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Cardiac Stents Alone Don’t Work

I have a friend who had a blocked cardiac artery. A couple of years ago he had angioplasty on it, and his doctor inserted stents. The stents got rid of his chest pain and other symptoms, but didn’t do anything to get at the underlying cause of the blockage, which had to do with an unhappy combination of genetics and a –- perfectly admirable –- taste for rich, fatty foods. Like steak. (More on that in a moment.)

Before having the procedure, his doctors spent a lot of time with him explaining what the surgery would and wouldn’t do. In particular, the doctors explained that the stents would do their job, but he had to do his. He needed to eat better, exercise more, and take his medications. He’s followed most of that advice, and is doing well.

Unfortunately, his experience is not typical. A recently published study found that more than 80 percent of patients who had gotten angioplasty and stents thought they were alone a cure for their problems.

These patients are wrong. So how can it be that they are coming to this strange conclusion? According to some, it’s the doctors’ fault.

Patients are not to blame for the misunderstanding about angioplasty and stents, said Dr. Michael Pignone, a medical editor for the Boston-based Foundation for Informed Medical Decision Making and a professor at the University of North Carolina School of Medicine.

“The onus is on us as health care professionals to really drill down to what is the essential information,’’ Pignone said. “We need to learn from patients what is the most important information to them.’’

It’s a little unfair to blame the doctors, since the study didn’t find out what doctors had told patients. None of the conversations between doctor and patient were observed, so we have no idea what happened, even if Dr. Pignone’s point is an important one. For all we know, the doctors tried very hard to get patients to understand what they needed to understand.

In this sense the study is interesting, but very unsatisfying. But even in the absence of data, we can look to some of the deeper truths of human nature.

In a remarkable review of Pauline Chen’s new book Final Exam, Iris Monica Vargas notes how the promise of modern medicine –- “that the body was not just an irrational repository of disease but a potentially reparable biological machine” –- drives how people think about medical care. If your body is a machine, with all sorts of tubes and wires and things, isn’t a procedure to open up a blockage in one of those tubes a cure? It sure sounds like one, and as a patient, it’s what you want to hear. It has to be very difficult for even the best doctors to get their patients to understand the reality of their plight, and to act accordingly.

And it’s part of a larger truth about human nature: Our denial of the reality of death. In fact, we deny it so strongly that we often do things that help bring it about more quickly. We smoke, we don’t exercise, we eat badly, we’re overweight –- even though everyone knows these things can be very, very bad for you. Especially if you’ve already had a blocked artery.

So it was embarrassing for my friend when he ran into his surgeon at a steakhouse recently. “It’s okay,” the doctor said. “Everything in moderation.” After all, he was there too, wasn’t he?

It’s good advice. But we should think about that advice as not just an excuse to indulge in the things we enjoy, but also as a reminder of how important it is to do the things we must to take care of ourselves.

*This blog post was originally published at See First Blog*


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