Is the practice of medicine making doctors sick?

by Carolyn Thomas   @HeartSisters   

Sue Robins of Vancouver has an irresistible writing talent that’s somehow both quietly approachable and yet sneakily explosive. We see this talent in her book A Bird’s Eye View: Stories of  a Life Lived in Health Care. We also see it in her compelling blog essay, “We Are All In This Together” as she explores the “basic lack of humanity that ails health care – a lack of humanity for patients, families, staff, clinicians, physicians and administrators.”  As Sue says:

“We are all in this mess together.    .     . Continue reading “Is the practice of medicine making doctors sick?”

“The doctors want my symptoms but not my stories”

by Carolyn Thomas     @HeartSisters

Marilyn Gardner, in her 2014 book called “Between Worlds: Essays on Culture and Belonging“) wrote about a compelling conversation she once had:

Yet our physicians aren’t trained to embrace our stories, but instead to ask right away, “What brings you here today?” to kick-start a brief Q&A that can most efficiently solve the diagnostic mystery sitting across from them.      .     .    Continue reading ““The doctors want my symptoms but not my stories””

Dear Carolyn: “People can change for the better”

by Carolyn Thomas    @HeartSisters    October 28, 2018

We know now that childhood trauma is strongly associated with chronic illness later on, including heart disease. As I wrote in a recent blog post about ACE (Adverse Childhood Experiences), researchers warn us that scoring 4 or higher on the ACE test can predict a significantly higher risk of physical or mental illness as an adult. I was stunned when I took the test and saw that my own score was 4; I was well aware of my childhood experiences, of course, but I thought that only marginalized kids from desperately poor families were at high risk – and that wasn’t me! A history of psychological childhood abuse or neglect is not what we expect our doctors to ask us about – but this research suggests that maybe they should start.

.
One response to that post really hit home for me. Marie (who prefers not to use her real name here) lives with a type of ischemic heart disease called coronary microvascular disease (as I do, too). With her kind permission, I’m sharing her childhood story with you as the latest guest post in my regular but very occasional series called Dear Carolyn“:

Six ways NOT to motivate patients to change

by Carolyn Thomas  @HeartSisters  July 15, 2018

In classic scientific understatement, U.K. researchers Drs. Michael Kelly and Mary Barker observed that “most efforts to change health behaviours have had limited success.”(1)

No kidding. Right now, even as you read this, academic researchers all over the globe are applying for (and getting) grant funding to embark on yet another new study examining smokers who don’t quit, couch potatoes who don’t get off the couch, or overweight people who don’t lose weight. I can’t be 100% certain, of course, but I’m betting my next squirt of nitro spray that these studies will no doubt conclude that, yes indeed, those people do need to change their behaviour, and “further study is required”. Continue reading “Six ways NOT to motivate patients to change”

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

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

First, there was compliance. Then, adherence. Now, concordance!

by Carolyn Thomas     @HeartSisters

Non-compliant patients who, for whatever reason, do not follow doctors’ orders are a pain in the neck to their physicians. But to me, the most problematic part of that statement is the use of the word non-compliant. Simon Davies of the U.K.’s Teenage Cancer Trust once described it as “a word that sounds like it has punishment at the end of it.”  Yet physicians are frustrated about why so many of us still refuse to take their expert medical advice. Continue reading “First, there was compliance. Then, adherence. Now, concordance!”