Hidden Epidemic: Heart Disease in America
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Hidden Epidemic: Heart Disease in America + Take One Step for a Healthy Heart with Larry King  

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Chapter 7 - Doctor Patient Relations [8:07]

How to partner with your doctor. Strength and weaknesses in our health care system. Stents vs. bypass. New medications.

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Transcript: Chapter 7 - Doctor Patient Relations

How to partner with your doctor. Strength and weaknesses in our health care system. Stents vs. bypass. New medications.

LARRY KING: How about the doctor-patient relationship in all this? Do doctors really pay attention? Do they listen? Do they give us more than 23 seconds before they talk?

DR. PAULA JOHNSON: I do. But absolutely, I think they do, but you know, there are significant constraints right now in the healthcare system. And it's something that is a major issue once again in terms of how do we think about where we're going to go moving forward. There is not much time in a 15-minute visit to do a lot of preventative work. And I think we have to think long and hard about where we're going and the kind of relationships we want, need, and what is the kind of information that is really going to help patients get healthy.

DR. STEVEN NISSEN: It's a dialogue, Larry. You know, I love it when my patients come in and they've made a list in advance of their questions so they don't forget to ask them. They've made a list of their medications. An empowered patient who understands the disease and how it should be treated makes a big difference. A physician is going to pay attention. I wish it weren't always-- it didn't have to be that way, but there's nothing like a patient that really engages you.

DR. PAULA JOHNSON: And I would also say that patients need to be empowered to know that every relationship isn't for everybody, and that if it's the wrong relationship and you really feel not listened to, change. You really do need to do that.

LARRY KING: If you don't like your doctor, go to another. Dr. Legato, what about the patient weighing the benefits, if confronted with it, of stents versus bypass?

DR. MARIANNE LEGATO: That's a huge question, because now the tendency is, Steve will tell you, is to go to the stent. Most patients don't like the idea of having their chest cracked open.

LARRY KING: I didn't.

DR. MARIANNE LEGATO: But bypass leaves you healthy and intact for years and years and years, and so it's a very safe and--

LARRY KING: But it's a tough call.

DR. MARIANNE LEGATO: Very tough call.

DR. PAULA JOHNSON: But there are some areas where, for example, certain types of disease and especially in diabetics where bypass surgery we know does better than stenting. So I think it isn't a simple question.

LARRY KING: What new drugs are you excited about or treatments?

DR. STEVEN NISSEN: There's a revolution that's about to happen. We're going to have for the first time final data on studies using drugs that can raise the HDL levels substantially. We think we'll be able to make some people actually have an HDL, a good cholesterol level, higher than their LDL, their bad cholesterol.

LARRY KING: Which is very.


DR. MICHAEL ROIZEN: And the HDL is like a Drano for your arteries. It actually cleans out some of the bad stuff. That isn't to say to people, wait. Because remember, a third of people will die before they get to the hospital or before they get treated, so we really should tell people we've got a lot of prevention now in lifestyle.

As we know, 80 to 90% of heart disease can be prevented with lifestyle changes.

DR. PAULA JOHNSON: The real issue here is that we need to focus our training, our education, on the full spectrum of our disease, which is everything from prevention at the earliest ages through treatment, and really communicating with our patients that prevention is something that's doable and we've got to focus on, but if you end up with the disease we can help you. And I think there's hope at every single point along the way, and it's a very important message.

LARRY KING: Are statins incredible?

DR. STEVEN NISSEN: People who have high cholesterol who lower it with statins, reduces by about a third the risk of heart attack and stroke.

LARRY KING: What does it do?

DR. STEVEN NISSEN: It works in the liver to lower the LDL, the bad cholesterol level.

LARRY KING: Now why did they put me, along with the Lipitor, they put me on Zetia, which seems to be confronting it double ways, right? In the liver and outside the liver.

DR. STEVEN NISSEN: Ezetimibe or Zetia works in the GI tract, and it actually prevents the absorption of cholesterol from the diet.

LARRY KING: So I'm fighting it three ways?

DR. STEVEN NISSEN: You're fighting it several ways. You're fighting it with your exercise, you're fighting it with your diet, and you're fighting it with two medications.

LARRY KING: Is it possible my body might be confused? [laughter] Let's say you're my liver.

DR. MICHAEL ROIZEN: The only way it's confused, it says, heck, he's 20, what the heck has he got? I think your liver is very happy right now.

DR. PAULA JOHNSON: I do want to-- lipids are incredibly important and statins have been a real breakthrough. On the other hand, I have patients walking into my office who are on a statin but still smoke and blood pressure is out of control and are not exercising, and I think once again keeping it balanced with all the other things we need to do are very important. It isn't the magic bullet.

LARRY KING: When a drug is real good-- I had a friend tell me, "I take Lipitor, I don't worry about anything."

DR. MARIANNE LEGATO: Exactly. I've seen so many patients sit down to a steak more than once a month, mashed potatoes with gravy, and then say, "I'm on Lipitor; none of this matters." It's not the ideal.

DR. STEVEN NISSEN: Dusting your cheesecake with a little Lipitor on top is not the right way to lower your cholesterol.

LARRY KING: What one step would you recommend for a healthier start?

DR. MARIANNE LEGATO: Stop smoking if you do, and try to exercise every day.

DR. STEVEN NISSEN: Know your cholesterol, your LDL, your bad cholesterol, and your HDL, your good cholesterol.

DR. PAULA JOHNSON: Exercise. It is not only good for the heart but it's so good for preventing so many other things connected to cancer, arthritis, and so many of the things that make us sick.

DR. MICHAEL ROIZEN: Walk 30 minutes a day and call someone, call a support person, if you will, to make sure that you and they are staying connected so you have support and a passion for life.

SALLIE FOLEY: Don't lead a constricted life. Don't avoid things. Construct a life. Ask questions. Get help.

LARRY KING: ...... the light at the end of the tunnel is brighter.

DR. STEVEN NISSEN: It's brighter. We have new medications coming that are going to make a big difference. We've got public education campaigns. We have this Red Dress campaign to make women more aware.

LARRY KING: Great idea.

DR. STEVEN NISSEN: We have to do all these things. People have to listen. We have to engage the public. And programs like this do help in fact.

DR. PAULA JOHNSON: I think it's something we didn't talk about today, but children are critical. And we are seeing more of a movement around childhood obesity, risk factors in children. But if we can teach children to be advocates and to think about their health, it's important.

LARRY KING: If you want additional information, please call this 800 number now on your screen.


LARRY KING: Dr. Marianne Legato, Dr. Steve Nissen, Dr. Paula Johnson, Dr. Michael Roizen, and Sally Foley. Thank you all. We hope you found this as helpful as I did and we hope that you pay attention. Take care of your heart.

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