In it he bluntly states his conviction that the “growth of invasive cardiac procedures is attributable to…economics, overtraining of interventional cardiologists, fear and anxiety by patients and their families of imminent sudden demise [despite patients having stable symptoms], conflicts of interests between individuals and groups carrying out research…and the need of interventional cardiologists to perform a minimum number of procedures to maintain subspecialty certification.

“One could argue that the problem in the United States is that there are too many and not too few cardiac catheterization laboratories.”

His credibility in these matters is enhanced by substantial credentials: associate clinical professor of medicine, Harvard Medical School and Brigham and Women’s Hospital; director of the Lown Cardiovascular Center and president of the Lown Cardiovascular Research Foundation, affiliated with the Harvard School of Public Health. Committed to the Lown foundation’s charge of clinical research into the causes and treatment of heart disease, Dr. Graboys is also a heartfelt promoter of its mission: “a vision of medicine that joins scientific and clinical excellence with the art of healing…[to] help restore the bonds of trust and compassion between physicians and patients.”

This is not only something he champions, but also a fixed, painful recollection of the beliefs he says were validated at the bedside of his wife. “The most significant event in my life and as a physician was the illness and death of my wife, Caroline [in 1998], from colon cancer,” he says. “It made me realize what powerful healing can go on between a physician and a patient, and how important the support and advocacy of family and friends are. They all prolonged her life.”

The overriding concern Dr. Graboys has with the psychological well-being of patients, as well as their physical condition, predates his personal tragedy. As a fourth-year student at New York Medical College, Dr. Graboys took an elective with Bernard Lown, M.D., the renowned cardiologist at Harvard who is famous for groundbreaking work in heart disease and cardiac arrhythmias, and development of the modern defibrillator and the cardioverter. During this rotation the seeds for cardiology were planted, to flourish later in a residency at Boston City Hospital, followed by fellowships at the School of Aerospace Medicine in Texas, and cardiovascular medicine at the Peter Bent Brigham Hospital. At its conclusion he was asked to join the faculty at Harvard.

Given that he had rekindled his relationship with Dr. Lown during that fellowship, Dr. Graboys also continued the cardiac research that soon earned him a staff position at Lown. In 1991 he was named director of the Lown Cardiovascular Center, the research arm of the entity founded and still chaired by Bernard Lown.

With the passing of time, Dr. Graboys gained a reputation for advocating a noninterventional approach to the management of stable coronary artery disease. An early highlight was the publishing of his editorial “Stress and the Aching Heart” by the New England Journal in 1984. It is still a frequently cited article. “But you should know that we are very aggressive in directing patients for bypass and angioplasty when they remain symptomatic despite an adequate medical program,” he makes clear.

“In cardiac patients, the heart is literally aching. You can push pills or do interventions until you’re blue in the face. Unless you understand the human condition and where the patient falls under that umbrella, you can’t decide what treatment is best for them… The public knows stress is an independent risk factor in a coronary, but doctors won’t acknowledge it. I’ve found that if you ask a patient when a symptom began, you will find out there was a major disaster in the family-some psychological stimulus that set off a cascade of problems,” he says.

His patients are mostly referred by other cardiologists, including an inordinate number of cardiologists and cardiovascular surgeons who want their own second opinions. “I will tell you that our data show at least 50 percent who come for a second opinion don’t require intervention and will continue to do well on medication,” he says… “My position isn’t popular, but there are people who agree with me.”

When his life turns to research and teaching, Dr. Graboys is not so controversial. “We are in the business of outcomes research,” he explains. “If you do A, B, C or D, will the outcomes be reflected in survival?” As principal investigator for a seven-year-old trial of some 1,000 patients, Dr. Graboys is tracking what happens after they get their second opinions-what procedure was done, who lived and who died.

His teaching prowess has continually earned the reward of students and faculty through excellence in teaching awards. Last year was the piece de resistance. Dr. Graboys was recognized as “an outstanding faculty member who is judged to be exemplary in their [sic] compassion and sensitivity in the delivery of care to patients and family members.” This honor required nomination by medical students and resulted in his winning the second annual Healthcare Foundation of New Jersey Humanism in Medicine Award.

Dr. Graboys can tally numerous writing credits, including many that are not contentious. He currently serves on the editorial board of the Journal of Noninvasive Cardiology and formerly did so for the New England Journal. That he has a strong social conscience is evident from his work with Physicians for Social Responsibility. Yet with all these other interests, the bottom line for Dr. Graboys is still doctoring:

“We are privileged to be physicians. What other profession allows us entree to both the psychological and physical space? It was true 30 years ago when I graduated from medical school and it remains so today.”