Before my heart attack, much of what I knew about CPR (cardiopulmonary resuscitation) was learned by watching TV medical dramas like Grey’s Anatomy. Researchers who study how television has impacted public opinion suggest that TV actors following their cardiac arrest scripts are heroically brought back to life by another TV actor pretending to perform CPR over 70 per cent of the time. (1) Pulse restored, smiles of relief all around, and the cheerful patient and family heading for home while waving in gratitude to the brilliant hospital life-savers.
Australian researcher Dr. Mary Dahm and I were emailing back and forth about her recently published study on diagnostic uncertainty in medicine (one of my favourite subjects, I might add – especially when it involves female heart patients). I mentioned to her that the Emergency physician who had misdiagnosed my heart attack as acid reflux seemed remarkably confident at the time – despite being remarkably wrong. That misplaced confidence is what researchers who study diagnostic error call unwarranted certainty – a contributing risk factor for misdiagnosis. But Dr. Dahm raised the issue of whether diagnosing is what Emergency physicians actually do:
Here in the Lotus Land that is Canada’s beautiful west coast, my total hospital bill after my heart attack was ZERO. The costs of my Emergency Department visits, all cardiac diagnostic tests/procedures/treatments, my hospital bed, physician/nursing care – plus all follow-up appointments with a cardiologist – are entirely funded by our provincial government health plan. Unlike so many of the American heart patients I’ve encountered since my own heart attack, I left the hospital without ever worrying how I was going to pay for my medical care.