Blog | Tuesday, September 3, 2013

Too much care for the former president


George W. Bush got a stent recently. Unfortunately, it doesn’t look like he needed it.

Let’s backtrack. The former president, by all accounts, was in excellent health, without reported risk factors for heart disease, and recently ran in a competitive race for charity. On a recent physical exam, though he reported no symptoms, he underwent a CT scan which showed a blockage in an artery. At that point, Mr. Bush agreed to a stent, despite the reasonably clear evidence showing that stents in people without symptoms don’t make them live longer, don’t prevent heart attacks, and (since the person starts without symptoms in the first place), don’t make anyone feel better. Except, perhaps, those who sell stents.

You can find opinions of those who are careful never to say that this might have been a mistake. Let’s not mistake the horse for a zebra, though. It seems very unlikely that this procedure was indicated. But it happened anyway.

We know about the problem of overuse already. This particular instance, like any given instance, might not have taught us any unknown facts, but it does emphasize the same questions:

1. If a former president can accede to a stent he doesn’t need, what chance do the rest of us have in avoiding overuse?

2. What were Mr. Bush’s primary care doctor and cardiologists thinking?

3. Further to number 2, if we assume that, in fact, there were no extenuating circumstances to this case, and Mr. Bush was “overused” just like many Americans are, what is the best way to respond to a given case? Call out the involved physicians?

There must be some way to turn a much-publicized instance of contraindicated care into a turning point in the campaign to reduce overuse.

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.