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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

Living with both fibromyalgia and heart disease

5 Nov
by Carolyn Thomas     @HeartSisters

     Dr. Barbara Keddy

In her latest blog post, Dr. Barbara Keddy quotes my new book in this statement: Coping with a chronic illness is work” – an understatement coming from somebody like her.  She is a Professor Emerita at Dalhousie University in Halifax, a retired teacher of nurses, a respected author and blogger – but more importantly to this discussion, she has spent five decades living with fibromyalgia, and more recently, almost five years as a heart attack survivor. With her kind permission, I’m sharing her blog post here: part very personal essay, and part book review:

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How implicit bias in medicine hurts women and minorities

17 Sep

by Carolyn Thomas    @HeartSisters

It’s discouraging. I’ve read (and written) far too much about how the gender gap in cardiology has resulted in women heart patients being at higher risk of being both under-diagnosed compared to our male counterparts, and then under-treated even when we’re appropriately diagnosed (here, here and here, for example). Studies even suggest that when physicians review case studies in which patients present with significant cardiac symptoms as well as a recent emotionally upsetting event (identical except for the patients’ male or female names), the doctors are significantly more likely to determine that a man’s symptoms are heart-related, but a woman’s symptoms are just due to the emotional upset.(1)

But what’s been missing in this acknowledged gender gap seems to be the most important part: why is this happening, and what can we do to actually address it? Continue reading

A perfectly ordinary workday. Unless you’re the patient…

3 Sep

by Carolyn Thomas  ♥  @HeartSisters

I’ve lived on both sides of this scenario. For many years, my workplace was a hospital where I worked in public relations on the hospice palliative care unit. I’d arrive at the hospital for work early each morning and easily navigate the maze of hospital corridors leading up to my office. I’d chat happily over coffee with my nurse and physician colleagues arriving for shift change, and then unlock my office door to prepare for that day’s busy schedule. Showing up at the hospital became as routine for me as showing up for work had been during over three decades of my PR career in corporate, government and not-for-profit sectors in many other workplaces.

Yet on some level, I always knew that my familiar hospital workplace was anything but familiar to people out there who were making their way into that same hospital – but as patients.

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Thoughts on returning to work if you’re a heart patient

27 Aug

by Carolyn Thomas    @HeartSisters

A list of five Choosing Wisely recommendations from the field of occupational medicine caught my attention the other day. For those of you who have never had the pleasure of working with a real live occupational therapist, they are under-appreciated healthcare professionals who help recuperating patients develop, recover, and improve practical skills they need for daily living. The goal of the Choosing Wisely campaign is to basically help reduce waste in the healthcare system and avoid patient risks associated with unnecessary treatment. It’s all good. But the part of this occupational medicine list from Choosing Wisely Canada that stopped me in my tracks was the first recommendation on this list:
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