When former president George W Bush had a cardiac stent placed, I gave up. Nothing can stop them. Them being doctors who take care of the highest profile patients while simultaneously being clueless about what they’re doing. Bush had a stress test that was not indicated, then had a cardiac angiogram that was not indicated, and finally had a stent placed that could not possibly do him any good.
There is a mountain of evidence that patients with normal cardiac function do not benefit from coronary revascularization. I’ve presented it here previously. Our current president had a witches brew of tests that he shouldn’t have had in 2010 – an electron-beam CT scan of the coronary arteries (to look for heart disease), a three-dimensional CT scan of the large bowel (to look for colon cancer), and a blood test for prostate-specific antigen (to look for early prostate cancer). Good medical practice forbade all these moronic diagnostic expeditions. The president’s doctor was a family practitioner and naval officer. If he acted like this on a third year medical clerkship he’d flunk.
The only situation worse than being poor and in need of medical care is being rich and/or famous and assuming that your primary care doctor knows what he’s doing. Remember that everyone says we need more of these practitioners who are typically (not always, but almost so) ill informed about the best standards of diagnosis and treatment. When their patient is prominent they are possessed by fear and order every test they can think of in a frantic effort to cover their ass should something happen to Mr Big later on.
Slate magazine has an excellent summary of how lousy the care of important patients often is. They lament that if such poor care is the lot of the famous what chance does the little guy have. Well actually, he’s likely better off as his doctor won’t be driven witless by his patient’s fame; his patient’s ordinariness may allow his doctor a chance to exercise good judgement, if he’s capable of it.
President Bush’s case is particularly egregious. He has a cardiac stent in place and is doubtless on drugs to prevent clots like aspirin and/or Plavix. These are drugs that he wouldn’t have needed had he stayed away from the doctor. They markedly increase the risk of bleeding. So he’s getting a side effect without a therapeutic benefit. He’s also likely on a statin which likewise didn’t need. Again side effects without benefit.
The compulsion to take medicine is what distinguishes man from all the other species. The urge to order unnecessary diagnostic tests distinguishes the dangerously ill informed physician from the well informed minority. You can learn medicine, but good judgement seems innate. The leaders of American medicine have never wanted to deal with this truism: It’s easy to get through medical school, but very hard to practice good medicine. Only a minority of doctors manage it.
Neil I love your last article about Bush. 17 years ago my internist almost killed me by ordering a colonoscopy which resulted in in a ruptured diverticula , peritonitis, and I was saved by a good surgeon and the infectious disease specialists. He wanted to order many tests over the years and referrals, all of which I refused. The last straw was when I diagnosed my own hypothyroidism. He never took a proper history and went only by the one shot blood work. I finally fired him and have an internist and endocrinologist who examine and listen to me. I was saved to mentor voice students at Stetson U. in opera. The new generation of doctors are trained to order tests, not use good common medical sense, and God forbid listen to the patient. I love your web site. Conrad
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