[HSF] Too scared to touch.....

Thu May 3 15:24:02 EDT 2007

This is the story in all places with rationed resources - beneficiance
versus justice. This is a basic ethical conflict that always will affect
health care. Places with so called "unlimited" resources also have problems.
I bet if we ask the uninsured in US they will have a different story to
tell.
Prasanna

On 5/3/07, bbiocina at kbd.hr <bbiocina at kbd.hr> wrote:
>
> Hal, Don ,
> it seems that my  anecdote spiced  the discussion little too much.
> My point was completely different; how to deliver fair ( if  you are not
> able to deliver complete and appropriate) treatment with limited
> resources available. It is obvious that  the record from the spa
> hospital is ridiculously fake , but it  has been partially  based on
> presumption that  LM disease  must have  the highest priority.
> Let's take the case of Bojan Biocina : by today  297 pts. on  the
> waiting list ,  possible workload 4 cases/wk . There  is at least  50 LM
> , another 50  severe tripple vessel disease patients. If we forget
> other pathology ( valves  , combined etc. for a while ) , if you were me
> , how  would you handle the list : to operate LM first ( and to allow
> any new LM to jump the queue), to mix  the order with more serious
> tripple vessel ( criteria?) , or  to try to  judge  clinical criteria
> of  "stability"?
> With almost unlimited resources ( often seen today in Western  countries)
> medical/moral responsibility ih still high enough , but with  limited
> resources  it  could be much higher. In  light of  all of that , I think
> studies like  the Canadian one might help ( although , obviously ,
> judgment based on them might hurt  a particuklar individual).
>
> Bojan
>
> On 5/3/2007, "hgrmd at aol.com" <hgrmd at aol.com> wrote:
>
> >Don,
> >  Let's kick Prasanna's butt!
> >Hal
> >
> >-----Original Message-----
> >From: donross at bigpond.com
> >To: OpenHeart-L at lists.hsforum.com
> >Sent: Wed, 2 May 2007 6:45 PM
> >Subject: Re: [HSF] Too scared to touch.....
> >
> >
> >Prasanna,
> >Indeed, a lot of what we practice will be found to be imperfect , but a
> lot of the so called evidence based practice is also bullshit.
> >Do you really believe all Bojan's waiting list deaths had critical LM
> disease?
> >Remember the bikini and statistics?
> >Don
> >
> >PS It is great to have Hal onside for a change!
> >
> >On 02/05/2007, at 9:20 PM, psimha wrote:
> >
> >> Hal,
> >> Please read carefully, In never said anything about critical left >
> mains.
> >> Also if you carefully see what I said I said where is the > evidence .
> Some things that we practice need not necessarily be right.
> >>
> >> Prasanna
> >> hgrmd at aol.com wrote:
> >>> Don,
> >>> I agree with you. If Prasanna wants to send out critical LM's >> or
> LAD's hanging by a hair after an MI, that's his business. >> Around here, if
> such patient went home without surgery and boxed, >> we'd definitely hear
> about it.
> >>> Hal -----Original Message-----
> >>> From: donross at bigpond.com
> >>> To: OpenHeart-L at lists.hsforum.com
> >>> Sent: Wed, 2 May 2007 4:40 AM
> >>> Subject: Re: [HSF] Too scared to touch.....
> >>>
> >>>
> >>> When they have LM or TVD + poor LV....... most of my patients. I >>
> hope, therefore, you are not trying to put me out of a job? Don On >>
> 02/05/2007, at 10:53 AM, prasannasimha wrote:
> >>>> Where in literature has it been shown that a patient who is >>>
> stable > after an MI benefits from urgent in house >>> revascularization ?
> Prasanna
> >>>> Donald Ross wrote:
> >>>>> Also, one wonders about the not infrequent peri-op AMIs during >>>>
> non->> cardiac surgery that come our way for revascularisation >>>> prior to
> >> discharge. Is this unnecessary surgery as well, >>>> given it carries the
> same >> indications as regular coronary >>>> surgery? Don On 01/05/2007, at
> 10:04 PM, Hgrmd at aol.com wrote:
> >>>>>
> >>>>>> Ajit, I invested the time it took to read all of Prasanna's >>>
> >>>>> abstracts. I'm still not convinced that medical therapy with >>>>>
> beta-blockers is >>> the way to go for nearly every case. >>>>> Again, if a
> stress test in an asymptomatic >>> patient shows a >>>>> lot of myocardium
> with reversible ischemia, it would be >>> >>>>> potentially foolhardy not to
> cath that patient. Over the years, >>>>> we've been >>> referred lots of
> patients with left mains or >>>>> critical 3vd that were cathed prior >>> to
> an elective >>>>> noncardiac procedure (usually carotid, ischemic leg, or
> AAA). >>>>> >>> We did the CABG, they eventually got the vascular >>>>>
> procedure, and they did >>> fine. I've yet to recall "graft >>>>> closure"
> while the subsequent case was done. In >>> light of >>>>> the problems with
> DES, the cardiologists are much more likely >>>>> to use >>> bare metal
> stents in such scenarios. I do agree that >>>>> beta blockade, possible
> Swan, and a competent >>> ca
> > rdiac >>>>> anesthesiologist suffice for the vast majority of cardiac
> >>> >>>>> patients getting noncardiac surgery. However, there are plenty
> >>>>> of asymptomatic >>> cardiac time bombs waiting to explode for >>>>>
> those that never cath and treat >>> preemptively. Hal
> >>>>>>
> >>>>>>
> >>>>>> ************************************** See what's free at >>>>>
> http://>>> www.aol.com. >>>>>
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-- 
Prasanna Simha M