Dr. Jennifer Co-Vu is a pediatric cardiologist at the University of Florida Congenital Heart Center. She recently shared on Twitter a chilling report of what happened when 911 was called to help her own mother-in-law who was experiencing crushing chest pain. The ambulance arrived quickly, but paramedics told this 65-year old woman with diabetes that she was having a panic attack.
Unlike other women who are misdiagnosed in mid-heart attack, however, this patient had immediate access to something few of us have: doctors in her family. ..
Worried that this scenario sounded far more serious than a panic attack, her husband called their son (Dr. Co-Vu’s husband, who is also a physician) and asked him to intervene.
At first, the paramedic insisted to the son that his mother was not having a heart attack. He also recommended anti-anxiety medication.
Dr. Co-Vu describes her husband’s role in this intervention with the paramedic as “begging nicely”, adding:
“I wouldn’t have been as nice, and would have asked the paramedic if he had already given her aspirin, and then told him that I’m going to start timing his response to ‘door to balloon’ time.”*
The paramedic was ultimately persuaded to change his mind, and decided to take the woman to Emergency after all, where her heart attack was correctly diagnosed and treated.
But as Dr. Co-Vu observed:
“The real reason for disproportionately poor cardiac outcomes in women is NOT how chest pain is described, but how women’s chest pain is perceived. We need to refocus education to include the front line.”
She also added this about her mother-in-law’s experience:
Good question, Dr. Co-Vu.
Do we really need to beg?
The disturbing answer is that we might need to beg if the person having alarming cardiac symptoms is a woman. See list of related published journal links below for specific examples…
As Dr. Co-Vu says, it seems “surprising” that any paramedic’s initial diagnosis of a person with known cardiac risk factors and Hollywood Heart Attack symptoms like crushing chest pain would be “panic attack“.
But I’ve heard far too many similar stories from my readers over the past decade to be surprised by almost anything anymore.
There was something else about this story that bothered me almost as much as the misdiagnosis: Dr. Co-Vu’s mother-in-law was taken to Emergency only because her son-the-doctor intervened on her behalf.
I shared this concern on Twitter with Dr. Co-Vu:
The implicit bias that Dr. Co-Vu is now personally acquainted with since her own family member’s alarming experience is alive and well in cardiology.
Researchers continue to report that female heart patients tend to be under-diagnosed (and worse, under-treated even when appropriately diagnosed compared to our male counterparts) in what’s become known as the cardiology gender gap. See also: Excuse me while I bang my head against this wall…
Our resulting poorer outcomes compared to men are often blamed on this implicit bias against women among medical professionals.
As you already know if you’ve read the disturbing results of many emerging studies that I’ve written about (here and here, for example), researchers who study this phenomenon compare how male heart patients are treated when compared to their female counterparts. See also: Cardiac gender bias: we need less TALK and more WALK
One of the most disturbing recent examples was a study published in 2018 in the journal, Women’s Health Issues.(1)
Researchers compared the pre-hospital care of both male and female heart patients over the age of 40 who had been transported to hospital after calling 911 for help.
It wasn’t only the study’s findings that women being transported to hospital were less likely than men to receive recommended treatments (including even the minimal basics such as aspirin or cardiac monitoring) that shocked me. That appalling reality has been reported by cardiac researchers so many times that’s it’s at risk of being considered tired old news by now (for example, Pope et al., 2000; Blomkalns et al., 2005; Jneid et al., 2008; Dey et al., 2009; Meizel et al., 2010; Balady et al., 2011; Poon et al., 2012; Koopman et al., 2013, etc. etc. etc.) See also: The Sad Reality of Women’s Heart Disease Hits Home
It’s also why we are often forced to conclude, in the wise words of Laura Haywood-Cory (who survived her own heart attack at age 40):
“Sucks to be female. Better luck next life!”
But the part of this study that seemed to cause the most excitement was this conclusion:
“When transporting female heart patients from the scene to the hospital, Emergency Medical Services (EMS) personnel were significantly less likely to use lights and sirens compared with male patients being transported.”
And as Dr. Co-Vu also determined in her Twitter exchange, the defense offered for women’s poor outcomes during a heart attack is often that women’s symptoms are “atypical”, thus easier to misdiagnose than in men. She now maintains that even clearly “typical” cardiac symptoms like the crushing chest pain suffered by her mother-in-law can be ignored by healthcare professionals due to this pervasive implicit bias against women.
Some of the same professionals may blame women’s poor cardiac outcomes on women themselves. Maybe, they suggest, our poor outcomes are due to women’s tendency to delay seeking emergency care, or because of the way we communicate our cardiac symptoms to physicians.
But instead of continuing to blame the female heart patient, why not expect the ones who are making decisions based on implicit bias against women to wake up?
Women should not need to have two physicians in the family in order to get appropriate care during a cardiac event.
Image of begging frog from Alexas/Pixabay
* Door-to-balloon (D2B) time: The time between the arrival at a hospital of a patient with an acute heart attack and the opening of that patient’s blocked coronary artery via balloon angioplasty (and usually a stent). The recommended D2B time is 90 minutes or less for best outcomes.
1. Lewis, Jannet F. et al. “Gender Differences in the Quality of EMS Care Nationwide for Chest Pain and Out-of-Hospital Cardiac Arrest.” Women’s Health Issues, December 10, 2018.
NOTE FROM CAROLYN:I wrote much more about identifying cardiac symptoms (even if you don’t have a doctor in the family) in Chapter 1 of my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local bookshop (my preference!) or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 20% off the list price).
Q: Have you or a loved one ever felt like you had to beg for appropriate emergency treatment?
- How can we get female heart patients past ER gatekeepers?
- Fewer lights/sirens when a woman heart patient is in the ambulance
- Excuse me while I bang my head against this wall…
- Same heart attack, same misdiagnosis – but one big difference
- Cardiac gender bias: we need less TALK and more WALK
- Unconscious bias: why women don’t get the same care men do
- Words matter when we describe our heart attack symptoms
- ‘Gaslighting’ – or, why women are just too darned emotional during their heart attacks
- The heart patient’s chronic lament: “Excuse me. I’m sorry. I don’t mean to be a bother”
- Heart attack misdiagnosis in women
- Those curious cardiac enzymes
- The sad reality of women’s heart health hits home
- Gender differences in heart attack treatment contribute to women’s higher death rates
- Heart disease – not just a man’s disease anymore