The Patient Was…

Medicine, like many other areas in life, has its buzzwords, those catchy words or phrases that become popular for a while and seem to capture a core meaning or intent. The underlying ideas may actually be old, but the heightened usage implies novelty and special relevance, perhaps even insight. We wrote about one, Shared Decision-Making, not long ago, and emphasized that the idea wasn’t really new after all, but in reality represented just incremental change in an old and common practice.

The Heart Team represents another apparently new and suddenly vital concept in the care of cardiology patients. But, in actuality, it is a new name for an old and established practice in medical care. The proliferation of scientific knowledge has perhaps given it renewed relevance, but there always was a “team” of doctors caring for patients in some way or other when necessary.

There is a longstanding debate about the wisdom of groups versus that of individuals. The argument is both philosophical and practical and, like so many things, the right answer depends on context and circumstance. A study from the Wharton School summed it up nicely, I think, when they found that the answer depends on the complexity of the problem: Individuals do better when tasks are simple, while complex problems are best solved by groups.

In many team-building exercises, a common theme is attempting to solve a problem first as individuals, then as a team. The scenarios often involve simulated disasters where the participants have to choose among various courses of action to survive. First, everyone has to make their own choices; then they collaborate to find solutions. Almost always, the group effort is more successful than that of any individual.

On the other hand, I always chuckle at the observation, made in jest, that a camel is a horse put together by a committee.

How does all of this relate to medical care, in general, and to cardiac care, in particular?

In earlier times, diagnoses were simpler and fewer. The current International Classification of Diseases, which is the standard system in the United States to classify diagnoses, lists thousands of individual entries, including thousands more than just a couple of decades ago. The 2025 update added 324 new codes reflecting changes in disease classification and emerging conditions. When diagnoses were simpler and fewer, individual physicians could recognize and manage more of them. As scientific knowledge expanded dramatically in recent years, and diseases were understood to be more complex, it became more difficult for individual doctors to absorb all the new information.

Only half in jest, an older doctor with whom I once shared an office told me, “The reason I don’t go to conferences anymore is that my brain has no more room for new information. I can barely remember what I supposedly know now.” Parenthetically, when I found that he had to refer to a cheat-sheet to remember proper dosing of routine drugs, he accepted my suggestion of retiring.

Medical care has become more specialized as scientific information has expanded. Almost every medical and surgical field now has sub-specialties. Cardiovascular disease, for example, has many separate areas of focus including electrophysiology (heart rhythm), heart failure (inadequate heart muscle function), coronary disease (blocked arteries in the heart), peripheral vascular disease (disease of blood vessels outside the heart), interventional cardiology (inserting catheters into the heart and its blood vessels), heart valve disease, echocardiography (ultrasound of the heart) and other cardiac imaging (CAT scans, MRIs) to name just a few of the more prominent ones.

Whereas, in the past, a general cardiologist could master most or all of the available scientific knowledge about the heart and vascular system, the general cardiologist today often serves more as a “gate-keeper” to other more specialized colleagues. With so much new information about diagnosis and treatment, including testing, drugs, devices, and techniques, it is rare, if not impossible, for a single individual to master all that is known and useful.

Hence, the advent of The Heart Team.

The concept is well described in a recent article in a prominent cardiology journal: The heart team is a multidisciplinary group (including multiple specialties) that collaborates on complex cases to provide the best options for care of the patient. The idea is admirable, even noble. But as the article itself reports, despite current guidelines recommending heart teams, data on designing, implementing and assessing the success of the heart team approach is limited. In other words, the idea is great, but we really cannot yet say just how to constitute the team, how it should actually function, and if, in fact, it accomplishes its goal in ways that otherwise would not be achieved.

My question is: Does The Heart Team really represent something new or is it a buzzword for something that has been part of medical care for a long time? Is it a valuable new idea or just an incremental and natural evolution of medical care for patients?

From early times, medical care was always, in a sense, a “team” effort. In the Hippocratic oath, physicians pledge to honor their instructors and pass on knowledge, so sharing of information was already an ethical and practical principle of care. The Latin origin of the word “doctor” refers to “teacher,” and as early as the Middle Ages the term was applied to medical practitioners. In traditional Native American healing, medicine people often sought help from others to address illness. A medicine man might consult other healers, especially if the illness was complex. This meant, among other things, sharing knowledge, combining ceremonies, or using remedies from different traditions.

In more modern times, doctors routinely called upon consultants with specialized knowledge and experience in cases where diagnosis was difficult or optimal treatment was uncertain. This was a team effort even if not designated as such. When my own mother was suffering from heart failure due to disease of two of her heart valves, her physician called upon a more experienced specialist to help manage her illness. This was a heart team, however simple in its design.

Currently, heart teams are often more complex. With more specialized knowledge, more experts tend to become members of the team. But expertise and experience are not uniformly distributed, and one individual or group may have more influence than others in critical decision-making. Seniority and institutional hierarchy may also play a role in whose opinion carries sway. Additionally, as more members comprise the team, more tests are likely to be ordered, and greater expenses related to personnel, equipment, and activities are generally incurred.

Communication with patient and family, such a crucial element in optimal medical care, may suffer in the setting of team efforts. Who has ultimate responsibility in conveying complicated information and recommendations?  If the role of the primary physician is minimized, as is often the case in modern hospital protocols, who and where is the trusted confidante in whom the patient and family have placed their faith?

What I have tried to convey in this piece is that the concept of a medical, and in this case, heart team is not new. There has always been collaboration among healers in caring for patients. The current form has evolved in a way that has definite benefits but also certain drawbacks. Evidence that the current Heart Team construct is optimal is limited. As more knowledge is gained and more diagnostic and treatment options become available, the optimal management of complicated patients within the current system of health care will be tested.