Cath Lab Digest

No one would dispute that the information age is upon us. And its impact can be felt everywhere including – naturally – our daily practices, patient management and decision-making processes. Sounds good…? Think again:

A patient came for an office visit and evaluation of a recently diagnosed AAA after referral from his PCP. The same story has unfolded after self-referrals. He (along with wife and daughter) brought a trove of information obtained from a variety of sources – the Internet most notably. They literally came into the exam room with a huge pile of stuff! Some of the questions and “questioning” begin to emerge shortly after the initial introductions and welcomes. Somehow, I managed to proceed with my evaluation, physical examination, etc. Thankfully, they allowed me to say a few words about the diagnosis, and begin to talk about aortic aneurysms… but only for about 5 minutes. It was then that I was bombarded with a long list of questions that had apparently been constructed after their extensive search and research of “aneurysms.” The questions covered a wide field, including not just AAA and thoracic aneurysms, but also cerebral aneurysms, AV malformations, and a few other vascular conditions… Marfan syndrome and genetic diseases were in the mix as well!?

I recognized immediately that this was the beginning of a very bad relationship… a “lose-lose situation,” not unlike some I had seen too many times in the past. None of them was a professional person, and none had a good or even reasonable understanding of the issues at hand. But they did have lots of information! And they seemed bent on dissecting out every angle of the disease process and its treatment, including the type of device to use, type of anesthetic, and the rest. In other words, they felt that gaining a complete understanding and knowledge of all the issues would be necessary before they could make a final decision on a treatment course of action.

It was then that I decided to put an early end to such nonsense as I announced: “Let’s stop right here! If I allow you to go on and play the ‘information Q&A game’ as conducted by you, we will all end up in a bad place where confusion and indecision reign! In my view, searching for and seeking a good basic understanding is most reasonable and can be productive. However, it is my learned solid conviction that there is only one important decision you need to make and it is this: will you place your trust in me and follow my advice? This decision can and should be made after our initial conversation and meeting, and based on information about my reputation and qualifications that no doubt you must have found through the Internet and elsewhere before ever coming to my office.” I went on to say that’s exactly what I do with my own family when I am asked for advice on various conditions and symptoms, etc. If possible, I just point them in the direction of a physician or specialist deserving of such trust. Period. The concept that one should achieve a specialist-level understanding of complex medical issues before making a decision is foolish and counterproductive. And it can most certainly lead to inaction and, worse yet, bad outcomes.

I’d be most interested to hear reactions and views on this important matter. Am I alone here?

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Dr. Frank J Criado is a Board-Certified Vascular Surgeon and Endovascular Specialist at the Union Memorial Hospital-MedStar Health in Baltimore, Maryland – USA.

Dr. Criado is widely acknowledged to be a pioneer in endovascular therapy, with a 20-year + interventional experience. He has contributed extensively to the literature with more than 100 peer-reviewed published articles – mostly on various vascular and endovascular subjects, and Editor-in-Chief of Vascular Disease Management (VDM). He has also been active in clinical research, with a major focus on aortic stent-graft and carotid interventions, and endovascular technologies in general. He was the National Principal Investigator (P.I.) for the Medtronic Talent AAA clinical trials in the U.S., and a member of the Executive Committee for the Medtronic Valor Thoracic trial.

He is a founding member and immediate past President of the International Society of Endovascular Specialists (ISES), founder and current President of the endovascular surgery society of Latinamerica (CELA), and a member of all major U.S. and international vascular and endovascular societies. He is a Fellow of the American College of Surgeons (FACS) and of the Society of Vascular Medicine (FSVM), and a member of the Board of Directors of the Society for Vascular Surgery (SVS).