Why Cardiology Needs to Embrace Thoughtful Restraint
In a world where modern medicine can do almost anything, the temptation to do everything has never been greater. Cardiologists, armed with sophisticated tools and decades of training, often find themselves in a position of power—and pressure. When a patient presents with chest pain or an abnormal test, the reflex to intervene can feel automatic. But for Dr. Andrew Rudin, MD, a nationally recognized cardiologist and a leading voice in evidence-based care, the real measure of a physician’s wisdom is knowing when not to act.
“More care doesn’t always mean better care,” Dr. Rudin explains. “Sometimes it means more cost, more risk, and more confusion—for everyone involved.”
As the volume of diagnostic and therapeutic options continues to grow, so too does the risk of overtreatment—a phenomenon that has quietly become one of the most serious threats to patient safety and healthcare sustainability. Nowhere is this more visible than in the field of cardiology.
A Culture of Doing
For decades, cardiology has been defined by its capacity to act. Procedures like angioplasty, stenting, and catheter ablation revolutionized treatment and saved millions of lives. But success has come with a side effect: the emergence of a culture that values action over observation, speed over reflection, and imaging over listening.
According to Dr. Rudin, the shift began innocently enough. As cardiologists learned to prevent heart attacks with early intervention, the line between urgent and elective care began to blur. Gradually, procedures once reserved for acute events were being offered to patients with stable symptoms—or no symptoms at all.
The result is a system in which many patients undergo tests and treatments that offer little clinical benefit, simply because the technology exists and the infrastructure supports it.
“We’ve confused possibility with necessity,” Rudin says. “Just because we can see a narrowing in an artery doesn’t mean we need to fix it.”
The Problem With Pathologizing Normal
One of the most subtle dangers of overtesting and overtreatment is that it can turn normal variation into perceived pathology. For instance, an incidental finding on a cardiac CT scan might lead to more imaging, more follow-up, and even invasive procedures—none of which improve outcomes, but all of which contribute to patient anxiety and system overload.
This phenomenon, known as the cascade effect, has been well-documented in recent years. A minor test result triggers a series of follow-ups, sometimes ending in complications that would never have occurred if the original test hadn’t been performed.
Dr. Rudin argues that part of the solution lies in redefining what counts as “abnormal.” Not every deviation from textbook physiology requires intervention. Not every imperfect image demands correction.
“We have to remember that medicine is not math,” he says. “It’s judgment. It’s narrative. It’s asking the right questions—not just ordering the right tests.”
Patients as Partners, Not Passengers
One of the most profound shifts Dr. Rudin advocates for is a return to shared decision-making. In many clinical settings, decisions about testing and treatment are made quickly, often without a full discussion of risks, benefits, and alternatives. Patients, overwhelmed by complexity or urgency, may defer to their physician without realizing they have choices.
Dr. Rudin believes that empowering patients is not just ethical—it’s clinically effective. When patients are given time, education, and support, they often make more conservative, thoughtful decisions that align with their values and reduce unnecessary care.
He sees this not as a failure of medicine, but as an invitation to practice medicine more wisely.
“The best medicine happens when the patient and physician are aligned in purpose,” he says. “That alignment takes time, trust, and transparency.”
Medical Education Needs a Reset
To change the culture of overtreatment, Dr. Rudin believes we must begin with how we train doctors. In many residency and fellowship programs, procedural skills are emphasized over communication, reflection, or restraint. Young physicians learn to “rule out the worst-case scenario” rather than to manage uncertainty with confidence.
Rudin teaches his trainees that good medicine is not just about getting the diagnosis right—it’s about knowing which diagnosis matters and when treatment helps.
This means moving away from algorithmic thinking and toward contextual thinking. It means recognizing that the most important question is not “What is the disease?” but “What does this patient need right now?”
The Economics of Overtreatment
Beyond patient safety, overtreatment has significant economic implications. Unnecessary tests and procedures drive up healthcare costs, consume valuable resources, and contribute to physician burnout. In many cases, they also expose institutions to liability when complications occur from interventions that were never truly indicated.
Dr. Rudin supports reforms that reward quality over quantity—systems that encourage physicians to spend more time with fewer patients, rather than rushing to meet procedural quotas. He acknowledges that structural change is difficult, but insists it’s necessary.
“We can’t solve overtreatment with guidelines alone,” he says. “We need to change what we value in medicine.”
A More Humane Model of Care
At its heart, Dr. Andrew Rudin’s message is a deeply human one. He is not against technology or progress. He is not calling for a return to the days of guesswork and limited tools. What he is calling for is balance—a medical culture that honors evidence, respects the patient’s voice, and is humble in the face of uncertainty.
In this model, the cardiologist is not just a technician or diagnostician. He is a guide, a teacher, and a steward of trust. He knows that sometimes the hardest decision is not whether to intervene, but whether to pause.
And in that pause, something essential happens: the space for true care is created.