In modern medicine, we often face a common problem: too much testing, diagnosing, and treating. We tend to believe that more tests and treatments mean better care. But sometimes, even simple tests can make things more confusing instead of clear. This confusion can lead to delays in making important decisions, more treatments than necessary, and in this case, postponing surgery.
Let me share a true story. I wonโt identify the doctors or the hospitalโa story that highlights how the tests done before surgery can sometimes cause confusion and delays in treatment.
A 30-year-old software engineer, typically in good health, was scheduled for an elective appendectomy. Previously diagnosed with acute appendicitis, he underwent conservative antibiotic therapy and was advised to schedule the appendectomy for a later date.
He had a routine pre-op assessment. No symptoms or health issues; normal BP, glucose, creatinine, and lipids. Normal weight. Walked briskly 5 km daily without chest pain or breathlessness. He didn’t smoke or drink alcohol.
Almost all scheduled surgery patients, regardless of age, gender, type of surgery, or whether they have heart symptoms, typically undergo a routine ECG these days. This patient followed the same protocol.
The ECG appeared mostly normal, except for a T-wave inversion, deemed a benign abnormality by the physician.
However, the surgery and anesthesia teams chose to be cautious. They requested more tests to make sure the patient was “fully fit” for the operation.
Despite the surgery being routine and brief, with no symptoms or risks of complications, the teams wanted the patient to have a full cardiac workup.
A stress test (treadmill) was recommended to rule out coronary artery disease. The patient walked on the treadmill for 9 minutes. His heart rate and blood pressure rose as expected. He felt no chest pain. However, the ECG showed slight changes; the test report read “borderline positive”.
Before testing, his chance of coronary artery disease was 5%. After the Duke treadmill Score, it went up to 20%. Even with the higher score, there was still a good chance of having a normal angiogram.
“Let’s take no chances,” the physician urged, and the family agreed. They went ahead with a coronary angiography to check how much his coronary arteries were blocked.
The results revealed 70% occlusion in the right coronary artery, with other major heart arteries normal. He could not recall any heart symptoms; his heart was healthy, pumping at a 65% ejection fraction on echocardiogram. He cleverly Googled “angina” and confidently stated he had never felt those symptoms before.
In the Cath Lab, the cardiologist and family weighed the pros and cons of angioplasty. The family felt nervous, while the cardiologist remained composed. The family deemed the 70% blockage “a bit too significant” and urged the cardiologist to clear it.
The cardiologist hinted that medical treatment could be a better choice, but the family, having consulted three doctors via WhatsApp in the waiting room, remained firm in their request.
Prompted by the family, the cardiologist went ahead with the angioplasty. The patient lay on the Cath Lab table, unaware of the discussions.
With careful skill, the cardiologist placed a stent in the coronary artery. “The artery is clear now,” the cardiologist pointed to the open artery displayed on a large computer screen for the family to see. The patient and family felt relieved, and congratulatory messages about the successful angioplasty spread rapidly on WhatsApp.
“We did the right thing,” said the patient’s wife, as everyone praised the doctor and cardiologist for finding a hidden blockage.
The next day patient went home. He was prescribed two blood thinnersโAspirin and Ticagrelorโto be continued for a year.
With his heart arteries clear after angioplasty, the patient was keen to have his appendix removed. As soon as possible. He asked surgeons and anesthesiologists for advice. “Can you take me quickly for the operation?”
The two green gowns checked his discharge card, talked it over, then came back with bad news. “We can’t operate,” they said. The patient was shocked. “Stopping the blood thinners could cause a heart attack. It’s too dangerous. Wait a year,” the surgeon advised.
Back home, the patient was deeply confused. It seemed like a catch-22: before, they couldn’t operate because they thought his heart artery was blocked. Now it’s open, but still no surgery. ECG changes delayed it before, and now, even with the stent and blood thinners, it’s delayed again. He felt stuck, back at square one, trying to make sense of it all.
Should he have had a pre-op ECG in the first place, he began to wonder. “Did that ECG cause all this confusion?” he wondered. He began to get increasingly uneasy Did the doctors become defensive, and did their series of tests result in the postponement of my surgery?” he began to ask himself.
So, he waits, not knowing what’s ahead. Next year, more tests await him. Another round of tests, another procedure, and the cycle could repeat itself.
And all the while, the appendix seems to mock him, having the last laugh.