[HSF] Not all patients are stupid (OT)

[Tea Acuff]

I'm not really against getting the advice of an expert to help solve a problem. What i am against is letting the expert define the (my) problem.

Let me give a brief description of a situation that highlights the difficulties with defining "appropiate" behavior. 

I recently was asked to see a 30ish year old with diffuse Wegeners disease of the lung and subsequent ESRD on dialysis for a "staph" vegation on the mitral valve. He had 3+ MR and 3+TR with PAH of 50-100 depending on the measurement.

I went up to talk to patient about the surgery and complex uncertainities that we would possibly face. He was indisinterested at best. As a frequent finding with ESRD patients minor issues seemingly unrelated to his "problem" animated him more than the "severity of his situation". 

I discussing the case with his referring pulmonologist postop it occurred to me that what I was really saying to this patient during my "informed consent" seesion was something like, "We are going to move you to a different prison cell where we will beat you a little more than usual. What do you think of that?" Obviously nephrologists and surgeons have certain thought processes and would be best likely at WHAT THEY DO, but I suppose the patient is looking for something to help HIM not us. 

See my next meandering for a more formal reflection of what i am thinking around...

tea



----- Original Message ----
From: Ben Bidstrup <benjamin.bidstrup at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Saturday, April 5, 2008 4:43:10 PM
Subject: RE: [HSF] Not all patients are stupid (OT)

Careful with experts.

Ex: an unknown quantity
Spert: a drip under pressure.



>  >The idea expressed is somewhat counter to the argument that all 
>cases should be referred to experts.> tea
>
>Tea
>
>I see your words are well chosen - and of course the interpretation 
>depends on what really yourself or the reader understands by the 
>word 'experts'. In the USA at least, there are very few clinical 
>problems now that are not treated by experts of one form or another.
>
>Ani
>
>
>
>
>
>>  Date: Mon, 31 Mar 2008 21:21:48 -0700> From: tacuff at swbell.net> 
>>To: OpenHeart-L at lists.hsforum.com> CC: > Subject: [HSF] Not all 
>>patients are stupid> > This article was posted about a need for 
>>surgery coverage for PCI. A reader posted the following comment. 
>>Maybe we should just start talking truth to the patients instead of 
>>explaining how smart we are. The idea expressed is somewhat counter 
>>to the argument that all cases should be referred to experts.> 
>>tea > > Small hospitals push to do heart work> Associated Press, by 
>>Marilynn Marchione > Original Article: > www. 
>>news.yahoo.com/s/ap/20080329/ap_on_he_me/angioplasty_safety > > 
>>CHICAGO - Is it safe to have your arteries unclogged at a hospital 
>>that lacks heart surgeons who can operate if something goes wrong? 
>>Many states ban this except in emergencies like heart attacks. But 
>>more small hospitals are trying it in non-urgent cases, and the 
>>largest study ever done of this, released on Saturday, suggests it 
>>may not be as risky as has been feared. If confirmed by other 
>>ongoing studies, it could change policies in many states. > 
>>********************> Reply ...> Medicare did a study comparing the 
>>outcomes of the first 60 times a surgeon did an operation to the 
>>results obtained thereafter. They did this for many surgeons and 
>>many operations. They concluded that no surgeon should ever do the 
>>first 60 of anything. > 
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon
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