Angry Doctor

Monday, September 12, 2005

Life’s a Gamble

The comments on the post on Patient Autonomy generated some questions concerning cholesterol and cardiovascular risk.

I would first of all like to remind all of the Disclaimer. I will not answer any medical query directly because it is illegal and irresponsible for me to do so.

What I am going to do instead is to rant in general about the issue of cardiovascular risks.

Fact is, modern medicine, like life, is just a big gamble. We rely on the principle that God is essentially fair when dealing with doctors, and when a patient has a certain disease he would have certain sets of symptoms and signs so we can make a diagnosis, and when we treat a certain disease a certain way the patient usually improves.

That forms the basis of modern Evidence-Based Medicine, which in a nutshell means we treat 10,000 people with drug A and 10,000 people with drug B for five years, and then see which group does better. If the difference is big, we recommend all patients take that 'better' drug. Risk factors are studied the same way.

But of course the problem is what works for one person may not always for another.

In my practice I have utilised the angry doc 4D model to explain this concept to my patients. It runs thus:

Getting a heart attack or stroke is like striking the top prize in 4D.

Having risk factors is like buying 4D tickets.

The more risk factors you have, the more tickets you've bought yourself. So if you are a healthy 30 year-old who doesn’t smoke, exercises regularly, is not obese, and have parents who do not have heart disease or stroke, you have one ticket. If you are 65, fat, have high blood pressure, smoke like a chimney, have two parents who had heart attacks, have high cholesterol etc., you have bought yourself a handful of tickets.

If your blood pressure or cholesterol levels are high, you have bought 10 big 10 small on those tickets (OK, I don’t actually buy 4D but I assume that’s how it works?).

So now, the question is: who has a higher chance of striking the top prize?

The second question is: who will strike top prize?

The fact is the healthy young guy can still strike the top prize, and that the old smoker may not strike at all.

But the real question you should be asking yourself is: am I feeling lucky?

Well, are ya?


Bonus Risk Assessment (see Disclaimer)

Here's an online calculator you can use to assess your cardiovascular risk.

7 Comments:

  • Hmm. I like your angry doc 4D model!

    I hope you dun mind if I use it for patients as well? :)

    Very good. I'm sure the locals will really identify with it.

    To expand on it. The prize can also be 1st prize, second prize, starter prize etc. For example death is 3rd prize. And stroke with total paralysis with no death is 1st prize. TIA is starter prize.

    Very good model. They should teach this in medical school!

    :D

    PS: I just got an offer to work in NSW for AUD$4000 a week with calls 1 in 3 for 4 weeks with a AUD$1000 and crate of wine bonus on top of that.

    Do you think it's a good deal?

    By Anonymous Dr Oz bloke, At September 12, 2005 11:30 am  

  • Oi! I angry doc, not agony doc lah. Not sure about your Australian offer, but let's just say they must think that THEY are getting a good deal.

    Can use my model no problem. I'm sure I'm not the only doctor using this model anyway. :)

    By Blogger angry doc, At September 12, 2005 12:35 pm  

  • So...what is the weightage of the cholesterol factor based on conventional medical wisdom??

    Based on most textbook?

    By Blogger Ranting Rock, At September 12, 2005 2:47 pm  

  • And thanks for the effort ^^

    Appreciated it.

    By Blogger Ranting Rock, At September 12, 2005 2:47 pm  

  • Oi! Tell you not to ask some more you ask!

    *sigh*

    OK lah, go here lah:

    http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof

    By Blogger angry doc, At September 12, 2005 2:51 pm  

  • This angry doc very nice man wor ^^

    Thanks la.

    Really want to tell people around me shutup about cholesterol and that is why I am doing homework so that I won't behave like a fool.

    I am not really interested in the medical implications....hehe..so don't be stressed hor ^^

    Thanks again.

    My score is 2% ...guess I can tell others to stop bothering me about cholesterol ^^

    By Blogger Ranting Rock, At September 12, 2005 10:59 pm  

  • Good analogy

    By Anonymous belladona, At September 13, 2005 9:49 pm  

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