Sunday, May 30, 2010

Things cardiologists never tell you. Introduction from your concerned cardiologist.

As a practicing cardiologist, I had to answer most unexpected questions every day. I did it meticulously each time, with a great sense of responsibility, and a great patience. I took my time. I wanted a patient to be happy with my explanation, so we are “on the same page”. Guess, what?

Once I had to deliver unpleasant news to a dear patient of mine. The news was: she had many blockages in her coronary arteries and her heart muscle became weak over years. She needed a bypass surgery. After a bypass surgery, which improves blood flow to the heart muscle, there was a chance that her heart muscle function would improve.

As usually, I went on and on about where the blockages were, what were the risks and the benefits of the open heart surgery, and how long was an expected recovery period.

Patient was listening to me attentively, without interruption, and agreed to the surgery at the end. Then I asked her, as I usually do, if she had any questions. I was stunned when she said:

“Doctor, I think I will have surgery done. I will go with your recommendations. I have only one question: are those veins coming to or from the heart?”

“Excuse me? VEINS? We are talking about the ARTERIES, not veins!

“OK, arteries. I mean, are they before or after the heart?”

“Well, let me start all over again. They are nor BEFORE, neither AFTER the heart. They are ON THE HEART and IN THE HEART!!!” (After thirty minutes of explaining of what seemed obvious to me, I realized that my patient had no concept of cardiac anatomy whatsoever!)

If you think, this is an exception, you are very optimistic. Every single day we see patients, who blindly (yes, blindly!) trust what we tell them, and accept most complicated and risky procedures without having a clue why they need it, and what exactly going to happen to them. You may say: “How about informed consent? Aren’t they supposed to sign it before the procedure? You bet. They do sign. You think they understand everything before they sign. They think they understand. They SAY they understand. And still don’t have a clue! Unbelievable, right?

Another fresh example of what patients may ask me was this one: A physically active, vibrant, and happy 89 years old patient of mine was obviously very excited about something wheh he came to see me for a routine follow-up. When I asked him why he looked so happy and upbeat that day, he enthusiastically said: “Doctor, I studied some literature at home. I read this newspaper article about defibrillators, that they prevent a sudden cardiac death. Well, I decided to ask you to give me one, so I can live for another 40-50 years. Do you think my insurance will pay for it”?

Good question, Mister, let me think…. I don’t think so, especially that at the age of 89 your cardiac problems include only high blood pressure and mildly elevated cholesterol, not a cardiac arrest while playing a final NBA game, or a terribly weak heart muscle following 5 heart attacks at the age of 45.

On the one hand, I feel bad for my patients for lack of knowledge in this field. On the other hand, I realize that it’s not their fault. I spent all these years in training and practice, getting the idea, why should they get it in thirty minutes? I feel I have a right and a moral obligation, as a cardiologist, to clarify things for them. This very goal prompted me to start this blog.

The heart is the most important organ in human body (if we don’t count the brain), and also the most vulnerable one. One can not make mistakes here.

This blog is for people like you, who want to know what they are doing. Who want to be in control of their bodies, to make right choices, to give truly INFORMED consents in the future.

Let’s start our journey into “cardiology made simple”, not “cardiology made confusing”. Hopefully, if you let me lead you through this, the years of your unanswered questions and guessing will be a history.

Svetlana Nikitina, MD, PhD
(your concerned cardiologist)

1 comment:

  1. I am very happy to see your blog, very good article for audience,

    Each year, cardiac complications and diseased occur within 30 days after major non cardiac surgery in more than 10 million people worldwide.

    Today, however, the tether is fraying. How can we use technology to bring Cardiologist database in USA

    closer to patients rather than making them more remote?

    Small tips to avoid heart attack

    • Take responsibility for your health. ...
    • Know your risks. ...
    • Don't smoke or expose yourself to second-hand smoke. ...
    • Maintain a healthy blood pressure. ...
    • Monitor your cholesterol (blood lipids). ...
    • Limit your calories. ...
    • Make exercise a daily habit. ...
    • Pick your pills wisely.