As a cardiologist, I often find myself talking to patients about invasive tests and procedures. On busy clinic days, it is not unusual to refer a few patients for a heart catheterization or, perhaps, a transesophageal echocardiogram or device implant. During such conversations, patients often ask, “Doc, if it were you—what would you do?”
I admit I found those questions irritating at first. We’re not talking about me, I thought, impatiently, we’re talking about you. But after practicing medicine for a few years, I’ve begun to see such questions (“If it were your mother, what would you tell her?” is another favorite) as an understandable—if ultimately unanswerable—way for patients to make sense of medicine’s tangle of individual choices.
A patient I saw recently, F., asked me about treatment of her atrial fibrillation, a common irregular heart rhythm. She had, for several years, undergone various attempts at cardioversion (an electrical shock delivered to the heart to “reset” it) as well as antiarrhythmic drug therapy. Now, she was told by her electrophysiologist, it was time for an ablation—a procedure in which catheters are inserted into the heart to “burn” the offending excitable cells. Mostly, she said, she felt fine. Or, at least, she thought she did. She was still able to pick up her grandkids from school and work in her garden, and if she was tired from time to time, well, who wasn’t? But, still, she was worried about the arrhythmia that was recorded on her Apple Watch. What should she do, she asked?