When medical guidelines don't fit the patient

10/27/2013 | New Yorker (free content), The

The decision to place stents in blocked coronary arteries is not one taken lightly by physicians, writes cardiologist Dr. Lisa Rosenbaum. She shares her own history of strictly adhering to treatment guidelines regarding appropriate use of stents and medical therapy, only to learn that strict adherence to such standards leaves little room for the art of medicine and the patient's perspective. Even the widely discussed COURAGE study is based on exquisite control of factors such as risk, adherence and follow-up that often don't apply in practice. "[N]o one wants to read a story about doctors putting in stents because they are trying to do the right thing for their patients," Rosenbaum writes. "... [W]e must be careful not to let the bad behavior of the few malign the good intentions of the many."

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New Yorker (free content), The

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