Malvinder Parmar

Medicare created the heart team requirement for TAVR for a reason. A surgical opinion was supposed to be a check on the system. It isn't working. "People let you know if they're happy or not happy that you did not sign off on someone to get a TAVR. Let me just leave it at that." And if you're a young surgeon without referrals? You need to be on that heart team. You need the aortic call. You need the cases. "If I were desperate, I probably would have done the same thing. You've got to put food on the table. You're not doing anything illegal." That's not corruption. That's a system that put a young surgeon in an impossible position — and called it a check and balance.

Many years ago I hurt my knee playing sports. I was referred to the orthopedist for one of the local pro teams. After keeping me waiting for 2.5 hours, he diagnosed a cartilage tear and recommended surgery. I was so mad at his manner and tardiness I left without scheduling. The next week I got a second opinion from a much younger doc who was likely more current on the recent medical literature. He looked at the same MRI. He said he could do surgery now but his advice was to wait 30 days and see if it healed on its own. It did. Medical reversal is when a practice that became widely used is later shown to be ineffective or even harmful. Examples like meniscus surgery show the need to keep gathering evidence. A not immaterial part of the practice of modern medicine doesn't improve health, and may be net harmful.

Hit me with a harsh medical fact.