First, Do No Harm: Misleading Media Reports Are Detrimental to Cardiovascular Patient Care

It’s one thing for media reports to inadvertently spread confusion based on highly scientific, complex reports and conflicting experts. It’s quite another to spread fear and distrust based on lopsided reporting derived upon unsubstantiated and misleading information.

One such example was published on MSNBC.com on Tuesday, January 29: “Conveyor-belt cardiology puts profits first,” by Robert Bazell, NBC’s chief science and health correspondent. The story’s sub-headline reads: “In the battle of stents vs. bypass surgery, the best care may be neither.”

In his latest story, Bazell cites an anecdotal example of Miami doctors bragging about implanting stents “knowing full well it was unnecessary.” He says he “overheard” the doctors while he was in “incognito” (dressed in scrubs). The implication was that the conversation he heard was common among physicians when no one else was around. We don’t know what the rest of the conversation was. Nor do we know the context of what he supposedly heard. He acknowledges these interventional cardiologists are the exception, that most interventional cardiologists are “honest and caring.” If he really believes this of interventional cardiologists, why even mention this event?

Bazell makes another accusation that disturbs me even more because he claims it is a common practice. He writes that “all too often” interventional cardiologists urge “lightly sedated patients” to have an immediate angioplasty, allowing “no opportunity for the patient to weigh other options; no chance for a second opinion.”

This is flat-out wrong. Informed consent is at the center of how we practice. Patients who undergo angioplasty have been thoroughly briefed by the interventional cardiologist, and have given their consent before they are sedated and tested. For patients in non-emergency situations, this frequently occurs in the doctor’s office. In more acute settings, physicians still explain what they are recommending to the patient (or his or family members) and obtain consent prior to any invasive diagnostic procedure or medications. This is standard practice and is done because once the interventional cardiologist sees the results of the diagnostic procedure, it may make the most sense to proceed directly with an intervention in the best interest of the patient. Even with prior consent, interventional cardiologists may stop after the diagnostic procedure to go over their options once again in a more specific manner based on the additional information provided by the angiogram, particularly if the decisions or risks are not straighforward. Bazell, in his reporting, does not tell his Web readers of this important informed consent process, instead distorting the reality of patient care .

1/31/2008 The source archive page carried a “Read all” link; the remainder of this post was not recovered and has not been reconstructed.