4um: Doctors may not fully explain risks of common heart procedure

Status: Not Logged In; Sign In
Health
See other Health Articles
Title: Doctors may not fully explain risks of common heart procedure
Source: [None]
URL Source: [None]
Published: May 21, 2015
Author: Lisa Rapaport for Reuters
Post Date: 2015-05-21 02:27:53 by Tatarewicz
Keywords: None
Views: 37
Comments: 6

NewsDaily... (Reuters Health) – Patients mulling whether to get a common procedure to unclog blocked arteries may not get enough information from their doctors to make the best choice, a small study suggests.
Researchers analyzed recordings of 59 conversations between cardiologists and patients about a common procedure called percutaneous coronary intervention (PCI), which is done to reopen arteries and restore blood flow to the heart – and found just two discussions covered all the points needed for patients to make an informed decision.
“When you are facing a decision that has a number of consequences one way or the other, there are a number of issues that you are supposed to address and we found, overall, that very few conversations had all the elements,” said Dr. Michael Rothberg, of the Center for Value Based Care Research at Cleveland Clinic in Ohio.
The procedure, also referred to as a balloon angioplasty, involves attaching a tiny deflated balloon to special tubing that’s threaded through arteries to the site of the blockage. Then, surgeons inflate the balloon to clear away the debris, often leaving a tiny wire mesh cage called a stent inside the vessel to prevent future clogging.
While the procedure can relieve pain and prevent heart attacks in some patients, it doesn’t benefit everybody and it also carries risks such as infections, damage to blood vessels or a ruptured artery that requires open-heart surgery to repair.
“Having a PCI if you don’t really need one is not something an informed patient would do,” said Floyd Fowler, Jr., a senior scientific advisor at the Informed Medical Decisions Foundation who wasn’t involved in the study. Without enough information about the advantages and harms of a procedure as well as any alternative treatments, patients may overestimate the benefits of surgery, he said by email.
The study focused on patients considering the procedure to relieve symptoms of chronic stable angina, a type of chest pain that can flare up as a result of exercise or stress and can sometimes be managed with rest or medication.
Doctors discussed alternative treatments just 25 percent of the time, and were even less likely to take time to confirm whether patients understood information or to explain the pros and cons of different stents that might be used during surgery.
In most conversations, physicians recommended the procedure and when they did, most patients followed their advice. In the rare instances when doctors didn’t express an opinion or recommended against the procedure, patients always listened.
Most patients with chronic stable angina falsely believe that this operation can prevent heart attacks or death, even though its main benefit is easing chest pain, the researchers note in JAMA Internal Medicine.
“Patients should be asking if the treatment will affect how long they live or prevent an event like a heart attack,” Dr. Grace Lin, an internist at the University of San Francisco Medical Center and co-author of an editorial published with the study, said by email. “Patients should consider asking for a second opinion if they feel like they haven’t been given all the information they need in order to feel comfortable making a decision.”
SOURCE: bit.ly/1EYtdwf JAMA Internal Medicine, online May 18, 2015.
(c) Copyright Thomson Reuters 2015. Click For Restrictions
Health News

Read more at newsdaily.com/2015/05/doc...dure/#2oQepBey4Uj6fbpj.99
Post Comment Private Reply Ignore Thread
Top • Page Up • Full Thread • Page Down • Bottom/Latest
#1. To: Tatarewicz (#0)
Now look, would doctors ever let GREED nudge them across an ethical line like full disclosure re a high-dollar operation?
What are they, in it for the money?

NeoconsNailed posted on 2015-05-21 7:52:54 ET Reply Trace Private Reply
#2. To: NeoconsNailed (#1)
Maybe the answer is for the state to fully fund doctor training and pay them a comfortable annual salary to treat people and do research and promotion of illness prevention as well as cures. In my case I've had a half dozen docs/specialists, one after another, high pressure me into going for a $100-grand heart ablation to "cure" a recurring tachycardia which seems to be induced by anxiety and weather-front states (which docs poo-poo). Their tactics are funny which generates a light-hearted, tachycardia avoidance-prevention mood; but I guess, in the end though, they'll have the last laugh.

Tatarewicz posted on 2015-05-22 1:35:37 ET Reply Trace Private Reply
#3. To: Tatarewicz (#2)
Well, sounds like you've got a good idea how to manage it without them. Hope so.

NeoconsNailed posted on 2015-05-22 1:48:51 ET Reply Trace Private Reply
#4. To: NeoconsNailed (#3)
Then there's this from Medscape:
Bound by Vows, Tied to Responsibilities Julian L. Seifter, MD

