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Fighting, battling, and beating: combat metaphors in medicine are just wrong

29 Nov

by Carolyn Thomas    @HeartSisters

Are you “battling” heart disease”? Have you “beaten” cancer? Are you “fighting” a chronic illness? These wartime references are metaphors as described by Dr. Jack Coulehan, a physician, an award-winning poet, and editor of the 5th edition of The Medical Interview: Mastering Skills for Clinical Practice, a best-selling textbook on the doctor-patient relationship.(1)  Dr. C explains that there are several basic metaphors used in medicine that to a large extent generate the vocabulary of doctor-patient communication – but can also unintentionally objectify and dehumanize the patient.

Here are three of the most prominent metaphors you’re likely to encounter in health care:  Continue reading

How Minimally Disruptive Medicine is happily disrupting health care

17 Oct

by Carolyn Thomas    @HeartSisters

I’ve been on an adventure recently to a magical, faraway place. It was my second visit to the world-famous Mayo Clinic in beautiful downtown Rochester, Minnesota. My first trip there was exactly seven years ago as a freshly-diagnosed heart attack survivor. I had applied (and was accepted) to attend the annual WomenHeart Science and Leadership Symposium for Women With Heart Disease at Mayo Clinic – the first Canadian ever invited to attend. This is a training program that arms its graduates with the knowledge, skills and (most of all) Mayo’s street cred to help us become community educators when we go back to our hometowns.

Thus, a circle that began with me sitting in a 2008 training audience was completed as I became one of the presenters onstage in front of an audience of cardiologists at a Mayo medical conference on women’s heart disease. (Thank you Drs. Hayes, Mulvagh and Gulati for your persistent invitations!)  But long before I took the stage last weekend, I’d been invited to come to Rochester a day earlier to meet with some pretty amazing Mayo staff. Continue reading

Which patients does the “patient voice” represent?

9 Aug

by Carolyn Thomas  ♥  @HeartSisters

There are patients. And then there are patients. 

Let’s consider, for example, two friends of about the same age, same height, same size, same socioeconomic demographic – each one (in an amazingly freakish coincidence) a survivor of a similarly severe heart attack, admitted to the same hospital on the same day. Let’s call these two made-up examples Patient A and Patient B.

Patient A is diagnosed promptly in mid-heart attack, treated appropriately, recovers well, suffers very little if any lasting heart muscle damage, completes a program of supervised cardiac rehabilitation, is surrounded by supportive family and friends, and is happily back at work and hosting Sunday dinners within a few short weeks of recuperation.

Patient B, on the other hand, experiences complications during her hospitalization, recuperation takes far longer than expected, repeat procedures are required, her cardiac symptoms worsen, she suffers longterm debilitating consequences, and is never able to return to work.

Yet despite these profound differences, physicians would still describe both of these women with the same all-inclusive descriptor, “myocardial infarction” (heart attack).  Continue reading

Kindness in health care: missing in action?

14 Jun

by Carolyn Thomas    @HeartSisters

I don’t remember much of what happened during that fateful visit to the Emergency Department.  I remember the on-call cardiologist saying something to me about my “significant heart disease”. After hearing those words, I felt so stunned that – although I could see his lips moving and could hear sounds coming out of his mouth – he may as well have been speaking Swahili.  (Doctors, please remember this in the future when delivering life-altering diagnoses to your patients!)

What I do vividly remember, however, is a small but profound act of kindness later that day when I was brought to my bed in the CCU (the cardiac intensive care unit). Continue reading

When you know more than your doctors about your diagnosis

31 May

by Carolyn Thomas   @HeartSisters

One of my blog readers needlessly suffered debilitating cardiac symptoms for a number of years before she was finally correctly diagnosed (thanks to a second opinion) with coronary microvascular disease (MVD). During those years, she’d read everything she could get her hands on in a desperate effort to solve this mystery. But when she asked her own physician if MVD might be the culprit, he dismissed this diagnostic possibility, adding that he “didn’t believe” in coronary microvascular disease.

Didn’t believe in it?!

Please note, darling readers, that we’re not talking about the Tooth Fairy here.

We’re talking about a woman living with a cardiac condition that’s been well-studied (as in, peer-reviewed studies done by respected heart researchers and published in actual real-life medical journals).

Continue reading

“I’m just not a pill person” – and other annoying excuses

26 Apr

drugs hands

by Carolyn Thomas    @HeartSisters

Dr. Lisa Rosenbaum writes in the New England Journal of Medicine about a friend who is worried about her father since two of his sisters have recently died following strokes.  She asks her friend:

“Is he on aspirin?”

“Oh, heavens, no,” the friend replies. “My parents are totally against taking any medications.”

“But why?”

“They don’t believe in them.”

Curious about what she calls this instinctive non-belief, a commonly observed reluctance to take the medications their physicians recommend (aka non-compliance or the slightly less patronizing non-adherence), Dr. Rosenbaum wanted to understand how patients feel about taking cardiac medications. The consequences of not taking one’s meds can be deadly, yet almost half of all heart patients are famously reluctant to do so.(1)   Dr. Rosenbaum, a cardiologist at Boston’s Brigham and Women’s Hospital, wondered: Are there emotional barriers? Where do they come from? Can we find better ways of increasing medication adherence if we understand these barriers?*

So she interviewed patients who’d had a myocardial infarction (heart attack), both at the time of the initial cardiac event, and again months later.  Their answers fell into five distinct themes that might be surprising to doctors feeling frustrated by their non-compliant patients. Continue reading


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