Jay Neugeboren: Perfect Health, but for the Quintuple Bypass

A dozen years ago I had emergency quintuple bypass surgery that saved my life. But the surgery would never have taken place, and I wouldn’t be here, if a life-long friend of mine—Rich Helfant, a cardiologist—had not listened to me tell my story. I also told the story in a book, Open Heart: A Patient’s Story of Life-Saving Medicine and Life-Giving Friendship, published by Houghton Mifflin in 2003. The article reprinted here appeared on the Op-Ed page of The New York Times, April 2, 2004.

Perfect Health, but for the Quintuple Bypass

By Jay Neugeboren

Two surprising medical studies -- one questioning the value of so-called good cholesterol and another finding that extremely low levels of cholesterol may reduce the risk and severity of a heart attack -- have put the debate over coronary disease back on the front pages. And while any new scientific knowledge is of course a good thing, I worry that our continued focus on medical testing and prescription drugs as the primary ways of preventing heart disease will distract us from a more important element in treating illness: the well-trained doctor who knows his patient.

Consider my experience. Five years ago, at the age of 60 and without any conventional risk factors or symptoms, I received a diagnosis of coronary artery blockage -- over the phone, from a cardiologist 3,000 miles away -- and underwent emergency quintuple bypass surgery.

Two doctors had examined me in the previous months (I had been experiencing some shortness of breath and a burning sensation between my shoulder blades), but they failed to discern my problem. This may have been somewhat understandable. For the previous 25 years I had swum a mile a day and regularly played tennis and basketball. I had never been a smoker. My cholesterol and blood pressure levels were normal. And, at 5 feet 7 inches tall and 150 pounds, I was perhaps five pounds heavier than I was in high school.

One of the doctors performed an electrocardiogram and an echocardiogram and diagnosed a viral infection of my heart muscle. Fortunately, I had also been talking frequently to a childhood friend who was the former chief of cardiology at Cedars-Sinai Medical Center in Los Angeles. When I told him that my cardiologist thought the problem was viral, he replied, ''It's not viral -- I want you in the hospital as soon as possible!''

Within a few days I was admitted to Yale-New Haven Hospital, where an angiogram revealed that two of my three major coronary arteries were 100 percent blocked, with the third 90 percent occluded. In a six-and-a-half-hour emergency operation, my life was saved.

Since then, I have been thinking: as miraculous as the technology is that saved my life, if not for the clinical judgment of an old friend who took the time to consider my entire case, all the medications and machines in the world would have been useless.

In cardiology, I've learned, getting the diagnosis right is no simple matter. If you add up all the commonly known risk factors -- smoking, high cholesterol, high blood pressure, obesity, lack of exercise, genetics -- they account for only about half of heart disease cases. Moreover, according to the American Heart Association, 50 percent of men and 63 percent of women who die suddenly from heart disease have no previously known symptoms.

Although baby boomers tend to obsess about cholesterol scores the way we used to obsess about SAT scores, such figures are often meaningless or misleading. Add to this the fact that the way doctors are now taught, and the way the health care system is now run, have undermined the traditional doctor-patient relationship. Not only do doctors have less and less time to meet with us, but, given the vagaries of health insurance, the doctor we see one time may not be the same doctor we see the next time, and so we often remain strangers to one another.

It is also not comforting that a study in 1997 of 453 residents in internal medicine and family practice revealed that they failed to identify the distinctive sounds of common heart abnormalities with a stethoscope 80 percent of the time. True, using a stethoscope, listening to the patient and taking a careful history may not be the only ways to accurately diagnose heart disease. But in the words of Dr. Bernard Lown, inventor of the defibrillator, listening to the patient and taking a careful history remains ''the most effective, quickest and least costly way to get to the bottom of most medical problems.''

My old friend the cardiologist has similar concerns. ''The diagnostic acumen of the physician at the bedside, on the phone or in the office, has been severely compromised,'' he told me. ''Because the mind-set has become, 'Well, the tests will tell me anyway, so I don't have to spend a lot of time listening.' ''

This, I suspect, was the mind-set I ran into. I was seemingly healthy, two doctors who examined me failed to discover the gravity of my condition, and I nearly died.

So, while it is surely important to pay attention to cholesterol research and advances in technology, it might do at least as much good if hospitals and insurers would simply give doctors the time to know and hear us. The dictum of the great physician William Osler -- listen to the patient and the patient will give you the diagnosis -- still holds true.

P.S. My friend Rich Helfant’s line to me was, “It’s not viral, goddamnit! I want you in the hospital as soon as possible!” The NY Times cut the word “goddamnit.”