Silo Busting: Why I Attend HRS Scientific Sessions May 18, 2010

It is human nature to develop a routine in our life and career. As we care for patients, perform procedures and think critically about medical and scientific issues, we tend to establish fixed patterns of behavior and thought. Our practice is molded by our prior training, personal career experiences and exposure to the experience of others in the form of publications, conferences and conversations. I would argue that the last factor is the most important one – the exchange of ideas and observations with colleagues from other institutions. These are the influences that keep us centered and on track.

When we become insulated from outside influences, we may easily establish a practice pattern that veers off from the mainstream, occasionally to the point of failing to adhere to the standard of medical care. The concept of practicing medicine without sufficient outside influence has been metaphorically likened to a grain silo because of how a silo both stands out from the surrounding scenery and creates a firm barrier between its contents and the outside world.

I believe that most health care providers whose practice behavior is unusual or unique have arrived at that point in a relatively innocent way. We all tend to be most moved by our own successes and failures, and we adopt at least a modicum of caution based on our most recent complications or misadventures. And if an adverse outcome regrettably resulted in the threat or actualization of legal action, the impact on that physician’s future practice behavior will likely be more extreme, regardless of merit of the claim. Such practice changes, based on anecdote, may or may not result in improved quality of care. Because of patient individuality and the lack of perspective when it comes to self-assessment, it can be challenging for the health care provider to judge whether his or her delivery of care is as effective as it could be.

And this is where exposure to other styles, data, individuals and groups can be so therapeutic and powerful. It is impossible to improve when we don’t know what we don’t know. But when our eyes are opened to (or we are reminded of) alternative strategies, insights, and techniques, then the process of critical comparison can begin.

A perfect example of this concept is demonstrated in the practice of lead extraction.  While my procedural practice runs across the EP spectrum, lead extraction is the most unique service I provide, with little daily opportunity to engage in dialogue with peers about decision-making or techniques. And this is almost universally true, since high success rates and low complication rates are best achieved when the lead extraction experience is concentrated among one or two operators at a given medical center. And so each lead extractor necessarily develops a “silo” type practice, selecting tools and methods that are tailored to his or her style and prior experience. At the Heart Rhythm Society Scientific Sessions, it was remarkable to hear various lead extraction experts describe their techniques, and recognize that a range of practice styles can each achieve excellent results despite their notable differences. While there should be an element of “playing to your individual strengths,” everyone has room for improvement and it is only through such exposure to peers that we can each decide what additional elements we wish to incorporate into our practice.

I believe it is vital for each of us to repeatedly expose ourselves to alternative ways of providing medical care, which includes critical comparisons of patient assessment, judgment, treatment options, procedural techniques, and, most importantly, outcomes.  I guarantee that the “silo” practitioner, over time, will not be the pinnacle of health care delivery.  And if self-improvement does not prove to be a sufficient motivator for some individuals, the shift toward quality-based practice evaluation and reimbursement assuredly will be.

I always feel invigorated after attending the Heart Rhythm Society’s Scientific Sessions for many reasons, but a fresh exposure to the experience and practice of out-of-town colleagues, and the resultant casting off of blinders, remains my favorite.