Assess Options Before Going Under Knife, Says Expert
Former chairman of the Cardiology Department of All India Institute of Medical Sciences (AIIMS), New Delhi, Dr K Srinath Reddy, has said that patients need to seek a second opinion before agreeing to cardiac surgery as unnecessary procedures are being carried out in the country.
In an interview with Express, Dr Reddy, who is currently Director, Public Health Foundation of India, was recently in the city to participate in the 65th annual conference of the Cardiological Society of India, provided his insights on the options available before patients for cardiac procedures.
When a cardiologist advises an invasive procedure like bypass surgery, stenting or angioplasty, how should the patient decide on whether to go ahead?
Many patients in India are being rushed into cardiac surgeries. Depending on the severity of the case, patients can take their time and decide whether they want to get operated. If in doubt, they can seek an alternate opinion from another cardiologist. They can also consult their family physician. The physician should in turn discuss with the cardiologist on whether a surgery is really required.
Do we have too many cardiac interventions going on right now in India?
Interventional cardiology has a great number of benefits for patients who really need it. However, it does appear that there are far too many procedures being performed than are really required. There are no technical audits so it is difficult to say how many procedures are being done.
Are cardiologists in India marching towards the trend of ‘overtreatment’ like in the US?
Yes. In the US, there is increasing concern due to overtreatment for patients who do not really need it as well as inappropriate treatment. The same concern applies in India where it is a greater cause for worry because the regulatory restrictions here are far less than in the US. There, insurance systems have ensured guidelines and checklists, but we do not have even that in India. The environment here is laissez faire and there is induced demand and inappropriate treatment.
How can cardiac surgeons decide whether a patient is really a potential candidate for surgery?
There is a need to shift from getting ‘informed consent’ to ‘involved consent’ from the patient. A good cardiologist should not decide to operate based on just symptoms. They need to look at the level of the disease, affected blood vessels, functioning of heart muscles and history of heart attacks. Angioplasty, stenting and bypass surgery are all useful, lifesaving procedures that reduce symptoms substantially and restore normal life. But it is quite likely that on careful consideration, several procedures being performed now could be unnecessary or not urgent.
What kind of explanation should patients seek from a cardiologist rushing them into surgery?
They should seek greater transparency and explanation for why the doctor is recommending a particular procedure. Doctors should clearly state the pros and cons of a procedure.