Subtitle: In cardiology, the hardest choice isn’t what we can do—it’s knowing when not to.
I didn’t become a doctor to say “no.”
Like most physicians, I trained for years with the assumption that more intervention meant more help. That new technology, advanced procedures, and cutting-edge tools were the future—and that our job was to apply them as skillfully and frequently as possible.
But after more than two decades in cardiology, I’ve come to believe something different: that restraint is sometimes the most powerful—and most ethical—form of care we can offer.
Not because we’re doing less. But because we’re thinking more.
And when it comes to treating heart disease, thinking carefully is more important now than ever.
The Stent That Changed Everything
Coronary artery stents are one of the most significant breakthroughs in modern cardiology. They revolutionized how we treat heart attacks, saving countless lives by reopening blocked arteries in real time. I’ve placed many myself. I’ve watched patients go from crisis to recovery in a matter of hours because of this device.
But the problem is what happened next.
Over time, stents became more than a tool—they became an assumption. Chest pain? Stent. Abnormal stress test? Stent. A 70% narrowing on an angiogram? Stent.
And yet, over the past 15 years, large, rigorous studies have shown that for patients who are stable—not having a heart attack—stents often don’t prevent future heart attacks or extend life. This includes the landmark COURAGE trial, the ISCHEMIA trial, and a growing body of global data.
That knowledge changed my practice. It changed my thinking. And it deepened my commitment to doing what’s best for patients—not what feels reflexively satisfying.
What Patients Deserve to Hear
When someone comes to my office after being told they “need a stent,” I don’t start with technology. I start with a conversation.
“How are you feeling?”
“What did your symptoms feel like?”
“What concerns you most right now?”
“What have you already tried?”
Then we talk through the results—calmly, without pressure. If the patient isn’t in crisis, we explore all options, including medication, lifestyle changes, and risk reduction strategies.
And we talk about risk. Because every procedure, even a routine stent, has its risks—bleeding, vessel damage, medication complications, and downstream effects on care. Those are real. They deserve real discussion.
The goal is not to talk someone out of treatment—it’s to talk them into understanding. That’s a very different thing.
Practicing in Tennessee
When I relocated my practice to Tennessee, I came with a renewed focus on prevention and education. The region has some of the highest rates of cardiovascular disease in the country. It also has incredible patients—hardworking, curious, open-hearted people who often haven’t had access to preventive care or clear communication.
Here, I’ve found a community that’s hungry for honesty. They don’t want sales pitches. They want someone to take the time to explain the why, not just the what.
I’ve had patients say, “No one ever told me I could try changing my diet and medication before a procedure.” That tells me we’re not doing enough to explain—not because we don’t care, but because we’re stuck in a system that values speed over understanding.
In Tennessee, I’ve built a practice that rejects that model.
The Cost of Doing Too Much
It’s not just about patient outcomes. Over-treatment is expensive. It drives up the cost of care for everyone. It contributes to physician burnout. It adds complexity to patients’ lives that may not lead to better health.
But most importantly—it erodes trust.
When patients feel like they’re being pushed through a system that acts before asking, they become skeptical. Rightfully so.
We don’t rebuild that trust by being passive. We rebuild it by being thoughtful.
Sometimes the bravest thing a doctor can say is, “You’re okay. We can wait. Let’s do this together, step by step.”
What I Want Younger Doctors to Know
I mentor medical students and residents when I can, and I tell them this: your job is not just to know the newest treatment. It’s to know your patient. That means taking time. That means resisting pressure to act just to act.
There’s a deep satisfaction in choosing not to intervene—when it’s the right call. Because then, you’re not just a technician. You’re a physician.
And the best physicians don’t just treat—they think, they guide, and they care deeply.
Redefining Excellence in Cardiology
The next era of heart care won’t be defined solely by new stents or surgical techniques. It will be defined by how wisely we use the tools we already have.
That means:
- Investing more in prevention
- Educating patients as partners
- Rewarding long-term health outcomes over short-term interventions
- Shifting policy incentives to support restraint when appropriate
- And ensuring that listening remains our most used diagnostic tool
To me, that’s the real future of cardiology.
A Heartfelt Ask
If you’ve been told you need a stent—or any procedure—ask questions. Don’t be afraid to seek a second opinion. The best doctors won’t be offended. In fact, they’ll respect you for it.
Ask:
- Is my condition stable or urgent?
- What does the latest evidence say?
- What are the risks and alternatives?
- What happens if we wait?
These aren’t just smart questions. They’re life-changing ones.
Final Reflection
At the end of the day, cardiology is about more than opening arteries. It’s about preserving lives, protecting dignity, and practicing with purpose.
I still use stents. I still believe in bold interventions when they’re needed. But I also believe in quiet courage—the kind it takes to wait, to explain, to say no.
Because doing less, when it’s the right thing, is still doing medicine. And sometimes, it’s the most powerful medicine we have.