Copyright 2009 Track Your Plaque, LLC
http://www.trackyourplaque.com/newsletters/newsletter0709.asp
When you put your life into the hands of a stranger, you might be entrusting it to someone who has one thing in mind: How to profit from the experience. Perhaps you gain health from it, perhaps not -- that’s not the point, sadly. Understand this sad fact and modern healthcare suddenly makes sense.
Here is Laurie’s chilling story of her near-fatal brush with Dr. Aldesani.
Tuesday, August 19, 2008
At approximately 5:40 am, I was struck with chest pain. My husband, Ray, drove me to a nearby hospital where I was given oxygen and a cardiac workup.
Eventually, I met Dr. Aldesani and he told me that I had suffered a heart attack and would need to have cardiac catheterization to locate the blockage and put in a stent. When I voiced my concern about putting in an unnecessary stent, he became agitated and said if I didn’t let him put a stent in, I would just have another heart attack.
While Dr. Aldesani was gone, I asked a nurse if I could get a second opinion from another cardiologist, but he said they would have to talk to Dr. Aldesani first because they couldn’t go behind his back.
When Dr. Aldesani returned I asked him again what the risks of this procedure were and if there were other options. He became even more agitated and would only tell me that I need to have the procedure done. He said, “Now listen, I don’t want to waste your time, and you don’t want to waste my time, so what do you want to do?
It made me feel uncomfortable. I felt as if he only wanted me to speak when spoken to and that he was offended that I was question his judgment. I asked if there was another cardiologist that I could talk to. Not wanting to anger him further, I said it was nothing against him but that I never had any kind of surgery before and I would just feel better if I got a second opinion from another doctor. Dr. Aldesani acquiesced and called in Dr. Steve Cutler.
Dr. Cutler arrived and, after asking me a number of questions, said that he thought the cardiac catheterization should be done. I asked if he could do the procedure instead of Dr. Aldesani, but Dr. Cutler said he wasn’t licensed to do so. I then asked him what Dr. Aldesani’s record was with the procedure and Dr. Cutler hesitated, lowered his head and said, “I think you should ask Dr. Aldesani that.”
I now feel that I should have trusted my initial instincts, but there was no one else available to do the procedure and both doctors had me convinced that, if I didn’t have this procedure done soon, I could die. I signed a paper, consenting to the procedure and agreeing that if something went wrong, they had the right to do an emergency bypass procedure.
Later, I was lying on a flat metal surface. I was lucid and felt relatively comfortable (considering the circumstances). A small screen was to my left, and I could hear Dr. Aldesani’s voice as he pointed out a blockage in my artery. He said, “I can pull it out with a wire.” Then, his voice rose, becoming unexpectedly aggressive. He said, “So what do you think, should I take it out?” Now bellowing, “You’re so smart! What do YOU think I should do? Do you want a second opinion?!“
I felt completely vulnerable and powerless as he mocked and ridiculed me with the questions I had asked him hours earlier. His unpredictable and threatening behavior in the midst of performing my heart procedure scared me deeply. I was terrified of what he might do.
Tuesday, August 19, 2008; 7:30 pm
Dr. Aldesani told my family that “there was a complication” and we learned that a healthy artery had been dissected during the procedure. At this point, he told my family that he would like to have me taken to a facility where open heart surgery would be available should I need it.
Wednesday, August 20, 2008
At approximately 9:00 am the next morning, surgeon Dr. Hector O’Hanley told my family that the artery wasn’t healing and a lifesaving open heart surgery was needed or I would die.
Later that day, at approximately 2:30 pm, I had double bypass surgery.
Track Your Plaque, LLC; Editor's Comments:
In the midst of an emergency, or, in this case, what appears to be a pseudo-emergency, we sometimes have to submit to the judgment and abilities of the people around us. We usually trust hospitals and doctors to do what is in our best interest, particularly when we are at our most vulnerable.
If Laurie could replay this unfortunate scene again from the start, here’s some advice I’d offer:
I asked a nurse if I could get a second opinion from another cardiologist, but he said they would have to talk to Dr. Aldesani first because they couldn’t go behind his back.
