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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

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”.
Continue reading

Misdiagnosis: is it what doctors think, or HOW they think?

25 May

As a heart attack survivor who was sent home from the E.R. with a misdiagnosis of indigestion despite presenting with textbook symptoms (central chest pain, nausea, sweating and pain radiating down my left arm), I’m pretty interested in the subject of why women are far more likely to be misdiagnosed in mid-heart attack compared to our male counterparts.

Dr. Pat Croskerry is pretty interested in the subject of misdiagnosis, too. He’s an Emergency Medicine physician, a patient safety expert and director of the critical thinking program at Dalhousie University Medical School in Halifax. In fact, he implemented at Dal the first undergraduate course in Canada about medical error in clinical decision-making, specifically around why and how physicians make diagnostic errors. Every year, he gives a deceptively simple critical thinking quiz to his incoming first-year med students.

So here’s your chance to practice thinking like a doctor. Try answering these yourself, but as Dr. Croskerry advises, don’t think too hard. If you were an Emergency Department physician, paramedic or first responder, he warns, you’d have only seconds to size things up and make a decision. Don’t read ahead to peek at the answers! Now, here are your questions:   Continue reading

When your “significant EKG changes” are missed

30 Mar

by Carolyn Thomas  @HeartSisters

A new cardiac study out of Montréal tells us yet again what women heart patients have already known for years: women receive poorer care during a heart attack than our male counterparts do. Quelle surprise . . .  But one specific finding caught my eye: one of the cardiac procedures that these researchers compared in this study was the use of the diagnostic electrocardiogram test (ECG or EKG) in male and female heart attack patients.(1)

They found that women were less likely than men to receive an electrocardiogram within the recommended 10 minutes of arriving in hospital with suspected cardiac symptoms.

It turns out, however, that even when we do finally get hooked up to a 12-lead EKG in a hospital’s Emergency Department, the doctors there may not be able to correctly interpret the “significant EKG changes” that identify heart disease. Continue reading

Cardiac gender bias: we need less TALK and more WALK

23 Mar

by Carolyn Thomas  @HeartSisters

News flash! Yet another new cardiac study from yet another group of respected researchers has been published in yet another medical journal suggesting that (…wait for it!) women receive poorer care during a heart attack compared to our male counterparts.(1)

As my irreverent Mayo Clinic heart sister and heart attack survivor Laura Haywood-Cory from North Carolina once observed in response to a 2011 Heart Sisters post:

“We really don’t need yet another study that basically comes down to: Sucks to be female. Better luck next life!’, do we?”

Well, Laura - apparently we do.  Because those studies just keep on coming. Continue reading

Stress test vs flipping a coin: which is more accurate?

1 Mar

by Carolyn Thomas  @HeartSisters

You may not have any signs or symptoms of coronary artery disease while you are just sitting there quietly reading this post. In fact, your symptoms may occur only during exertion, as narrowed arteries struggle to carry enough blood to feed a heart muscle that’s screaming for oxygen under increased demand. Enter the diagnostic stress test, used to mimic the cardiac effects of exercise to assess your risk of coronary artery disease.

During stress testing, you exercise (walk/run on a treadmill or pedal a stationary bike) to make your heart work harder and beat faster.  An EKG (aka ECG) is recorded while you exercise to monitor any abnormal changes in your heart under stress, with or without the aid of chemicals to enhance this assessment.

So for doctors who like to order stress tests for their patients with possible heart issues, imagine their reaction to this blunt warning from Dr. David Newman:    Continue reading

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