I always find it amusing to speak to other techs and nurses in the lab. It amazes me the number of lab staff who believe that the more equipment you pull, the better doctor you are. Or, the longer you take to perform a procedure, the better you are. I’ve always seen the opposite: use less hardware and less time, and the patient is better off for it. Of course, that could come from a horse riding perspective where the less hardware makes the better rider.

But seriously. How can it make a better doctor when he routinely uses 2-3 guide catheters for an intervention? (Of course, there are those times, but I’m talking about doctors who have been doing this for years and still call for multiple guides for a left system or right system.) And don’t start with, “But they’re just out of school!” I’ve worked in enough training hospitals to know how many procedures these guys do. They should know what works best for them. And just today, 3 12mm stents placed when one 30mm would have worked better. (And it wasn’t a great result, either.) The less hardware, the better.

I started in the lab in the old days, when Rotablator had just come out; IVUS was fairly new, FFR wasn’t used much where I was, and laser was big…but only one of our doctors used it. And we got GREAT results. The reason? Our doctors were good. They did what was necessary, not what was “fun” or “new and improved” or anything else. They tried Rotablator, and found it didn’t make the results any better; it just cost them time and extra contrast and radiation doses. Of course, they can charge more for using it…

There will be times for the “toys”. A time for the Impella…but not every unprotected LMCA (I did an unprotected LMCA last month without Impella, and it went beautifully). A time for the CSI, a time for the Rotablator, a time for the laser. BUT NOT EVERY CASE.
Remember, especially the RTs: TIME is an important factor in radiation protection. The less fluoro time, the less exposure to the patient. And the less exposure to the patient, the less exposure to you. And everyone should remember the cost to the patient in contrast. Contrast Induced Nephropathy is on the rise. And long cases with 250+ ml of contrast is a big reason. Those are things to think about, too.

And now for the techs and nurses who believe you know better than the doctor: YOU DON’T. Well, not most of the time, anyway. The doctor is thinking about dozens of things that never entered your mind. You see the image, he sees the image + lab work+ radiation time + patient history + the last image that looked like this + a dozen other things that you don’t know about. He’s the one making the decisions, not you. He’s the one in charge, not you. He’s the one losing his license if something goes wrong…and you don’t want to join him because you went outside your area of expertise. You see, doctors are like referees: No matter how wrong they are, they are right. There will be a doctor here and there who will take suggestions from you, and you are right to offer them. (And sometimes it works best to phrase them in the form of a question.) But they are only suggestions from someone who isn’t seeing the entire picture. The doctor is in charge. It is his job to place the stent. It is his job to decide what equipment to use. It is his job to decide when you’re done. Focus on your job and let him do his.
OK. Rant over. Carry on!