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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

Why we ignore serious symptoms

3 Feb

by Carolyn Thomas    @HeartSisters

Before my heart attack, I spent almost two decades as a distance runner. Many of the elite marathoners I knew (and certainly the one I happened to live with!) obsessed mercilessly on every detail of their last race, but not so much on the daily joys of running itself. It was the destination and not the journey that seemed to matter to so many of them, especially during race season.

The members of my own running group could never be accused of being elite runners. Our motto was: “No course too short, no pace too slow.”  But over those decades, whenever my group was in training for a specific road race looming on the calendar, I could watch myself being sucked into that seductive groupthink trap of running even when I was sick, running when I was injured, running because it’s Tuesday and Tuesdays meant hill work, running with an ankle or knee taped and hurting. Getting to a more important destination (the race) became bigger than paying attention to those less important messages (don’t run today).

In fact, I learned from other runners to deliberately mistrust whatever my lazy-ass self was trying to say.  I learned to ignore the messages my own body was sending me. Continue reading

When thyroid problems masquerade as heart disease

27 Jan

by Carolyn Thomas    @HeartSisters

I love a medical mystery that gets solved by a patient, don’t you? In May 2009, one of my regular readers – known to me and other readers here simply as JetGirl - experienced what she calls “classic heart attack symptoms” of very sudden onset, and sought help immediately at the Emergency Department of a Los Angeles hospital.  The 45-year old former airline pilot was released from hospital after a week’s stay in the Coronary Care Unit with a vague cardiac diagnosis of ischemia*.

Six months later, JetGirl once again experienced more cardiac symptoms including “massive chest pain” and shortness of breath.  This time, nothing was found.    Continue reading

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