chronic medication to prevent device-related complications, and not-inconsequentially, the stigma of the diagnosis of severe coronary artery disease. How many of the affected patients went on to higher insurance costs, potential loss of job positions, limitations of lifestyle, etc.?
Midei appears to assume a narcissistic position, failing to blame himself for performing needless procedures and allowing gross erosion of his professional ethics and judgment. He appears to have become a willing victim of the rewards brought from his unbelievably high number of procedures and attendant income. As with many others of power and position, he clearly appears to have “believed his own hype” and cannot grasp the concept that he can be wrong or personally at blame. (Think Rod Blagojevich) It is difficult to muster pity for a medical professional who has profited at the cost of his patients. Similarly, I found a black humor reading that a man who was earning $600K/year BEFORE the hospital TRIPLED his salary has difficulty affording his home or paying for child college costs. One wonders at what level he must be living (or whether indeed this is simply another fabrication).
It is a tragedy when a bright and accomplished professional allows such wholesale erosion of his judgment and actions. It is a much greater tragedy when the trust of patients is abused for the sake of personal profit. I concur with the actions of the Medical Board and hope that they see fit to either keep this clearly unrepentant man away from patients or, at bare minimum, keep him on a short leash with close overview of his procedures in an ongoing fashion.
As an aside, one must raise the issue of whether Midei’s hospital was inclined to overlook these issues. He was a highly paid “rainmaker”, and while there was apparently no contractual stipulation regarding productivity, there was also little, if any, oversight of his activities. Quality review is an inherent and important part of modern medicine and did not appear to be adequately present in this case. While the primary fault remains that if the physician, the institution appeared to be a willing (and profitable) partner. No doubt, this too will be further explored.
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