CT angiograms are non-invasive tests that examine arterial anatomy and are more effective than stress tests in determining the risk of heart attack or death. Even patients with moderate to severe heart artery disease do just as well on optimal medical treatment (OMT) alone compared with OMT and a stent. If you are not receiving OMT for your heart artery disease, you are not receiving patient-centered care based on the latest evidence. What do you think about this dramatic change in treatment recommendations?
I think many physicians choose less than the best treatments due to financial incentives, lack of knowledge, insecurity, and lack of self-confidence. Physicians report that other physicians overtreat and order excessive tests due to fear of malpractice, patient pressure, difficulty accessing prior medical records, equivocal treatment indications, inadequate time to spend with patients, lack of adequate information from prior history, pressure from management, and trying to look good in performance evaluations. Education on best treatments followed with regular personalized performance feedback by trusted peers with rewards for better performance and consequences for poor performance may gradually lead to more patients receiving the advice and treatments they deserve. It would also help if more patients knew when they were getting right advice and treatments.
I’ve been thinking about this and your previous articles on OMT. It all makes perfect sense to me. But from my nursing perspective, I’ve often been at the bedside when a physician tries to persuade a patient to “see it their way”, especially when it will be more lucrative for themselves and/or the hospital or save themselves some time. Not meaning to sound harsh—I’m aware that there are a whole lot of moving parts that go into this beyond time and money—but I cannot tell you how many times as an OB nurse that I saw a patient end up getting a C-section when what they really needed was more time, or more information. Example: I worked for many years with on OB who used to pull up a chair at bedside, and by the time he got done talking, the patient thought that having a C-section was her own idea all along! 9 times out of ten, the reasoning didn’t line up with current best practice or evidence-based medicine. It was disheartening, to say the least.
I have always advocated for my patients through education, but often even my best efforts failed because patients were uncomfortable with disagreeing with or questioning a physician.
Because of my medical training I am comfortable and confident with my ability to advocate for myself. But the average patient often is not, and will feel uncomfortable with the notion of disagreeing with or questioning a physician who is selling them stents or a stress test over OMT.
From my years of data mining in the real world, CTA is better than stress tests. However, that’s comparing a taller dwarf to the much shorter ones! CTA also produces huge numbers of false positive results and it is a structural anatomic test, pretending to be a “functional” one. The reality is, CTA is far from a “functional test” when it comes to compare with MCG Technology, which is a truly electrophysiology measuring technology. MCG is a far superior Cardiovascular functional test than ANY current modalities available! That’s the truth!
I think many physicians choose less than the best treatments due to financial incentives, lack of knowledge, insecurity, and lack of self-confidence. Physicians report that other physicians overtreat and order excessive tests due to fear of malpractice, patient pressure, difficulty accessing prior medical records, equivocal treatment indications, inadequate time to spend with patients, lack of adequate information from prior history, pressure from management, and trying to look good in performance evaluations. Education on best treatments followed with regular personalized performance feedback by trusted peers with rewards for better performance and consequences for poor performance may gradually lead to more patients receiving the advice and treatments they deserve. It would also help if more patients knew when they were getting right advice and treatments.
I’ve been thinking about this and your previous articles on OMT. It all makes perfect sense to me. But from my nursing perspective, I’ve often been at the bedside when a physician tries to persuade a patient to “see it their way”, especially when it will be more lucrative for themselves and/or the hospital or save themselves some time. Not meaning to sound harsh—I’m aware that there are a whole lot of moving parts that go into this beyond time and money—but I cannot tell you how many times as an OB nurse that I saw a patient end up getting a C-section when what they really needed was more time, or more information. Example: I worked for many years with on OB who used to pull up a chair at bedside, and by the time he got done talking, the patient thought that having a C-section was her own idea all along! 9 times out of ten, the reasoning didn’t line up with current best practice or evidence-based medicine. It was disheartening, to say the least.
I have always advocated for my patients through education, but often even my best efforts failed because patients were uncomfortable with disagreeing with or questioning a physician.
Because of my medical training I am comfortable and confident with my ability to advocate for myself. But the average patient often is not, and will feel uncomfortable with the notion of disagreeing with or questioning a physician who is selling them stents or a stress test over OMT.
Any thoughts on this?
From my years of data mining in the real world, CTA is better than stress tests. However, that’s comparing a taller dwarf to the much shorter ones! CTA also produces huge numbers of false positive results and it is a structural anatomic test, pretending to be a “functional” one. The reality is, CTA is far from a “functional test” when it comes to compare with MCG Technology, which is a truly electrophysiology measuring technology. MCG is a far superior Cardiovascular functional test than ANY current modalities available! That’s the truth!