W’s Stent


This is a really great opinion piece in the Washington Post from a physician, Vinay Prasad MD.  He talks about how George W. Bush recently received a  stent in his heart without any history of having symptoms.  If W. was a regular citizen, he would not even have been given a cardiac test to check for blockages.   Evidence does not support any benefit in testing asymptomatic people! The author sums it up by saying:

Although this may seem like an issue important only to the former president, consider the following: Although the price of excessive screening of so-called VIPs is usually paid for privately, follow-up tests, only “necessary” because of the initial unnecessary screening test, are usually paid for by Medicare, further stressing our health-care system. The media coverage of interventions like Mr. Bush’s also leads patients to pressure their own doctors for unwarranted and excessive care.

I have always believed that rationing, done in an appropriate and evidence-based manner, is warranted.  We physicians are still stewards of the healthcare system and when you run out of money doing stupid tests and procedures then no one gets healthcare.  That being said, politicians have never followed the same rules of us common folk.  Why else would they have excluded themselves from Obamacare?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “W’s Stent

  1. August 22, 2013 at 3:33 pm

    I worried about the necessity of the stent when I heard about it. But I agree with Chris that it’s possibly preventive medicine in this case.
    I also wondered about the fact that W is – and has been – so active all these years, but was found to have enough disease to spur his docs to place the stent!

  2. Chris Rhody D.O.
    August 21, 2013 at 11:25 am

    Look actual preventive Medicine. Just what we aRE TOLD TO DO, BUT NEVER ALLOWED. Sorry small keyboard but ending the sentence shouting is appropriate. Examine what is done for soldiers and what is done for citizens. In the military this type of prevention is not that atypical. He would also get a full panel of blood work and an EKG. In addition to the stress test he probably got a colonoscopy. Or what they called a “physical” when I was in school.

  3. Pat
    August 19, 2013 at 6:45 pm

    Of course, if W. paid for his own stents, why the hell should I care? And where do we draw the rationed line? We’ve determined that Granny and Grandpa should have ACE/digoxin/diuretic, echoes, and cardiology consultations gratis. We’ve determined that demented, contracted nursing home patients deserve full-court press ICU services. Evidence certainly wouldn’t support the latter, and both instances cost the taxpayer – as opposed to the patient – big bucks. My point, academic admittedly, is that we should have no problem what W. or any private citizen shells out. To me, this story is more about the fundamental flaw in government-provided care, which Bush ’43 supported and expanded.

    • Philip
      August 20, 2013 at 4:43 am

      I agree; why can’t patients ration themselves based on competitive prices? Taking the paternalistic (RVU) view that imposes a fixed value on all things ignores what patients want causes plenty of problems, and physicians should have the right to refuse what are evaluated as unnecessary procedures — even at risk of losing those patients.

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