Feeds:
Posts
Comments

Posts Tagged ‘oci vs cabg vs omt’

One of my fellows gave a discharge summary  for a 62 year old patient with stable diabetic  CAD  who had Triple vessel disease with a final advice reading as CABG / PCI/or OMT .

There was a near fury over his angiogram report in the cath meet. How can be  eligible for all the three Intervention at the same time ?.(PCI -Percutaneous coroanry Inervention ,CABG-Coroanry artery by-pass graft, OMT-Optimal medical therapy )

The lesion in question was , Triple vessel disease(Non critical LAD) and significant LCX and again a non critical RCA .Syntax was less than 22 for sure , however the patient  had class 2 angina (now reducing ) .When asked to explain  , the fellow  argued since the patient  is symptomatic , has DM with TVD  he is eligible for CABG , since  LCX lesion was discrete and PCI was distinctly possible , of course as all three  lesions would be  eligible for OMT on any given day  ! he inferred .

How can  a cardiologist be so casual and non-commital in an important medical decision where a life of a heart is at stake.There was a unanimous condemnation about the report. As a consultant he has to be specific , one can’t leave the decision to  your patient’s whims  . . . rather it’s our scientific whims  that should prevail  !

 

MEDICAL VS PCI VS CABG OMT COURAGE BARI 2D FREEDOM FAME STUDY MASS 2 CASS OPTOMAL MEDICAL MANAGEMENT SYNTAX ACC AHA ESC GUIDELINES PTCA STS EUROSCORE NEJM

The curiosity continued and looked amusing for many. I was the only one supporting  his argument ! After all , he is being frank and understood the futility of  applying  evolving knowledge base in critical decision making. But, I  asked him to grade the choices .In my opinion  OMT should be the first choice if it can be administered , but reality tells me  true OMT is rare as a modality  at-least in  this  part of world . However every one should insist for it.

Apart from poor  compliance for OMT , pressure  mounts for a procedure from peers and non peers . I am  sure  many  patients  will end up with an  invasive modality sooner or later  backed by a  second or  third opinion  driven by that elusive googled intellect !

Final message

When clinical decision making is debatable with available knowledge (Especially with futile and evolving knowledge base !) , please include your patient into the debate and you may even consider giving him the veto power.If Hippocrates is alive today , I am sure he will argue for medical  knowledge and ignorance should be equally shared with their  patients.

Counter thoughts

Don’t give the choice to your patient  . . . that would mean you lack  clarity, wisdom and confidence !

No, I don’t agree , I know there are  some  patients who are  well informed , rational , more focused than even a professional  !

 

 

Read Full Post »