When several great options exist for treating a medical problem, which choice is the best?
Of course, the answer is “it depends.”
Medical decision making is not always cut-and-dried, and even the most highly trained specialists can disagree about the best plan of action.
When enough specialists disagree on the right course of treatment, a “clinical controversy” is born. Clinical controversies highlight the many possibilities of modern medicine and the deep expertise doctors must draw upon to treat complex problems.
Columbia neurosurgeon Dr. E. Sander Connolly, Vice Chairman of Neurosurgery, often helps other neurosurgeons navigate these complex situations. Neurosurgeons at Columbia University Medical Center/NewYork-Presbyterian Hospital are known for rigorous training, technical expertise, frequent collaboration with other highly trained specialists and access to the most up-to-date technologies.
They are also able to focus deeply on their areas of specialization. The result is extremely knowledgeable doctors whose judgments are invaluable to their patients and respected by their peers.
Dr. Connolly, for example, is known for his expertise in managing a type of bleeding in the brain called intracerebral hemorrhage. Intracerebral hemorrhage is a serious medical emergency, and time is of the essence in its treatment.
But in certain cases, Dr. Connolly advocates spending a little bit of time on a procedure called an angiogram. An angiogram allows a doctor to make a map of blood vessels in the brain and may be accomplished by directly (DSA) or indirectly (CTa) delivering dye into the blood vessels.
Once he has the map, Dr. Connolly can quickly put together a plan based on the best possible information. He may move right into emergency surgery, immediately perform minimally invasive surgery or begin treatment with medicine.
Performing an angiogram (even a CTa) before beginning treatment has both potential risks and benefits. The time taken for the procedure is very well spent—if the angiogram ends up revealing essential information. But if the angiogram doesn’t reveal anything helpful, the time spent performing it could have been better used in another way. So neurosurgeons want to use this approach only in cases where it is likely to be useful.
Dr. Connolly can call upon his extensive experience and his deep knowledge of the literature to quickly decide in each case whether performing an angiogram makes sense. He wants other neurosurgeons to be aware of the benefits of the procedure as well, and to have the information they need to make rapid decisions about it.
So at national and global gatherings, Dr. Connolly presents on the subject to his peers. He describes when an angiogram is best used and explains why he is such a strong advocate of taking the time for the procedure when it is likely to yield useful information.
In short, Dr. Connolly uses top-of-the-line technology to gather the best information whenever it makes sense for his patients. This helps him provide his patients with the highest standard of care. In turn, he can help set that standard for other practices as well, making sure all neurosurgeons are well-informed enough to navigate this particular clinical controversy.
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