University of Minnesota

“It Isn’t Always Fun” – On Giving Advice

During the 1960s I had served as director of the Minnesota Heart Association’s Cardiac Rehabilitation Unit and practiced internal medicine and preventive cardiology in St. Paul. I was also medical director of MSI, a local insurance company that served regional farm and consumer cooperatives. So, it was not strange that in 1972, I received a telephone query one afternoon from a man I knew only slightly, the CEO of a large St. Paul insurance company. Charlie, we will call him, indicated that his company had been approached by Ramsey County Hospital to make an ongoing commitment to its community-wide cardiac resuscitation and emergency efforts. The executive thought it a good idea medically and for the image of his company but he wanted to know what I thought.

“Well, Charlie,” I replied, “this is a brand-new field. People want it. The profession wants it. Industry wants it. The new Ramsey emergency unit needs help to get started. You probably have a win-win situation.”

I went on to explain, however, that analyses we had made of the potential contribution of such emergency services gave estimates that the overall effect would be small in actual lives saved. I indicated that these services would neither reduce the rate of new heart attacks nor lower the cardiac risk among upcoming generations. I characterized CPR and emergency cardiac care as Bandaid for a hemorrhage. Though many had jumped on this bandwagon, its support was based on the ballyhooed technology rather than on a rational appraisal of costs versus benefits or on a clear look into the future.

So I told ole Charlie that he could hardly go wrong supporting the emergency care program. But I advised him that in my view his company could make a greater long-term contribution by putting resources to work at the other end — through preventing heart attacks and reducing high risk in the first place. I offered to put him in touch with colleagues who could give his company an opportunity for equally high visibility in the community and, over the long run, probably a larger return per dollar contribution.

He thanked me for my advice and said he would pass it on to his company’s board within the next days. End of conversation.

CPR saves the day

Hardly a week later, I opened my morning newspaper to read that my acquaintance, ole Charlie himself, Chief Executive Officer of such-and-such Insurance Company, had collapsed that morning at the corner of Seventh and Robert Streets in St. Paul. The article went on to indicate how, remarkably, moments later, he had been resuscitated on the spot by the Ramsey Hospital Emergency Service. He was now resting quietly, though still in critical condition, in the Coronary Care Unit of that facility. The article also reported that the emergency team leader was of the opinion that Charlie’s resuscitation was facilitated by efforts of a bystander trained in the Ramsey County CPR program. Critical, too, was the new ambulance unit’s superb three-and-a-half-minute response time to the emergency call. I recall no details of my subsequent telephone conversation with Charlie a short time after this event. Charlie, incidentally, is still living, hale and hearty. The reader will divine correctly, however, that the action taken by his board of directors in support of cardiovascular research in St. Paul was in the form of life-saving, gung-ho, emergency services, not some vague academic idea about preventing future heart attacks in the community.

I still think I gave Charlie good advice. Only the timing could have been better.

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