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(Circulation. 1996;94:1781-1785.)
© 1996 American Heart Association, Inc.

Articles

Cardiologist Adapts to Healthcare Change for the Year 2000

The Herrick Lecture

Richard Gorlin, MD

The Dr George Baehr Professor of Clinical Medicine and Senior Vice President, the Mount Sinai Medical Center, and Medical Director, the Mount Sinai Health System, New York, NY.

Correspondence to Richard Gorlin, MD, Mount Sinai Medical Center, Box 1018, 1 Gustave L. Levy Pl, New York, NY 10029.

Key Words: cost-benefit analysis • health maintenance organizations • healthcare planning

	Introduction

 
Cardiology as a medical discipline has reached a critical stretch of white water unlike any it has navigated over the past 40 years. The changes our specialty now faces have been brought about not, as in the past, by conceptual or technical advances but rather by cost barriers that will govern every aspect of our work, including education, research, and clinical practice, for as long as anyone can predict.

	History: How Did We Get Here From There?

 
A little more than 40 years ago, when I first entered Dr. Lewis Dexter's laboratory as a cardiology fellow at Harvard Medical School and the Peter Bent Brigham Hospital, cardiac catheterization had been in use for only about 3 or 4 years. It dominated our work in unraveling the questions of circulatory physiology and biochemistry. Shortly thereafter, we began to focus on how the heart functions both as a muscle and as a pump. That was an era of both technological innovation and conceptual advancement best exemplified by new, accurate radiographic imaging techniques. These methods augmented and complemented the physiological pressure-flow measurements and revolutionized the field. They showed us the cardiac chambers and the coronary and other arteries in ways never before possible, thus refining the concept and role of cardiovascular dimension and volume in heart function. All of this culminated in the 1980s with the advent of focused intervention and remarkably effective surgery. Molecular biology, which now dominates academic cardiology, was beginning to find its place in the field. We now have unique drugs for clinical care, and large clinical . . . [Full Text of this Article]