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which leads to issues such as the need for multiple medications and possibly a defibrillator, frequent hospital and oce visits, and a high risk of mortality if the patient reaches stage 4 heart failure. By acting quickly, we reduce the personal and financial burden on the patient as well as healthcare costs." For outpatient chest pain with normal stress test results a nd a n a ngiogra m t hat does not revea l a n emergenc y condition, the specia lists perform an elective procedure, he adds. In addition to stent placement, elective procedures include pacema ker a nd def ibrillator i mpla nt at ion . Elect rophysiolog ist s working in the lab may perform abla- tions to correct arrhy thmias. Severa l of the interventiona lists specia lize in radial angiography, entering through the radial rather than the femoral artery — a procedure that is popular with patients, Dr. Schwartz says. PATIENT-CENTERED DIAGNOSIS: NONINVASIVE CARDIOLOGY The process of accurate diagnosis starts with conversation, Dr. Semertzides says. In fact, the fulf illment he gains from interacting with patients to successfully resolve their heart conditions is why he chose noninterventional cardiolog y as his focus. " I wa nt ed t o d i a g nose a nd g u ide patients to the proper interventionalist or surgeon," he says. "As the years went by, I found working with patients was enormously satisfying. Clinical work is so rewarding. I get involved with patients from the start, perhaps even when they are having a heart attack. I take pleasure in being involved throughout the process of care and rehabilitation, helping get them back on their feet." The diag nostic process is patient- driven, Dr. Semertzides adds. " I place a h ig h pr ior it y on listen- ing to what my patients have to say," Dr. Semertzides says. "During the oce visit, when I ask, 'How are you doing since we last saw each other? ' and they tell me there's an issue, I focus follow-up questions on that response. Patients t y pica l ly descr ibe chest discom for t va g uely. At y pica l pa in may a r ise in female patients or those with diabetes, so we're on the lookout for that. Patients may describe fatigue, shortness of breath or lightheadedness as well. A ll these generate a problem list that I review mentally, thinking, 'This symptom could represent this disease. Perhaps a stress test or another type of test will uncover that.' The physica l examination helps me narrow it further. If I hear a louder or dierent murmur than I did six months prior, I may order an EKG." If a complaint or test result is grossly abnormal, Dr. Semertzides says, he sends the patient directly to the hospital — a process that is streamlined by the location of his practice. " Proximit y is a rea l adva nta ge for patients," he says. "It was not by mere cha nce that we chose a practice site close to the hospita l. We didn't wa nt patients to drive themselves from here to there, and even if we summoned an ambulance, we didn't want the drive to be long or delayed." The logic of exam-based diagnosis is one half of the cardiologist's problem- solving approach. The other consists of detailed, technolog y-assisted testing, made possible by advanced tools available at Brookhaven. "In addition to noninvasive EKGs and stress tests, as well as diagnostic angio- grams, we perform echocardiograms " When you have worked as a physician for a number of years, you can follow people — nurses, for example — from the time they start until they become seasoned in their profession. You see how they improve in what they do and how they do it. It is a pleasure to witness. They become experienced as you become experienced. Your community and your patients all benefit as a result." JAMES N. SEMERTZIDES, MD Waqas Khan, MD, and Dr. Schwartz, Knapp Cardiac Care Center interventional cardiac physicians 0 8C O V E R F E A T U R E

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