There is no such rule. The patient has a right to another opinion, whether or not the primary doctor approves. The nurse would have an obligation to notify the primary doctor that a second opinion is being sought, but it is entirely within the patient’s rights to obtain another opinion.
When Dr. Aldesani returned I asked him again what the risks of this procedure were and if there were other options. He became even more agitated and would only tell me that I need to have the procedure done.
Unacceptable. Everyone deserves an explanation about the procedure they are about to undergo. If Laurie had been critically ill, delirious, or not in full possession of her faculties, then the healthcare provider must simply act in the patient’s best interests. But to deny a description of the risks of a procedure just because she “really needed to have it” (if that was true) is simply unacceptable.
At that point, Laurie could have 1) insisted, 2) demanded a second opinion, whether or not Dr. Aldesani agreed, or 3) demanded transfer to another hospital if she knew of a doctor who would accept her as a patient (which is usually not difficult).
I asked if [Dr. Cutler] could do the procedure instead of Dr. Aldesani, but Dr. Cutler said he wasn’t licensed to do so.
This was a clear set-up by Dr. Aldesani. He sent someone in who was likely to agree with him (probably for political reasons) and who (purportedly) was unable to perform the procedure in his place.
This is a difficult situation. However, possibilities for handling it better include 1) identifying a second opinion source yourself with the assistance of friends, family, and nurses (who can be an extremely useful resource); 2) if the second opinion of Dr. Aldesani were accepted, asking why he chose who he did and asking both Dr. Aldesani and Dr. Cutler what their relationship was (partners, friends, etc.).
I now feel that I should have trusted my initial instincts, but there was no one else available to do the procedure and both doctors had me convinced that, if I didn’t have this procedure done soon, I could die.
Dr. Aldesani used the tried-and-true tactic of cardiologists everywhere: Scare them to death, then “save” their lives with a procedure. Sometimes it’s true, often it’s not. While Laurie may indeed have required a procedure, it was hardly the dire situation painted by the doctors.
Why do they use this tactic? Many reasons: It abbreviates the conversation, since patients become eager to have the procedure. (Proceduralists hate talking to patients.) It tends to pre-empt any liability if the procedure goes sour, since it was “necessary to save her life.” Lastly, it increases procedural volume, since just about anyone is unable to endure the fear of being told they were going to die without the procedure.
I felt completely vulnerable and powerless as he mocked and ridiculed me with the questions I had asked him hours earlier. His unpredictable and threatening behavior in the midst of performing my heart procedure scared me deeply.
Too late. Laurie was trapped, a victim of the unprofessional, inexcusable behavior of Dr. Aldesani. At this point, she had no recourse - partly sedated - with catheters inserted in her body.
[Dr. Aldesani] told my family that he would like to have me taken to a facility where open heart surgery would be available should I need it.
A non-emergent procedure being performed at a facility with no surgical backup? While clinical trials have confirmed that emergency angioplasty during an ongoing myocardial infarction (heart attack) can be safely performed in such “no backup” hospitals with equivalent results to that obtained in a hospital with surgical backup, there are limited data to support non-emergent angioplasty. In fact, some data suggest that mortality is doubled: http://www.bmj.com/cgi/content/extract/321/7272/1308
The fact that no surgical backup was available and the likelihood of adverse outcomes should have been fully disclosed prior to Laurie’s catheterization. There was no way for Laurie to have known this. But, Dr. Aldesani’s intractable reluctance to discuss the procedure concealed this crucial fact.
Learn from Laurie’s unfortunate experience. Having met Laurie, I can see how this sweet, accepting woman could have been bullied into a procedure. Don’t let it happen to you.
There is a time and place for procedures. When the situation permits, it is your right to receive 1) an adequate explanation of a medical procedure, its risks, benefits, and alternatives, 2) a second opinion if you are dissatisfied with the first, and 3) humane treatment regardless of differences of opinion.
Laurie and her attorney have since filed a lawsuit against Dr. Aldesani, who continues to operate a busy practice.
DISCLAIMER
While the content and text of “Laurie’s” story are genuine (except edited for brevity) and provided by “Laurie” herself, all names and personally identifying information have been changed.
Have you ever heard the word “cure” in a doctors’ office? 
