When I was sent home from the Emergency Department with a misdiagnosis of acid reflux, I felt horribly embarrassed that I’d made such a fuss over nothing (well, nothing but textbook heart attack symptoms like chest pain, nausea, sweating and pain radiating down my left arm). It then took me two full weeks of increasingly debilitating cardiac symptoms before I forced myself to return to that same hospital, desperately ill yet still not completely certain this could be heart-related. After all, hadn’t an Emergency physician with the letters M.D. after his name told me quite emphatically:
“This is NOT your heart!”
It was only when my symptoms became truly unbearable that I knew I had to go back to the E.R. This extreme reluctance to get help is what doctors call “treatment-seeking delay“ behaviour, and in the middle of a heart attack, it can be a deadly delay. We already know that the average person in mid-heart attack will wait four hours before getting medical help. Why? One reason may well be that we’re too simply too embarrassed to attract attention to ourselves during a heart attack.
I wanted to share with you this email conversation, with their permission, between two health care professionals. One is an American, Dr. Angelo Alonzo, director of the Yale Heart Study; the other is Len Gould, an Australian psychologist who runs a cardiac rehabilitation program for heart patients – and more importantly, is a heart patient himself who has undergone bypass surgery.
Their topic: people who are too embarrassed to seek emergency medical help even when experiencing heart attack symptoms.
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Sent: January 25, 2012 8:59 PM
From: Len Gould To: Angelo Alonzo cc: Carolyn Thomas
Subject: Yale heart study
“I found a reference to your work on the Heart Sisters website run by Carolyn Thomas. She also provides a link to your Yale heart study. I keep in touch with Carolyn as I am interested in her work and admire her greatly. Since I am referring to her site, I am copying this correspondence to her.
“I am a psychologist who runs a cardiac rehabilitation workshop for heart patients. Being a heart patient myself, I took up this work after my bypass 16 years and five months ago – hey, who’s counting? 🙂
“Only last night, I was running a session where a group member told me that he had not called the ambulance because he had been “embarrassed”. He did not want to be embarrassed in front of his workmates!
“We may consider this odd, but I have been in a similar situation, and so too have many of my audiences over the years.
“It is not only the patients who need re-education, as many partners or friends often make fun of people who call for help when it is finally determined that the symptoms were not heart-related.
“For example, a colleague of mine recently had chest pains and went to the local emergency ward (as he should). However, a number of people have since told this story as “Bill’s little attention-seeking episode”. Naturally, this will impact any future decisions he makes as to
whether to be checked out or not.
“Getting the balance right between identifying symptoms as heart-related and calling for help, versus doing nothing on the assumption that they are not heart-related, is a very perplexing situation that many heart patients find themselves in. I often say:
“Before a heart event, every chest pain is indigestion; after a heart event, every chest pain is a major heart attack approaching.”
“Sadly, it is almost impossible to know the difference.”
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Sent: January 26, 2012 10:30 PM
From: Angelo Alonzo To: Len Gould cc: Carolyn Thomas
Subject: Yale heart study
“After Carolyn posted about the Yale Heart Study on Heart Sisters, we had a very nice spike in participation, for which we are indeed grateful.
“All of the experiences, responses and feelings you note are definitely part of my own experience too after 40 years of working on cardiac care-seeking delay. Embarrassment is certainly a large element of the equation, and it repeats itself in each study I have conducted as well as in the delay literature.
“Finding that balance between the “worried well and the walking sick” is very difficult; almost everyone I have interviewed has struggled with balance while fearing embarrassment and, as you point out, other pejorative labels.”
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Here’s how cardiologists at Cleveland Clinic explain why timing is everything when it comes to being too embarrassed to seek immediate medical care for heart attack symptoms:
“When an acute myocardial infarction (heart attack) occurs, there is a limited amount of time before significant and long-lasting damage is done to the muscle of your heart.
“If a large area of the heart is injured during the heart attack, full recovery becomes much more difficult. To obtain the greatest benefits of emergency care, anyone who thinks they are having a heart attack should get to the hospital within one hour of the onset of symptoms. The sooner you get to the E.R, the sooner the appropriate treatment can begin, meaning the lesser the chances of permanent damage.
“Sadly, only one in five patients actually gets to the hospital within this time frame. Therefore, many people who survive the MI are unnecessarily left with large portions of the heart scarred by the heart attack. This decreases the heart’s ability to pump blood effectively.
“Such patients may experience lifelong problems such as shortness of breath and angina (chest discomfort). Patients are also at an increased risk of developing heart failure, in which the heart weakens progressively over time.”
Their best advice about whether or not you should call an ambulance for immediate help when experiencing cardiac symptoms?
“Don’t be embarrassed to death!”
NOTE FROM CAROLYN: I wrote much more about many kinds of treatment-seeking delay behaviours – like being too embarrassed to call 911 – during a heart attack in my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the JHUP code HTWN to save 20% off the list price).