Tuesday, August 11, 2009

Second opinion

Last summer an elderly patient of mine managed to survive an out of hospital arrest and received an implantable defibrillator. He was in his eighties, had undergone a prior bypass, and was not in the best of health. He had developed significant valvular disease with congestive heart failure but was doing reasonably well with medical therapy. I knew him well and did not believe that he would survive a second operation; consequently, I recommended conservative management. We discussed his situation at length, and he agreed with my recommendation. When he missed a subsequent follow up appointment, I was not particularly concerned as I knew that his wife had a number of medical issues, and he did return to the pacemaker clinic for routine interrogation of his defibrillator.

Yesterday I learned that his daughter had arranged for him to have a second and a third opinion, a process which over the past several months included a cardiac catheterization, a transesophageal echocardiogram, a trip to the OR (without actually undergoing surgery), an evaluation at the Mayo Clinic, and consultations with two different groups of surgeons. After being seen by a dozen or so cardiovascular specialists, none of whom ever tried to contact me, the verdict was that he was a poor surgical candidate and should be treated medically.

Lifted weights and did crunches last night. Swam at Nitro this morning with Tom, next to Greg and Tripp (one of the age group coaches), James and Larry. Clint wrote the workout and coached. The pool was set up long course.

200 swim, 200 kick, 200 pull
8 x 50 @ 1:00 drill with fins, IM order
Main set:
8 x 200 IM @ 3:10 with fins, each followed by a 50 lung buster (underwater) ; fastest was 2:52
400 easy


  1. What's the tab for all those subsequent opinions and hospitalizations?

  2. That is the $64,000 question. As I tell my patients, not everything can be fixed. I am beginning to think that applies to the health care system. I am continually frustrated by the lack of commonsense among physicians. As I used to ask my kids when they were small and did something crazy, "What about that seemed like a good idea?"