WomenHeart: “Still gender disparities in treating women’s heart attacks”
February is Heart Month! Please help to increase awareness of women’s heart disease – our #1 killer - by spreading the word to as many women as possible. For more information, visit WomenHeart: The National Coalition For Women With Heart Disease.
The ‘18 Second Rule’: why your doctor missed your heart disease diagnosis
The trouble with Dr. Jerome Groopman’s book, How Doctors Think, is that the docs who really need it won’t read it. But patients will, thanks to word-of-mouth buzz since it was published in 2007.
As a patient who has experienced a life-threatening misdiagnosis while having a heart attack, my own favourite part of the book is Dr. Groopman’s review of physicians who take “cognitive shortcuts’ during patient visits.
This means that doctors can jump to conclusions about diagnosis or treatment options, and then can’t budge even when contradictory evidence subsequently emerges. “Blame the 18 Second Rule!” advises Dr. Groopman, professor of medicine at Harvard. ”That’s the average time it takes a doctor to interrupt you as you’re describing your symptoms. By that point, he/she has in mind what the answer is, and that answer is probably right about 80% of the time.”
You may be saying by now: “Well, Carolyn, being right 80% of the time sounds like a pretty darned good track record, even if the doctor has jumped to conclusions and interrupted me after just 18 seconds!” This may be true, unless of course you happen to be one of the poor misdiagnosed schmucks in that 20% group. “It’s not that doctors lack sufficient clinical knowledge, but are rather tripped up by their biases,” writes Dr. Groopman.
Here’s how things can escalate once inaccurate bias comes into play. “Doctors are stumped by symptoms all the time,” explains Dr. Groopman, “By prescribing the wrong medication, for example, they often worsen the problem or even create a new one. Worse, misdiagnoses lead to an astounding 40,000-80,000 hospital deaths every year according to the American Medical Association, plus an uncounted number due to mistakes in the doctor’s office. Some 5% of autopsies find a condition missed by doctors that, if treated, might have saved the patient’s life.” Alarmingly, he describes the reality, actually researched at Johns Hopkins, that when doctors develop a dislike of a particular patient, they tend to shut down and close their minds. “It’s a set up for misdiagnosis - you do not get good care.” (more…)
Heart disease – not just a man’s disease anymore
Tragically, women still come up short when it comes to the diagnosis and treatment of heart disease. Mayo Clinic’s Dr. Sharonne Hayes, MD, director of the Mayo Women’s Heart Clinic in Rochester, Minnesota spoke recently to staff from WomenHeart: The National Coalition for Women With Heart Disease . Learn more here about why inequities continue, and how women can empower themselves and others to achieve equal and quality care for their hearts:
WH: “Recent studies show that compared with men, women have a 50% greater chance of being delayed in the hospital Emergency Room setting, and that women are less likely to receive the same care as men in the hospital setting generally. Do these studies suggest doctors and emergency first responders are really having trouble spotting heart attack symptoms in women?
Dr. Hayes: “Yes. While on one hand, these findings are discouraging and reflect true disparities in care, on the other, we have to acknowledge that health care providers’ best efforts are hindered by the lack of good science about women and heart disease.
“There is no good study out there that tells us how similar or different women are from men when it comes to heart attacks. Sometimes, the symptoms are not clear, clustered differently, and can be attributed to something like indigestion or anxiety.
“If you find yourself in an ambulance or Emergency Room, don’t be afraid to say to the paramedic or triage nurse, “I think I’m having a heart attack.” You want a proper diagnosis, and a straightforward blood test and EKG are the starting points. If the thought crossed your mind that you might be having a heart attack, you need to speak up.” (more…)
Cheap, quick bedside tests better than MRI in diagnosing strokes?
Do you remember as little kids when we liked to spin round and round very fast so that when we stopped, we’d stagger around in a state of delicious dizziness? As adults, though, feeling dizzy is not fun. In fact, dizziness is responsible for millions of visits to hospital emergency departments each year. While most cases are likely caused by benign inner-ear balance problems, about 4% are signals of cardiovascular disease such as stroke or Transient Ischemic Attack (TIA – a condition that often warns of impending stroke in the coming days or weeks).
About half of these dizzy patients who are experiencing strokes show none of the classic stroke symptoms like one-sided weakness, numbness or speech problems. In fact, some estimates put the number of misdiagnoses as high as one-third, losing the chance for quick and effective stroke treatment.
Just as the rule for getting immediate help during a heart attack is: “Time is muscle” – in stroke circles, doctors say: “Time is brain”. (more…)
His and hers heart attacks
Should we invent a new name for women’s heart disease? A review on the topic of gender differences in heart disease reminds us what many heart attack survivors already know: when it comes to heart attacks, women are not just small men.
Standard cardiac treatment typically focuses on obstructive coronary artery disease, which up to half of women may not ever experience. In obstructive coronary artery disease, the large blood vessels in the heart can become blocked through atherosclerosis, a condition in which fatty cholesterol streaks build up in the arteries. In fact, the Framingham Risk Score, based on a study of over 5,000 participants (and their descendents) followed since 1948, is the traditional measure of heart disease risk, yet this scale mistakenly classified almost 90% of women as low risk – which is hard to get your brain wrapped around given that more women than men die each year from heart disease.
But in small vessel disease, the narrowing of the very small arteries in the heart means they can’t expand properly when you’re physically active. As a result, your heart muscles don’t get an adequate supply of oxygen-rich blood. This inability to expand is called endothelial dysfunction. This problem may cause your small vessels to become even smaller when you’re active or under emotional stress. The reduced blood flow through the small blood vessels causes chest pain and other symptoms similar to those you’d have if you were having a heart attack. (more…)
