Brown is part of the Right Care Alliance, a collaboration between health-care professionals and community groups that seeks to counter a trend: increasing medical costs without increasing patient benefits. The executive had been very smart to seek more information, and now, by coming to Brown, he was very lucky too. He was willing to try all manner of noninvasive treatments-from a strict diet to retiring from his stressful job-before having a stent implanted. The executive told Brown that he’d felt pressured by the previous doctors and wanted more information. Brown, a professor in the cardiovascular division of the Washington University School of Medicine in St. And so the executive sought yet another opinion. The man set up an appointment with the cardiologist he was referred to for the catheterization, but when he tried to contact that doctor directly ahead of time, he was told the doctor wouldn’t be available prior to the procedure. Still, his primary-care doctor, like the cardiologist at the emergency room, suggested that the executive have an angiogram with a catheter, likely followed by a procedure to implant a stent. That test revealed an artery that was partially blocked by plaque, and though the man’s heart was pumping blood normally, the test was incapable of determining whether the blockage was dangerous. The primary-care physician suggested a different kind of angiogram, one that did not require a catheter but instead used multiple x-rays to image arteries. The cardiologist was dismissive and told the man to “do more research.” Unsatisfied, the man declined to have the angiogram and consulted his primary-care doctor. The man was an unusually self-possessed patient, so he asked the cardiologist about what he had found. While he was waiting in the emergency department, the executive took out his phone and searched “treatment of coronary artery disease.” He immediately found information from medical journals that said medications, such as aspirin and blood-pressure-lowering drugs, should be the first line of treatment. If the test found a blockage, the cardiologist advised, the executive should get a stent, a metal tube that slips into the artery and forces it open.
Listen to the audio version of this article: Download the Audm app for your iPhone to listen to more titles.Ī cardiologist recommended that the man immediately have a coronary angiogram, in which a catheter is threaded into an artery to the heart and injects a dye that then shows up on special x-rays that look for blockages.