“Can I please have a stent instead?”

I am no longer surprised when I hear patients begging for a stent just as the doctors inform them that they require a Bypass Operation. The scenario is standard: A young patient has severe disease in his coronaries, always much worse than what is recommended for a stent; so the doctors recommend that the patient undergo a bypass surgery.

In their desire to get home quick and also to avoid an operation, the patient and family either request for or insist upon the doctors that ?please doctor, please put in a stent for now?. It is rare that a Cardiologist would decline to pass in a stent in such a circumstance. I have on occasion been privy to counselling where certain unscrupulous doctors have been economical with the ill efects of stents.

What are the implications? For the young patient specially, they can really not avoid a bypass surgery in the medium to long term. There are many points to consider:

• The number of drugs post stent
• complications
• effects on lifestyle
• need for repeat angiography
• repeat stenting or bypass surgery

.Morally and legally it is now the patients responsibility since they asked for a stent despite the doctors advice to undertake a bypass operation. I suppose that even when this situation is tested on legal grounds, the dotors or hospitals may not be easily faulted.

A patient should be seeking the best course of action from his physicians and surgeons rather than insisting for one treatment or the other based upon a small amount of information he might have collected from his own limited resources. The ideal practice, as recommended by the European EACTS/ESC would be that a Heart Team comprising a Cardiologist and Cardiac Surgeon evaluate each patient together, discuss the best course of action based upon available scientific evidence, and then recommend further course of treatment.