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Post-hospital syndrome, revisited

22 Apr

by Carolyn Thomas     @HeartSisters      April 22, 2018

What does jet lag have in common with being discharged home following a hospital stay? After Yale cardiologist Dr. Harlan Krumholz returned from an overseas trip suffering from a particularly bad case of jet lag, he described the similarities like this:

“People were talking to me, but I couldn’t concentrate. I was a little clumsy. I could have fallen. I realized that I felt just like my hospital patients do when they go home.”

He recognized that many hospital stays can actually confer jet lag-type disabilities. In his article published in the New England Journal of Medicine, Dr. Krumholz dubbed this post-hospital discharge distress post-hospital syndrome. (1)
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What I wish I’d known before my hospital discharge

8 Apr

by Carolyn Thomas     @HeartSisters      April 8, 2018

I was feeling dead chuffed (as my UK friends would say) to be published again in the British Medical Journal (BMJ) recently.(1)  As part of their What Your Patient Is Thinking series, my guest essay includes what I now wish I’d known before being sent home from the Cardiac Care Unit following my heart attack diagnosis and treatment.  

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Same heart attack, same misdiagnosis – but one big difference

4 Feb

by Carolyn Thomas  ♥  @HeartSisters   February 4, 2018

Our two stories are freakishly the same in so many ways:

In 58-year old Nancy Bradley’s story, she went to the Emergency Department at the Royal Inland Hospital near her home in Kamloops as soon as she felt alarming symptoms she knew might be heart-related: dizziness, sweating, shortness of breath and “an elephant sitting on my chest” feeling. (In my story, I was 58 as well, and I went to Emergency at the Royal Jubilee Hospital near my home in Victoria as soon as my own alarming heart attack symptoms started).

All of Nancy’s cardiac diagnostic tests seemed to be “normal”. (All of my diagnostic tests seemed to be “normal”, too).

Nancy’s Emergency physician suspected heartburn, and suggested she take antacid drugs. (My Emergency physician suspected heartburn, and suggested that I take antacids).  Continue reading

The Physician’s Pledge gets some bold new wording

14 Jan

by Carolyn Thomas      @HeartSisters

Fanfare, please. The World Medical Association has released a revised version of what’s known as The Physician’s Pledge (1) as outlined in the Journal of the American Medical Association (JAMA). It’s described as “the contemporary successor to the 2,500-year-old Hippocratic Oath”. And although only about 11% of medical schools still use the ancient “do no harm” Hippocratic version, oath-taking is still an important part of most med school training.(2)

But if you’re a patient instead of a physician, there are some surprises in this revised WMA document just for you. Continue reading

When “nudging” doesn’t work to change patient behaviour

12 Nov

by Carolyn Thomas     @HeartSisters

CAROLYN’S WARNING: this article contains a C-word that drives many chronically ill patients stark raving bonkers. Continue reading only if you can stomach the word “COMPLIANT”

Dr. Aaron E. Carroll wrote a compelling essay in the New York Times recently. (By the way, I’ve often wondered why so many people – mostly men, I’ve observed – insist on formally using a middle initial? Is it to differentiate them from all of the other Dr. Aaron Carrolls out there?)*

Dr. Aaron E. Carroll’s subject has intrigued me ever since 2008 when I was told in the CCU that, from now on, I needed to take this fistful of new cardiac meds – many of them every day for the rest of my natural life. And pesky patients who, for whatever reason, do not follow doctors’ orders represent a perennial frustration in medicine. Sometimes the consequences of not being “compliant” (or “adherent”, the slightly less patronizing term) are brutal, so this decision not to can be deadly serious, accounting for two-thirds of medication-related hospital admissions. And more to the point, it begs the question of how to convince people to do what the doctor says they must (or, as some people – but not me – like to call it: “how to make non-compliant patients compliant”). Continue reading