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andré picard's second opinion

Danny Williams has the unquestionable right to get medical treatment in the United States.

But the ignorance and arrogance Mr. Williams displayed in making the decision to get heart surgery in Miami Beach is staggering.

As the Premier of Newfoundland and Labrador, he is one of the stewards of the medicare system.

The least we can expect from a political leader is some leadership and sound reasoning. What we got instead were inanities like: "This was my heart, my choice and my health."

Mr. Williams went on to tell The Canadian Press: "I did not sign away my right to get the best possible health care for myself when I entered politics."

The clear implication of that statement is that the surgery he sought in the United States was not available in Canada, and that health care in this country - and cardiac surgery in particular - is inferior.

That is utter nonsense on both counts.

Further, no one has suggested for an instant that being a politician somehow condemns one to a gulag of second-rate care. That is a straw man, and a flimsy one at that.

What we should expect from our politicians, however, is a degree of transparency and an ability to make evidence-based decisions.

Opting for a life in politics does not prevent you from making choices like going to the United States for care, but it does imply an obligation to explain your actions.

Skulking off to Miami, then petulantly refusing to detail why, just doesn't cut it. At the very least, Mr. Williams owes his employers (the public) explanations about his health and his absences from work. Like other employees, he also deserves time off to recover.

Of course, there are those who say: "Leave the Premier alone. It's his money, and his health is none our business."

That he is wealthy enough to afford to pay for heart surgery - the procedure can cost from $25,000 to $50,000 - is irrelevant. So is the fact that he recovered at his Florida condo.

What is our business is how and why a politician makes a decision that clearly has social policy implications. In this case, the personal is political.

Evidence-based decision-making is fundamental to the delivery of good health care, on a personal as well as a systems level.

If our politicians do not know how to use evidence to make decisions rationally, is it any wonder our medicare system is adrift?

Let's look at the evidence.

Last spring, during a routine check-up, Mr. Williams's doctor detected an abnormality, a heart valve that wasn't closing properly. The condition required only monitoring.

Eight months later, in December, 2009, the Premier was told the problem had become more severe and required surgery soon, though not urgently.

Like all patients, Mr. Williams wanted the best surgery available - meaning prompt treatment and a good outcome, with minimal complications and a relatively easy recovery.

He was offered the standard treatment for his condition, mitral valve repair. The surgery requires that the breastbone be cracked. which suggests longer recovery time.

Mr. Williams, wisely, sought a second opinion. Every surgery patient should.

The Premier was told the mitral valve could also be repaired with minimally invasive surgery - with smaller incisions and no cracking of the chest, suggesting less recovery time.

Up to that point, Mr. Williams did his homework relatively well. But then his decision-making went off the rails.

He contacted Lynn McGrath, a Memorial University alumnus who is a cardiovascular surgeon in New Jersey.

Dr. McGrath recommended a surgeon at Mount Sinai Hospital in Miami who does minimally invasive surgery, Joseph Lamelas.

While these men are excellent health-care practitioners, they know little about Canada's health system.

Had Mr. Williams asked his questions of the right people, he would have learned what procedures are offered in Canada, and that cardiovascular outcomes in this country are as good as in the U.S., and often better.

The surgery that Mr. Williams wanted and was medically appropriate was not available in St. John's, but is available in at least seven Canadian cities.

(And let's dismiss quickly the suggestion that every procedure should be offered in small centres like St. John's. In surgery, high volumes translate into better quality and safety, so it is wise to bring patients to central locations.)

If he'd sought advice in Canada, Mr. Williams would also have learned that minimally invasive surgery, despite the hype, is not necessarily the best option for his condition.

In the U.S. system, marketing, newness and profit margins too often trump evidence.

Mr. Williams's sin was not in going to the U.S. for surgery, it was in acting on partial information, uttering untruths about the availability of care, and smearing - however inadvertently - Canada's health system in the process.

The Premier said he did "some checking," but the reality is that he depended on the old boys' network and on prejudices about Canada's health system instead of readily available evidence.

Sadly, this is often how decisions are made by the politicians who are stewards of our health system, and we all suffer for it.

Health care in this country is good, but it would be better if we acted more often with our heads than with our hearts.

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