DISCLOSURES
Frank J. Veith, MD
Ownership Interest (Stocks, Stock
Options or Other Ownership Interest)
– Vascular Innovations, Inc.
FRANK J. VEITH
I HAVE NO CONFLICTS WITH
THIS PRESENTATION
OTHER THAN A BIAS FOR
VASCULAR SURGERY
WHO SHOULD BE
RESPONSIBLE FOR EVAR?
DEBATE
FRANK J. VEITH
‘VASCULAR SURGEONS: IT IS A
COMPLICATED PROCEDURE’
J. MICHAEL BACHRACH
‘IT’S A SIMPLE PROCEDURE:IT CAN BE DONE BY ICs,
IRs, CT SURGEONS, OR RNs, MEDICAL STUDENTS,
SECURITY GUARDS AND CLEANING LADIES’
AT THE OUTSET
I SURRENDER
• EVAR CAN BE A SIMPLE PROCEDURE &
WE HAVE HELPED INTERNS, JR RESIDENTS &
MEDICAL STUDENTS DO MAJOR PARTS OR
ALMOST ALL OF SOME SIMPLE EVARs
• I AM SURE SOME OF OUR GOOD RNs, ETC
COULD DO THEM TOO
SO I GUESS I LOSE
THIS DEBATE
IN THIS DEBATE BEFORE AN
AUDIENCE LARGELY ICs
& BIASED FOR MY OPPONENT
Sacrificial VS Underdog
- IT’S GOING TO BE
IMPOSSIBLE TO WIN
AS UNDERDOG, I SHOULD
ATTACK AND RIDICULE
MY OPPONENT
MIKE IS SUCH A NICE GUY
A GOOD SPEAKER & A
SKILLED INTERVENTIONST
I SHOULDN’T DO THAT
VALUE OF MEDICAL DEBATES
** Entertainment
• Confirm Pre-existing Prejudice
• Outcome Not Based On Logic
But On The Principle:
“My Mind Is Made Up, Don’t
Confuse Me With Facts”
SO LET’S SEE WHAT
THAT PREJUDICE IS
HOW MANY IN THE
AUDIENCE THINK I SHOULD
LOSE THIS DEBATE
TO MIKE ?
A DEBATE
IN THE BEST
BRITISH TRADITION
KEEP A STIFF UPPER LIP
RECOGNIZE THAT THE
PURPOSE IS TO WIN
& PRESS ON TO DO SO
SINCE I HAVE ALREADY LOST
MAKE IT MORE INTERESTING
& MODIFY THE MOTION A BIT
WHO SHOULD BE
RESPONSIBLE FOR EVAR?
DEBATE
VEITH’S POSITION:
‘VASCULAR SURGEONS:IT MAY
BE A COMPLICATED PROCEDURE’
J. MICHAEL BACHRACH
‘IT’S A SIMPLE PROCEDURE:IT CAN BE DONE BY ICs,
IRs, CT SURGEONS, OR RNs, MEDICAL STUDENTS,
SECURITY GUARDS AND CLEANING LADIES’
A GIVE-AWAY OR ADMISSION
ALL VASCULAR SURGEONS
SHOULD NOT BE
RESPONSIBLE FOR EVAR
SPECIFICALLY THOSE WHO
SPECIALIZE IN VENOUS DISEASE
LEG BYPASSES, AND THOSE
WHO ARE NOT ENDOCOMPETENT
- THE SAME APPLIES TO CTSs
AFTER ALL, SHOULDN’T WE
BE DOING WHAT WE ARE
GOOD AT ?
ISN’T THAT BEST FOR OUR
PATIENTS?
IF YOU SAY YES ON THOSE 2,
YOU WILL LET ME CHANGE
MY MOTION A BIT MORE
WHO SHOULD BE
RESPONSIBLE FOR EVAR?
