Selecting the therapeutic alternative for rehabilitating patients with occlusive arterial disease.

From the Department of Rehabilitative Medicine, Nassau County Medical Center, East Meadow, New York Choosing a therapeutic plan for a patient with occlusive arterial disease is clearly one of the vital functions of the physician and surgeon. That decision and the care which flows from it are the reasons the patient consults us. He does not consult us for the diagnosis, or to participate in our research or training programs. The criteria upon which our decision must be based depend first upon the complaints of the patient, then upon the patient’s general health, the state of the medical and surgical art, and the patient’s wishes concerning the disposition of his life and body. The decision must be based not upon what we are technically capable of doing and have a personal interest in doing, but on what we ought to do. An example of the latter deciding whether to reimplant a limb after severance by trauma. In most cases, even though we now have the techniques and the technical skill to perform the reimplantation, it is my experience that to do so is usually not in the patient’s best interests. There are four criteria by which to judge success in medical treatment.