My 75-year-old father has recently had a coronary angiogram and been referred for bypass graft surgery. When I was a cardiology senior house officer in the Jurassic period, he would never have been referred for such surgery at this age.
Even if he had been 20 years younger, he would probably have died on the waiting list.
Dad has a number of "comorbidities", all of which boil down to a life of overindulgence. He's an obese ex-smoker with type 2 diabetes who spent much of his adult life binge drinking - particularly in the heyday of Welsh rugby.
A week ago, I decided to accompany him to his outpatient appointment with the surgeon. This was preferable to endlessly telephone tag-chasing a busy professional in the vain hope they might remember the patient and be able to provide anything more than a reassuring patter.
The experience was illuminating. I had been wondering how the NHS could justify spending its resources on somebody who had never been able to show much will power and was likely to continue to eat and drink too much and take too little exercise after the operation.
I really did wonder about a world where we could take somebody in my father's condition and offer him the prospect of living another decade. But then for some years now I've been prescribing thousands of pounds of drugs to people in the last six months of their lives, so who am I to judge?
I had also been struggling with myself about whether to check the cardiothoracic outcomes published on the Healthcare Commission website, but I managed to restrain myself as I wanted to judge the doctor on his ability to look at the whole patient.
After what appeared to be some confusion over names, my father was called in and we sat in the consulting room with the angiogram playing on the screen at the desk. My parents didn't notice, but this was nerve-racking for me.
The surgeon was straightforward and direct. He admitted it didn't quite add up and that diabetes and coronary artery disease were not the whole story - there was a degree of muscle damage, which must be explained by the booze. My father was surprisingly frank about the five pints he had consumed before and after his weekly choir rehearsal the night before and we soon calculated that the seven to eight pints a week that he admitted was an underestimate. The doctor pointed out the impact this would have had on his diabetes, let alone his weight.
He then talked about a two-way pact - where dad would have to cut back on his alcohol and lose at least 8kg to be considered for surgery in the next few months. He went on to point out that doing so would probably make a bigger difference than the surgery. The consultation at times had the cringe-worthy banality of a Ricky Gervais sitcom - my father was described as the elephant in the room and his long-winded answers to questions often had to be cut short. He failed to see the irony in the fact that he was negotiating his operation date around a trip to Qatar with the choir.
After the 20-minute consultation, I left with my parents. Dad was deflated, having been nagged about his drinking, and mum was triumphant that, for the first time she could remember, a member of the medical profession had agreed with her about her husband's alcohol consumption. It seems even his GP colludes, saying he has to have something to enjoy!
I was truly impressed. Not only had the surgeon demonstrated in spades how he looked at the whole patient, but he had engaged my father in his part of the deal. He had made it clear that surgery was part of what needed to happen, but not the only part.
I have since plucked up the courage to look at the outcomes for the three hospitals suggested by the cardiologist, knowing that we had committed to the usual referral pathway offered. Individual data by surgeon was not available and there was 0.1 per cent difference between the three centres - although the numbers of patients being operated on at the hospital he is going to were higher.
Frankly, even if there had been a 3 per cent difference, I would have been happy. After a consultation of that calibre, with somebody who took the whole patient into account, I can't believe he doesn't know what he's doing in theatre.
And as for my father, he drank water at the choir this week. Having lost a few pounds, he is already less breathless. Let's just hope he can keep up his part of the pact in the longer term.