Saturday, October 11, 2008

How to make medical decisions

As a doctor, I often receive calls from friends who want to know more about their treatment options.

Here's an example.

Dear Dr. Malpani,

Many thanks for your offer to help us at this crucial juncture as we could really use some dispassionate advice.

My mother (Mrs.DF ), age 61 years, is a diabetic and high blood pressure patient for the past 14 years and her condition has largely been under control. She has been taking daily walks (2 Kms) and regular yoga exercises. Last November, she took a pilgrimage to South India and fell ill during that period. She was found to have high blood pressure (190/105) consistently and was rushed back to Mumbai.

I took her to Dr. AB (MD – Cardiologist & Diabetologist) at Chembur and she has been under his treatment since. She visited Dr. AB for her regular check-up on 6th Oct and her Doctor found small variations in her ECG and recommended that we do an Echo Cardiogram, Chest X-Ray, USG of Abdomen and Angiography. However, she experienced chest pain, sweating and pain in her left hand on 8th Oct and was rushed to a critical cardiac care hospital nearby (Dr. XZ Hospital, Chembur) within one hour.

Subsequent ECG revealed that she had experienced a mild Heart attack. Her condition is now stable and Dr. AB is very happy with her overall progress (pressure normal, kidney creatinine level normal, cholesterol levels normal both LDL and HDL. Only ESR, WBC are slightly elevated). Her Chest X-Ray reveals slight enlargement of the heart. She has now been shifted out of the ICCU and into the special room.

As next steps, I have been advised by Dr. AB to go for an Angiography at any leading hospital. But as you can imagine, I have numerous opinions from friends and well-wishers on everything from Angioplasty to Bypass surgery and am fairly confused.

I have also got an introduction to Dr. MN and Dr. OP ( from Chennai but operating at Lilavati).

I seek your advise on what I should really evaluate at this point as the various options are bewildering to a lay man. Sincere thanks for your offer to help.

Best regards

This was my advice.

I agree this is a hard call.

I'd suggest the following course of action:

1. Use your head. Read about the problem ( ischemic heart disease and its treatment options) and learn about your possible options. HELP is a good place to go to, if you want to find out the right information. Not every abnormality needs to be treated – and sometimes treatment can be harmful !
2. Get at least 2 opinions from consultants. The fist consultation will teach you what questions to ask – and how to make sense of the answers
3. Listen to your heart ( gut feelings)
4. Work out the logistics.

Outcomes are always uncertain, but if you follow the right process, you can take the path of least regret, so you have peace of mind you did your best !

Dr Malpani

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