www.medscape.com/viewarticle/844895_2

Doctors are caught between two kinds of commitment: the promise we made on entering the profession to put our patients first, and the demands of a job that sometimes pulls us away from patients, piling on tasks not directly connected to their care or well-being but required by hospitals, insurers, or government agencies. In a way, we are held hostage by the oath we are true to. When I attended my graduation ceremony at Albert Einstein College of Medicine, several decades ago, the class recited the Oath of Maimonides, including the following language:
Inspire me with love for my art and for Thy creatures. Do not allow thirst for profit or ambition for renown and admiration to interfere with my profession, for these are the enemies of truth and of love for mankind, and they can lead astray in the great task of attending to the welfare of Thy creatures.
Whether it's Maimonides or Hippocrates or more modern variations, the vow to put patients first, regardless of all other considerations, remains the same. We can't rise up and say, "Enough! (of code numbers, pharmacy calls, paperwork)." We have to find a way to stay true to our professional responsibilities to our patients while also meeting the demands of our jobs. Clinicians often find themselves in a bind: They can't do it all; they have to do it all. Clinicians often find themselves in a bind: They can't do it all; they have to do it all.
An example: It's 10:00 PM when I get to the parking garage, and then I can't remember where I left my car. When I arrived, 14 hours ago, I was thinking about the day ahead and didn't notice which floor I was on. Using my remote key, I follow the beeping sound one floor up and find my Volvo, alone except for one other car parked a few spaces away—and there's my friend, just getting into the driver's seat. The parking gods seem to like to put us near each other; we often meet here at this late hour. She is a primary care physician, my age. Turns out her last patient was at 5:00 pm. She fills me in on what she has been doing for the last 5 hours: writing notes, answering calls and email, searching for labs, writing to colleagues about shared patients, meeting with one of her patients who has been admitted to the hospital, leaving a note in the chart—a typical day not unlike mine. Borrowing From Peter to Pay Paul
Not everyone with professional obligations works 14-hour days. Recently I was on an evening flight out of Cleveland—the last flight to Boston on a Sunday—and my plane, delayed for 2 hours in Virginia, had finally arrived at Hopkins International. Once we had boarded and the plane had taxied onto the runway, I breathed a sigh of relief: I was going to make it home so I could get to work for an early Monday meeting. But after idling on the tarmac for 10 minutes, the plane turned around and taxied back to the gate. The pilot's voice came over the loudspeaker: "We're sorry, but we are 5 minutes over the maximum time allowed for a pilot to work in one day." Needless to say, I missed my Monday morning meeting.
Pilot fatigue is taken seriously. Some 30 years ago, house staff fatigue began to be taken seriously. The Libby Zion case resulted, as everyone knows, in strict regulation of the length of residents' work shifts, reducing trainee errors caused by lack of sleep because (obviously) they are no longer sleep-deprived. The fallout has been complicated, however. Errors arising from faulty "handoffs" also pose a risk because (obviously) now there is a handoff where there wasn't one before; residents, receiving a more piecemeal exposure because of the time restriction, can no longer follow a complex illness for a consecutive 36 hours.
Then there is the kind of phone call I get from the renal fellow at 3:00 AM Should she go into the hospital to see a uremic patient who is in the emergency department? It's not a clinical question but a scheduling one: If she comes in to see the patient in the middle of the night, she can't come to my afternoon clinic the next day because she'll have to leave at noon. At some point in my career, it became harder to keep abreast of these rules than to manage a potassium of 8 mEq/L and a pericardial friction rub.
why are hour restrictions applied only to the young, physically fit house staff and not the older physicians?

Sometimes I think we have this hours thing all wrong. If sleep deprivation impairs good judgment and worsens patient outcomes, why are hour restrictions applied only to the young, physically fit house staff and not the older physicians? You know—the ones who fall asleep during grand rounds that they are required to attend to get enough credit to stay credentialed. Is sleep important only before you are in practice? I can hear Mark Twain saying that "a good night's sleep is wasted on the young."

