GETTING TO THE HEART OF MEDICINE
HEART AND SOUL
AUTHOR Christopher Fine, MD
“My mother had it, too,”
she had told me in the
past, “but she fought
to the very end. I plan
on doing the same.”
Her hands were petite
and cracked with
decades of hard work
that one could only acquire from a family farm. She had the kind
of hands that longed to be touched, frequently pulling you in for an
embrace at your every meeting, when a hug was not yet taboo from
the pandemic. She sat in the same infusion chair every session. It
had a light blue color that glowed in the late morning sun. Her head
scarf changed every time I saw her, which wasn’t a coincidence: an
inside joke for all her fellow patients. That loud personality–which
always brought to mind the joy of blowing bubbles across the top
of a milkshake–was what made her “her.”
These are the human elements that can get lost in modern medicine,
but that make all the difference. The melding of cardiology
and oncology disciplines, albeit in its infancy as far as recognized
subspecialties goes, has an incredible opportunity to treat the whole
patient again. The totality of treatment can encompass physical,
mental, emotional and spiritual health across multiple fields. But
I’ve always asked myself, what is my best role as her cardiologist?
How can I treat her to the best of my ability?
In order to do no harm, a portion of the Hippocratic oath we all
take in medical school, we analyze risk/benefit ratios. This ratio is
frequently in the form of the number needed to treat (NNT). This
metric is used typically in studies about prevention, for instance, of
death or major adverse cardiac event. Consider a patient having a
myocardial infarction. On top of primary revascularization, which
is by far the most impactful treatment we can provide, we are quick
to prescribe high-intensity statins and aspirin as essential medications
for guideline-directed medical therapy. Similarly, for heart
failure patients with a reduced left ventricular ejection fraction, we
prescribe even more medications. In some situations, we recommend
implantable devices to improve the synchrony of ventricular
contraction, with the goal to make the patient live longer and feel
better. Depending on the trial you draw information from, the
NNT for statins (in patients with and without a prior heart attack)
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