My take on this is simple: The advice I provide is based on available scientific research on the subject, and I feel able to inform patients of this research (or on occasion, lack of it) to help them make rational decisions. I am not a cardiac specialist, though I have access to experts in the field whose opinion I often seek. I believe that an educated second opinion offers a much-needed outlet for every patient to make appropriate choices and decisions. I am simply an advocate, seeking to compile the best information possible to make every reader or patient a more empowered consumer.
First and foremost, you must have faith and trust in your physician and his abilities. In addition, being empowered and knowledgeable about your disease is critical in decision-making. To accomplish this, every adult must become computer-literate, as the Internet has completely revolutionized our access to information. Once you know how to search for a medical problem, the available information is overwhelming.
Just as important is learning how to use reputable medical websites. Some require a fee, but others do not. Among the best are WebMD, the National Institutes of Health at www.nih.gov, and all reputable medical schools and hospitals.
When deciding whether to have a particular surgery or procedure, ask three critical questions: Will the treatment prolong life? Will it improve quality of life? What are the side effects?
The patient I saw had already had two previous open-heart surgeries. His first open-heart surgery was in 1995 and the second in 2007. Now his stress test is abnormal and an angiogram shows worsening blockage. His cardiologist felt a third surgery should be considered but that he would leave the decision “up to him,” as he “was on the fence” about this one. What was the patient to do?
Well, actually, the decision is easy. First, will surgery prolong his life? He is aged 72, and although, according to the patient, he understood that the surgery would prolong his life by as much as 10 years, there is no scientific evidence to support this claim. In fact, there is no evidence that his life would be prolonged at all or that surgery would reduce the risk of a heart attack.
Would it improve the quality of life? Again, the answer is quite clear. Surgery or any cardiac intervention is effective in relieving symptoms such as severe limitation in exercise tolerance, shortness of breath or chest pain that no longer can be treated medically. But this patient had no symptoms; he had no shortness of breath, chest pain or heart failure; and his heart was pumping normally. No, the surgery would not improve his quality of life.
And finally, what are the side effects? Here the danger of a third open-heart surgery is high. The risk of death is in excess of 10 percent, and for memory loss or other serious medical complication, the risk is more than 50 percent. So the decision is easy: Surgery is not indicated. Rather than surgery, this patient must be treated medically and be compulsive about a heart-healthy lifestyle.
Remember: The goal of treatment must be clear. No question you should have implicit faith and trust in your physician. But this does not mean you should blindly follow his advice. Thanks to readily available information, you can learn if quality of life will be improved and the risk of side effects. If a physician tells you side effects are rare, or that his results are better than anyone else’s, beware. Obtaining this information will make it possible to make a rational choice that is appropriate for you.
Dr. David Lipschitz is the author of the book “Breaking the Rules of Aging.” To find out more about Dr. David Lipschitz visit www.drdavidhealth.com