Riding on the Rule-Go-Round
While I'm in curmudgeon mode: Billing for the uremic patient's procedure also requires me—the senior attending—to be on hand. Plus I need to know the billing rules. I carry those—not the Oath of Hippocrates—around with me. I ask you: What is wrong with this picture?
Here's a partial (much-reduced) list of the contradictory pressures operating on a physician in the course of duty:
Rush in, treat hyperkalemia, guide fluid therapy
Try to avoid the expense of asking the dialysis staff to come in on off-hours, incurring overtime pay
Get to the documentation (but don't use templates)—everything that is required for insurance to pay
Often, the insurers have changed the requirements just when you thought you understood what was needed. Did the rules change because you figured out what you had to do to get paid? By the way, did you start the note saying that this was a referral or consult? One gets paid, the other rejected. Did you bill using a diagnosis code used by another physician that same day? Careful, that could be fraudulent double billing. Did you list edema under the cardiovascular exam of the extremities? Jugular venous pressure, under HEENT or cardiac? And did you get a full "review of 10 systems" from the intubated, comatose patient? I had never counted the systems so was at first surprised to learn that there were 10.
I recall from my internship days a patient who came in with a Quaalude overdose in the middle of the night. As the patient began to wake up, he started to pull out his endotracheal tube—at which point my resident said, "Don't extubate him until I've taken his history." Our Oaths Never Expire
The basic problem is a conflict of interest between outside pressures and your oath. Should you consider the necessity of discharging the patient before noon as best for the patient? Bill at the highest level, earning congratulations from the billing office, or do and document what you judge to be important in each case and then bill accordingly? Should a billing aficionado look at the documentation (they do anyway) and then do the billing themselves? Why the physician? The highest billing code requires a significant allotment of time, so it's best to incorporate the number of minutes you spent with the patient into your note.
On the other hand, seeing lots of patients to generate revenue means that the time per patient is reduced. (The most time-efficient job I ever had was as a teenager—delivering newspapers in an apartment building.) Those "lots of patients" we see on some clinic days make us seem like an airline overbooking its flights. Some waiting rooms have an electronic board on the wall with the doctor's ETA: Dr Jones, 20 minutes late, gate 6. If all of your patients show up, you are going to run late—which the front office regards as a perfect time for patients to fill out a questionnaire evaluating your performance. Question #1: "How long did you have to wait?"
This brings to mind a story or two. I was running behind when the renal fellow started presenting the next patient to me. "This 49-year-old male..." The patient interrupted: "I'm 50." I turned to him. "Wow... the wait was that long?"
On another occasion, my first two patients arrived simultaneously. I saw the first patient, a parking meter attendant in uniform, and spent extra time because an unexpected problem arose. The receptionist told me that the second patient was pacing and anxious. When I discharged the first patient, I spoke to the anxious woman; she was hypertensive because she was worrying her meter had run out, and she had seen a parking attendant in the area. After her visit, she (like the meter attendant) needed to come back in 3 months. I told the receptionist to reverse the order next time: I would see the meter attendant second, so she would be busy while the anxious woman went out to her (expired) meter.
Clinicians experience many ironies, large and small, in their professional lives, but the contradiction that bothers me most involves choices that violate the oath we took to practice medicine ethically and humanely. The billing question raises a fundamental moral issue: Do instructions to see many patients in the shortest time while also billing maximally for long visits invite dishonesty? Should patients and dollars be interdependent?
There is nothing in the Hippocratic Oath about promising to bill and make money from patient care.

To return to Maimonides: "Do not allow thirst for profit... to interfere with my profession." Doctors don't make overtime pay, rarely take a sick day, and are at times coerced into following rules that aren't in the service of patients. There is nothing in the Hippocratic Oath about promising to bill and make money from patient care.
What oath should these administrators take? "Thou shalt not pressure doctors into making thy profits."

Tatarewicz posted on 2015-05-22 3:06:08 ET Reply Trace Private Reply
#5. To: Tatarewicz (#4) (Edited)
That is all sheer poetry, but I somehow can't shake the feeling that many of them ARE in it for the money right from the word go -- or because it happens to be what caught their interest as a subject by their college years, the same as other people choose a line of work without particular thought to its benefits to humanity.
If they were as nobly motivated as imagined, more of them would be quitting the rat race and going concierge or returning to the good old family doctor mode we baby boomers grew up with. The ones who are doing so aren't hurting for business.
More doctors would at least be saying to themselves "this field is bloated beyond recognition. We have got to band together and make sure it becomes affordable and manageable again -- the politicians certainly aren't going to on their own steam." As it is, they've been doing or hiring plenty of the lobbying that got us where we are today. Right?
All these bureaucratic duties that get imposed on them, they're nothing but another profession being totally JEWED without anybody uttering a peep about that factor. He who lives by enforced semitism will die by forced semitism if not willing to call things what they are and act accordingly.
The malpractice mess is a perfect example. People are only able to sue doctors over nothing because Jew lawyers and judges support it as a means of enriching themselves and wreaking havoc with goyish economics. amerika is to blame for letting this happen for fear of being called "anti-semitic", but each profession had the chance individually to stand up to it too, and blew it.
The more medicine costs, the less you get for it. (Where have we heard that before? Public edjewcation and lots of places.) Easily 15 years ago there was a Readers Digest article whining about how costs have risen so badly that hospital workers are freely having to perform medical functions above their station and this poses hazards to patients. In other words, the more expensive it gets the less time each doctor has to fulfill even his basic duties -- they're famous for making patients wait forever at appointments and then barely giving them the time of day.
Every report on what a crisis medicine's in makes it sound like it happened spontaneously or like some kind of evil spirits beyond our control are hexing it. The real story is more mundane, but since most of the sheeple worship doctors as a sort of mystic priesthood, a deliberate, no-fault cluelessness prevails.
Whether my view or yours is more accurate, there are serious yet avoidable problems. It didn't used to be like this. It doesn't have to be. It's NOT like this in supposedly backward countries like Thailand, where you can walk into a state-of-the art hospital, start telling them your problem, and they'll start immediately getting you real help it at a fraction of the cost here. Or is it Malaysia? Probably both.
That's because they haven't been JEWED yet. Thailand's president actually spoke up against the Jew world order, which is probably why their airliners are disappearing over the ocean.

NeoconsNailed posted on 2015-05-22 6:11:37 ET Reply Trace Private Reply
#6. To: NeoconsNailed (#5)
Thailand's president actually spoke up against the Jew world order,

It was Malaysian.

Tatarewicz posted on 2015-05-23 0:22:38 ET Reply Trace Private Reply
Top • Page Up • Full Thread • Page Down • Bottom/Latest

Freedom4um