Ideal patient care—One patient's quest for humane, non-invasive care

Dr. Craig Vinch, cardiologist at the Lown Cardiovascular Center, shares his perspective on a patient, Prof. G. S. H. Lock. This article was originally published in the Lown Forum, the newsletter of the Lown Cardiovascular Research Foundation.
----------

As a physician and a human being, I want to help people do the things they want to do, for as long as they can. I am grateful to Professor G.S.H. Lock for sharing his experience.

Angina led him to refrain from the walks he loved for exercise and for lifting his spirits. Previous consultants told him that the only option for his angina, beside angioplasty and stenting, was "DEATH." He didn't accept such scare tactics and sought our expertise in noninvasive cardiology for options to his predicament. Like most other people I know, he wanted to be free to do the things he enjoys in an unfettered way. Despite dire predictions from his initial consultants, he is nonetheless alive, well, and back to his walks, with close attention to a medical program tailored to his desires.

The publication of the COURAGE trial [1] in the New England Journal of Medicine one year ago underscores the importance of "optimal medical management" of coronary heart disease. Simply put, routine angioplasty and stenting do not provide additional benefit as compared with medical management for many patients with stable coronary heart disease. Yet from a patient's perspective, "optimal medical management" from many other physicians boils down to a checklist approach in which doctors remind themselves to prescribe antiplatelet agents, prescribe cholesterol lowering statins, prescribe beta-blocking medication, counsel against smoking, and prescribe ACE inhibitors.

Such a checklist approach totally obscures the patient as a person, their family, their social situation, their likes, dislikes, fears, etc. People are reduced to disease states and dealt with in an inhumane rote algorithmic approach. The Lown Cardiovascular Center's research and clinical experience tell us that ideal patient care involves a caring, patient-centered approach in order to deliver "optimal medical management" tailored to fit the unique person who has sought our advice. Time must be spent listening and learning about the person and their life. Time is an expensive commodity, but it is essential because understanding and trust cannot be developed without it. Building trust through time, compassion, and listening helps us to understand how to best integrate a program of medical care to reduce anxiety, promote health, lessen fear, and reduce risk of cardiovascular problems.

Professor Lock's experience is not a "best result" just for show. The Lown Center's research and the COURAGE trial emphasize the proven benefit of medicines for coronary heart disease. Our experience suggests that ideal patient care involves a patient-centered approach utilizing time and listening to develop a deep understanding of the human being and tailoring a program of care for that person.

Citations: 1. Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007; 365: 1503-1516.
http://content.nejm.org/cgi/content/full/356/15/1503

Clinical Encounter
Date Posted: 10 April 2008