[HSF] angiogram and Denying CABG

[Jbflegejr at aol.com]

Michael, I turned him down because he didn't have what I would consider  
critical stenoses in his major vessels, his LV was bad and his symptoms  suggested 
heart failure rather than ischemia, his mitral insufficiency I think  is 
secondary to his bad LV rather than the cause of it, I did not think that  
operation was likely to improve his situation, and I thought his prognosis from  his 
cancer was not as good as the one to five year survival that his oncologist  
estimated. 
I have long since alienated most of the cardiolgists by differing with  their 
surgical judgement and there are a few around that respect my decision  
making based solely on the patient's characteristics. From that point of view I  am 
fortunate to be near the end of my career. I really feel sorry for those of  
you who have to suck up to the cardiologists to survive and I do understand. I 
 was lucky to get my start before that was necessary and managed to eke out 
the  last few years in a hostile enviroment.
On another subject. I saw three new patients today with coronary disease  
that I am sure would have had stents a year ago and now have been referred for  
surgery. At least one of them has good commercial insurance and another  
medicare. I sense a changing attitude about stents in our cardiologists.  What are 
others seeing.
John Flege



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