Tag Archives: Dr. Lisa Rosenbaum

Heart attack: is it a clogged pipe or a popped pimple?

10 Jan

by Carolyn Thomas      @HeartSisters

decisionsWhen my little sister Bev was booked to have her tonsils removed at age six, our family doctor declared that I must have mine out at the same time – not because there was anything at all wrong with them, but because I was already 12 years old and, for some inexplicable reason, I still had my tonsils intact!  (Back then, kids with tonsils were apparently an endangered species. As New York ear/nose/throat specialist Dr. Steven Park described the historical take on tonsils: “In the 50s to 70s, it was a given that if you had tonsils, they were removed.”)

On our designated procedure date, Bev and I were admitted to the pediatric ward at St. Catharines’ Hotel Dieu Hospital together.  I remember this experience vividly because the archaic rule at the Hotel Dieu back then was that all pediatric patients had to wear diapers overnight.  DIAPERS! As a humiliated almost-teenager, I pleaded with my mother to convince the ward nurses that I most certainly did NOT need to wear diapers at my mature age! But rules were rules, and I somehow managed to survive both an unwarranted surgical procedure and its associated diaper humiliation.

It turns out I wasn’t the only person questioning the wisdom of taking out a perfectly fine pair of tonsils based on flimsy if any medical evidence.  Decades later, many researchers – including in this U.K. study published in the journal Archives of Disease in Childhood (1) – blamed not only the physicians who recommended the routine surgical removal of tonsils (and often adenoid glands at the same time) to treat childhood sore throat, but also “parental enthusiasm” as the factors influencing an entire generation of higher-than-necessary rates of surgery.

“Despite the enthusiasm with which tonsillectomy is offered and sought, there is little evidence of efficacy.”

I like this tonsil analogy to illustrate how medical attitudes, no matter how pervasive, can indeed change over time as our physicians rethink the status quo in order to embrace evidence-based medicine.

In other words, just because we’ve been doing this for a long time, is there any evidence that it’s actually what needs to be done? 
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“I’m just not a pill person” – and other annoying excuses

26 Apr

drugs hands

by Carolyn Thomas    @HeartSisters

Dr. Lisa Rosenbaum writes in the New England Journal of Medicine about a friend who is worried about her father since two of his sisters have recently died following strokes.  She asks her friend:

“Is he on aspirin?”

“Oh, heavens, no,” the friend replies. “My parents are totally against taking any medications.”

“But why?”

“They don’t believe in them.”

Curious about what she calls this instinctive non-belief, a commonly observed reluctance to take the medications their physicians recommend (aka non-compliance or the slightly less patronizing non-adherence), Dr. Rosenbaum wanted to understand how patients feel about taking cardiac medications. The consequences of not taking one’s meds can be deadly, yet almost half of all heart patients are famously reluctant to do so.(1)   Dr. Rosenbaum, a cardiologist at Boston’s Brigham and Women’s Hospital, wondered: Are there emotional barriers? Where do they come from? Can we find better ways of increasing medication adherence if we understand these barriers?*

So she interviewed patients who’d had a myocardial infarction (heart attack), both at the time of the initial cardiac event, and again months later.  Their answers fell into five distinct themes that might be surprising to doctors feeling frustrated by their non-compliant patients. Continue reading