Although not a doctor, my experience in consulting cardiologists over the years may be of interest to Malaysians in this age of high tech and increasingly expensive health care.
About three years ago I failed my treadmill test. Despite the fact that I had no heart disease symptoms, my cardiologist wanted me to have a coronary angiogram to see how badly my coronary arteries were blocked.
Although I initially refused to do it, I eventually submitted to an exercise heart scan which showed that there was a 24% of total myocardium blockage. On the basis of that result, I was strongly advised to have an angioplasty with possible insertion of one or two stents – a procedure which would have been rather costly.
Still unconvinced, I consulted two British cardiologists who advised that I should not be overly concerned over my condition unless there were clearer symptoms of heart disease, that is,
Pain, usually in the chest, with or without shortness of breath
Breathlessness, usually on exertion, with or without pain
The two distinguished experts pointed out that most adults over 40 years old have irregularity of their coronary arteries but that this was not necessarily a condition that warranted expensive tests or follow up surgery. Following their advice, I decided to leave well alone and have had no problems since.
Medical findings from elsewhere in the world confirm that the course of action I have taken is the right one.
In the USA, a research firm Mediqual reported that 35% of the coronary angiograms they studied had none of the objective clinical findings to validate an angiogram. That is to say, they were not done for an adequate clinical reason.
The key finding of the report is important to emphasize. This is:
An angiogram that is performed unnecessarily carries two types of dangers; the very real risks of the procedure itself (stroke, heart attack or death) and the risk that it will be followed by another inappropriate operation or procedure.
In layman terms, what this means is that in many cases, people are likely to die as a result of the expensive heart procedure and it is also possible that they may have lived longer had they not been persuaded to undergo surgery.
If the percentage of unnecessary angiograms is so high in America where people are better informed, it is likely that the situation in Malaysia is worse.
In view of the public and media attention given to the growing incidence of heart disease in the country and the wrong conclusions and medical aftermath that may result, I would like to suggest that the Malaysian Medical Association may want to formulate strict guidelines controlling the practice of cardiologists in ordering patients to do treadmill tests, scans, angiograms and other tests. Without adherence to such guidelines, many patients like me will be subjected to unnecessary, dangerous and expensive tests and possible surgery.
When Malaysian cardiologists order such tests, they should do so according to internationally recognized guidelines. If they do not, one might be tempted to think that they are being over-influenced by financial considerations.