Monday, December 29, 2008

On Young Women, Heart Attacks and Denial

I read this article that appears in the Chicago Tribune today about a 27 year-old woman who reportedly had a "heart attack." I'm not sure what the point of the story really was - perhaps to wake up young women that heart attacks can occur in their demographic - and if so, well, fine.

But there is another, more sinister tone in the article: one that doctors should not be trusted and are mostly interpersonal buffoons. Nowhere is there a thoughtful discussion about the potential causes of why a young woman might have a heart attack, like spontaneous coronary dissection, paradoxical embolis, congenital coronary anomalies or familial hyperlipidemias. Nowhere do we hear from the doctors who interacted with this patient. No, that would require some thought and journalistic background analysis.

Instead we are greeted, once again, to only the patient's perspective: "If your doctor won't listen, fire him and find one who will."

To that, I say, remember the case of Hank Gathers - a young basketball star with exercise-induced ventricular tachycardia and hypertrophic cardiomyopathy who was presribed beta blockers and advised not to play competetive sports. But he didn't like what the first doctors had to say to him. Instead, he "fired" his doctors and shopped around for another doctor who "listened" to him.

The rest, as they say, is history: Hank Gathers ultimately died of sudden cardiac arrest playing the game he loved.

Sometimes, doctors don't listen, that is true. Overburdened by higher patient volumes, more documentation requirements, and reduced compensation models in health care today, doctors are pressed like never before to do more with less time. Listening to patients sometimes takes a back seat to these demands. But patients, too, increasingly expect that they know what's best for them - after all they read it on the internet - and don't hear what their doctor says, or they ignore their advice completely.

Believe it or not, sometimes patients need to realize they have a role in their health care, too.

Even when the advice isn't what they want to hear.


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