31 October 2009

Dr. Bimal Chhajer
How to say no to a heart hospital?

It is a very common knowledge that once you reach a Heart Hospital with a chest pain or a heart attack it becomes very difficult to exit without undergoing a Bypass Surgery or Angioplasty. This is specially true for those coming from upper, middle class or rich patients who can pay promptly. Both these statements are almost true in 90% of cases. Once you are a heart patient it is definite that your blockage will be more than 70% or so. Most people develop symptoms only after they have 80% blockage. These blockages grow in a very slow speed (about 2-6% per year depending upon how bad your blocking factors or lifestyle are). Once you reach a cardiologist working in any of the heart hospitals who have angioplasty or Bypass facilities their first aim will be to convince you to under go one coronary Angiography using a catheter. Though it is an invasive test, most of the patients agree for it thinking that this is the only test to know the percentage of blockages( Which is not true!). But once the test is over they start pressurizing patients and their relatives to immediately agree for the Angioplasty or Bypass surgery. They try to create a scare announcing that the heart attack may happen at any moment. (Heart attack happens only when the membrane covering the blockage burst. This depends on the strength and elasticity of the membrane- which can never be predicted. In a patient with a 80% blockage the heart attack may not happen even for the next five years). If the patient does not agree they keep on pressuring.. see the possible statements in the box. They never explain what is a heart attack and how to avoid the heart attacks. Most of the patients agree instantly and pay up lacs of Rupees within minutes. The scare of death artificially created works very well, specially amongst the relatives. The pressures are also created by the family members and friends. Bypass surgery or Angioplasty is immediately done. The doctors often refuse to discharge the patients after angiography. If they refuse doctors put more pressure. Tips about how to get out: 1. Best is to agree for a Bypass or Angioplasty, but in a later date. Get a discharge in the pretext of arranging the money or a family marriage/ in-auspecious date. The doctors usually agree. 2. Tell them that you can not arrange money now, but will definitely get back within a few days. Asking for 10-15 days is a good bet. 3. Tell then that you will get it done by one of the best hospitals or by a better surgeon who you know or your relatives know very well. 4. Tell them straight, but firmly, that you do not wish to go for an invasive treatment even if it may be risk. 5. Tell them that you are feeling weak and would like to comeback after some recovery. This way is best when you had a heart attack. If you reach the heart hospital after 6 hours after the heart attack it is much better to wait for two three weeks for the damaged heart to recover- even if you decide to go for surgery or Angioplasty. Request them to give adequate medications for the next two weeks or so. Promise them that you will definitely come back. 6. Tell the Bypass surgeon that you would like to take opinions from few Angioplasty specialists. If it is a angioplasty doctor then tell them that you would take opinion from bypass surgeons. This hurts their ego and they usually have no defense. They may discharge you. (Remember the hospital authorities put a lot of pressure on the Cardiologists and surgeons to increase the number of operations. They set targets of number of operations for the doctors so the hospitals can make profits.. This is one of the major reasons why the doctors have to try hard to convince you, to modify your judgment. If they are unsuccessful they use a scare. Many have started using scare at the first step only. Otherwise a doctor must give his opinion in a much dignified way and let the patient decide after considering all the pros and cons.) Note: This is a personal opinion of the editor, and you may not entirely agree with him. Many of you would find the tips very handy and useful. Watch out for these Terms from Your Cardiac Surgeon or Interventional Cardiologist. > You are carrying an atom bomb. > You are sitting on a time bomb. It can burst….any time. > You are sitting in a room where the bulb is fused and there is a cobra inside. > You are driving a car without brakes. > I do not want to hide anything, but…you are……in a bad shape. > You do not get down of your bed, strict bed rest to be followed. > Next moment you can be dead. > Its a wonder that you are still surviving. > There is a good news…there is a bad news….Good news is that you are lucky that you reached the hospital in time. Bad news is that you have 80% critical blockage. > Dont go home get admitted immediately. > Bed rest till operation takes place. > If I discharge you you would not be able to reach home even. > Puts one hand on shoulder of son…sympathaize… very bad situation….nothing can be done > You are driving a car with a flat and punctured tire your only option is to change. > I dont know how you reached the hospital. If you were little unlucky you would not have bee…