The hospital discharge race: is sooner always better?

31 Aug

by Carolyn Thomas  @HeartSisters

wheelchairThey say that if you can remember the 1960s, you weren’t there. I do remember this about 1966, however:  I spent my birthday that year in a hospital bed, where I’d been a patient for a full month recuperating from a ruptured appendix and a nasty case of peritonitis.  Back then during the dawn of civilization, it was common for patients to spend far longer in hospital than we ever would now. For example:
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Heart scans: the triumph of profit over science

24 Aug

by Carolyn Thomas  @HeartSisters

This kind of ad is part of a growing marketing strategy to cash in on your fears. They’re run by for-profit hospitals, medical centres, and sometimes just non-professional entrepreneurs who park their big mobile body imaging vans in church parking lots.

For example, an ad from the Heart Hospital of Austin in Texas reads:

“Find a new way to tell Dad you love him! Show your love with a HeartSaver CT Scan!”

The website Track Your Plaque warns:

“The old tests for heart disease were wrong – dead wrong. Heart scans are the most important health test you can get!”

A radio ad for the Princeton Longevity Center in Princeton, New Jersey asks:

“Does your annual physical use the latest technology to prevent heart disease before it strikes?”

And this center’s website further promises that its full-day exams – which include heart scans and usually are not covered by health insurance plans – can detect the “silent killers that are often missed in a typical physical exam or routine blood tests.”

Yet most major health agencies (like the American Heart Association, the American College of Radiology, the American Cancer Society) do not recommend routine use of heart scans in low-risk people without heart-related symptoms.  Continue reading

When we don’t look as sick as we feel

17 Aug

by Carolyn Thomas  @HeartSisters

One morning, I overheard two of my co-workers chatting over coffee at the hospice palliative care unit where we’d worked together for several years. They were talking about one of our colleagues who had been off work on an extended sick leave. One said to the other:

“Oh, I saw ____ the other day. She was out riding her BICYCLE!” 

The way she said the word ‘bicycle’ stuck with me, tossed off with that pared down judgmental tone we use when what we really want to say is: “Hmph… Must be nice!”  The tone somehow implied that anybody who can hop on a bike and toodle around the neighbourhood on a sunny day couldn’t be THAT sick after all. Continue reading

Why patient stories actually matter

10 Aug

Most of our medical visits start with some variation of this opening question: “Why are you here today?” Connecting with and understanding patients thus requires doctors to listen to what’s called the patient narrative.  The importance of really hearing this narrative is beautifully described by U.K. physician Dr. Jeff Clark, writing in the British Journal of General PracticeBut the problem, as Dr. Clark reminds his peers, is that patients and doctors see the world in very different ways.  He also warns that the stories patients tell their physicians about why they’re seeking medical care may all too often be seen by doctors as merely a time-wasting distraction from “getting to the bottom of things.

The urge to get to the bottom of things may also help to explain what’s known as “The 18-Second Rule”.
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The day I made peace with an errant organ

3 Aug

by Carolyn Thomas  @HeartSisters

Here’s my theory: few health crises in life are as traumatic as surviving a cardiac event. I developed this theory while I was busy having my own heart attack in the spring of 2008.

For starters, heart attack symptoms often come out of the blue (in fact, almost two-thirds of women who die of coronary heart disease have no previous symptoms.(1)  Having a heart attack can feel so unimaginably terrifying that almost all of us try desperately to dismiss or deny cardiac symptoms. And according to a 2013 report published in Global Heart, the journal of the World Heart Federation, women are twice as likely to die within one year even if they do survive a heart attack compared to our male counterparts.(2)

So if – and each of these is still, sadly, a great big fat IF for too many women – we survive the actual cardiac event, and if we are near a hospital that’s able to provide an experienced team of cardiologists/cardiovascular surgeons/cardiac nurses, and if we are correctly diagnosed, and if we receive timely and appropriate treatment, and if the resulting damage to our oxygen-deprived heart muscle is not too severe, we get to finally go home, safe and sound.

And that’s where the real trauma starts.   Continue reading

What women need to know about pregnancy complications and heart disease

27 Jul

 by Carolyn Thomas     @HeartSisters

“I’d love to speak about the patient’s perspective at your Toronto conference in June,” I said last winter in response to an invitation from Dr. Graeme Smith, a Canadian obstetrician who teaches at Queen’s University in Kingston and specializes in high-risk pregnancies. “But travelling halfway across the country is just too hard on me these days.”

As the unofficial poster child for the well-documented link between pregnancy complications and premature cardiovascular disease, I was already very familiar with Dr. Smith’s work.  See also: Pregnancy complications strongly linked to heart disease”

Shortly after I turned down his kind invitation to speak, he invited me again (hey, he’s persistent!) – but this time he offered the irresistible option of speaking to the Toronto audience via teleconference. I asked him:

“Does this mean I can stay in my jammies, drink coffee at my kitchen table, and just speak to your group over the phone?!”

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