DEBATE
VEITH’S POSITION:
‘VASCULAR SPECIALISTS IF THEY
ARE COMPETENT: IT MAY BE
A COMPLICATED PROCEDURE’
J. MICHAEL BACHRACH
‘IT’S A SIMPLE PROCEDURE:IT CAN BE DONE BY ICs,
IRs, OR CT SURGEONS,
OK
WHO SHOULD BE
RESPONSIBLE FOR EVAR?
CRUX OF THIS DEBATE
VEITH’S POSITION
‘VASCULAR SPECIALISTS IF THEY
ARE COMPETENT: IT MAY BE
A COMPLICATED PROCEDURE’
J. MICHAEL BACHRACH
‘IT’S A SIMPLE PROCEDURE:IT CAN BE DONE BY ICs,
IRs, OR CT SURGEONS,
WHO SHOULD BE
RESPONSIBLE FOR EVAR?
CRUX OF THIS DEBATE
VEITH’S POSITION
NOT ABOUT WHICH SPECIALIST
SHOULD DO THE PROCEDURE
BUT WHO CAN DO IT BEST AND
MOST SAFELY & EFFECTIVELY
FOR PATIENTS
EVERY ONE AGREES WITH THIS
WHO SHOULD BE
RESPONSIBLE FOR EVAR?
CRUX OF THIS DEBATE
VEITH’S POSITION
IF THEY ARE WELL TRAINED,
I BELIEVE VSs, ICs, IRs, GSs, CTSs
CAN PERFORM EVAR
MUST BE ABLE TO DEAL WITH
PROBLEMS (INCL SURG) THAT
ARISE – OR HAVE ASSOC WHO CAN
AN ANALOGY
YOU & YOUR WIFE ARE HAVING A BABY
WHO DO YOU WANT TO DO DELIVERY?
ALL OK IF ROUTINE
• GP
BUT WHEN SOMETHING
• MIDWIFE
GOES WRONG, YOU
WANT THE BEST;
• FIREMAN
SHOULD WANT THE
• POLICEMAN SAME FOR PATIENTS
• OBSTETRICIAN
WHO SHOULD BE
RESPONSIBLE FOR EVAR?
DEBATE
VEITH’S POSITION:
‘VASCULAR SPECIALISTS IF THEY
ARE COMPETENT: IT MAY BE
A COMPLICATED PROCEDURE’
J. MICHAEL BACHRACH
‘IT’S A SIMPLE PROCEDURE:IT CAN BE DONE BY ICs,
IRs, OR CT SURGEONS,
SO YOU MUST AGREE
WITH MY MODIFIED
MOTION
THEREFORE I WIN
THE DEBATE !
WHO SHOULD BE
RESPONSIBLE FOR EVAR?
CRUX OF THIS DEBATE
IF THEY ARE WELL TRAINED,
I BELIEVE VSs, ICs, IRs, GSs, CTSs
CAN PERFORM EVAR
MUST BE ABLE TO DEAL WITH
PROBLEMS (INCL SURG) THAT
ARISE – OR HAVE ASSOC WHO CAN
VASCULAR SURGEON IS
BEST ABLE TO DEAL WITH
AAA RELATED SURGICAL
PROBLEMS
LIKE OPEN CONVERSION
WHY HAVE 2 MDs
IF ONE CAN DO
THE JOB
LESS $s, SIMPLER, ETC
TO HAVE ONE
WHO SHOULD BE
RESPONSIBLE FOR EVAR?
DEBATE
VEITH’S POSITION
‘VASCULAR SURGEONS: IT MAY
BE A COMPLICATED PROCEDURE’
J. MICHAEL BACHRACH
‘IT’S A SIMPLE PROCEDURE:IT CAN BE DONE BY ICs,
IRs, CT SURGEONS, OR RNs, MEDICAL STUDENTS,
SECURITY GUARDS AND CLEANING LADIES’
SO EVEN WITH THE
ORIGINAL MOTION
I WIN !