Heart Of The Matter: Treating The Disease Instead Of The Person

Heart Of The Matter: Treating The Disease Instead Of The Person

June 25, 201411:05 AM ET
Maria Fabrizio for NPR

Maria Fabrizio for NPR

A 56-year-old man is having lunch with his wife at a seafood restaurant just outside Boston when he develops crushing chest pain. He refuses an ambulance, so the man’s wife drives him to the ER.

What happens next says a lot about the difference that being a doctor or a patient can make in how one feels about the health care system.

First, how did the patient and his wife see the trip to the hospital?

When the man arrives in the ER, he is told to take off his shirt. He lies in the hallway, in pain, naked from the waist up. Strangers surround him. They don’t introduce themselves, and they talk over him, at each other.

Pagers ring and there’s a lot of beeping. Someone else must be really sick, he thinks; that must be why no one is paying attention.

After a few minutes, he signs some forms and finds himself being wheeled into an elevator. Masked figures enter. He feels a cool liquid flowing into his veins. The lights go out.

He wakes up hooked up to machines, uncertain what has happened. It takes several hours for the staff to find his wife, who is still waiting in the ER lobby and has no idea why her husband is in intensive care.

They are both surprised when they find out, two days later, that he’s had a heart attack. As soon as they get home, they file a complaint with the hospital about their terrible experience.

Now, how did the staff at the hospital see it?

A triage nurse greets the patient immediately upon his arrival and finds out that he has chest pain. Within three minutes, he gets an electrocardiogram that shows he is having a heart attack. The ER doctor activates the special heart attack pager, which immediately summons the emergency cardiology team.

The doctors and nurses arrive and bring the patient up to the catheterization suite. There, the attending cardiologist threads a catheter through an artery in his groin and pushes it all the way to his heart, where the doctor sees on an X-ray machine that a vessel is blocked. She inflates a small balloon in the catheter, opening the artery and restoring the flow of blood to the man’s heart.

All told, it took only 22 minutes from the time the man entered the hospital for the cardiology team to clear the blockage. The cardiology team is proud that they beat the national averagefor what they call door-to-balloon time by 42 minutes. The faster a blockage can be cleared, the better the odds are for a full recovery.

The patient gets well without complications. Two weeks later, he’s back at work and exercising again. The ER and cardiology teams consider the man’s case a resounding success.

Why then are there such different views of the same ER visit? Who’s right? The doctors who believe they delivered exemplary care, or the patient and his wife who feel he was treated badly?

As an emergency physician and advocate for my patients, I frequently hear clashing stories like these. When I review the cases, I find that the doctors and nurses are often surprised by the patient’s complaint because they did everything by the book and made no medical mistakes.

Indeed, in this case, every measure of sound medical care was met: prompt diagnosis, speedy and effective treatment and an uneventful, full recovery.

The objective measures that health care workers focus on are necessary, but they’re not enough by themselves. Every provider in this man’s case had good intentions and was working hard to respond to the medical emergency. But in their rush to open the blocked heart artery, they treated him as a disease to be cured, not a person to be cared for.

Would it have alleviated the patient’s anxiety for the doctors and nurses to introduce themselves, and to ask if he wanted his wife by his side? Would it have helped to assure him that all the activity was happening around him because everyone was trying to take care of him?

I think those simple courtesies would have made a difference.

These instructions aren’t on typical checklists for treatment of heart attack, yet they are part of caring for people as human beings. In modern medicine, we are fortunate to have incredible high-tech options available, but we must not forget the low-tech approaches that can improve communication and quality of care.

Patients and family members can also speak up when they are confused and scared. It’s possible that doctors explained what was happening, but not clearly enough.

What if the patient said he didn’t understand what was going on? What problems could have been avoided if the patient and his wife didn’t wait until after he was discharged to raise their concerns?

The two viewpoints of this ER visit end with one thing in common. Just as the providers were surprised by the patient’s complaint, the patient and his wife were taken aback when the team that I was part of presented them with their doctors’ point of view.

“We had no idea they were trying so hard,” the man said. “It’s too bad we didn’t know that at the time.”

Wen is an attending physician and director of patient-centered care research in the Department of Emergency Medicine at George Washington University. She is the author of“When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Care,” and founder of Who’s My Doctor, a project to encourage transparency in medicine.

Source:  http://www.npr.org/blogs/health/2014/06/25/324005981/heart-of-the-matter-treating-the-disease-instead-of-the-person?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=20140625

Know your devices medical alarm options!

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UnknownThere are a number of medical alarm options out there that target the elderly and disabled population. You should know that there are also devices that do not go directly to a monitoring center and instead directly dial 911. These are typically cellular and VoIP systems.

With cellular systems, they are not directly tied to a specific address because they are mobile and can go anywhere. This means you would have to rely on either the person using the device to know exactly where they are OR the phone giving 100% accurate GPS coordinates. This can be an issue in rural areas due to poor cellular service, and also in heavily populated areas such as an apartment complex or high rise building. Current technology only provides latitude and longitude without altitude.

If you use a device that is monitored by an alarm company they should preemptively solicit valuable information from you that would be available to pass to the 911 dispatcher should the need arise. This will allow responders to have a better location and nature of the incident if the patient is unable to talk or can’t be heard for any reasons.

Understand how your device works and make sure that they will be able to provide help when you need it most. The worst time to find out if your device will get you help is the moment when you need the help. A few questions and a little research can help in making the right decision.

Source credit: Grand Traverse 911

 

Chest Pain isn’t always from the heart

Causes of chest pain

Frequently people consult about experiencing chest pain. I know through training all chest pain is supposed to be referred to the emergency room for evaluation, but realistically many including myself am able recognize symptoms come from many different causes and may have different care needs. The emergency need for consultation is due the fact that many people will deny their symptoms are from a cardiac cause, delaying treatment and thus have pretty extensive heart damage or death. Evaluation thus is helpful in determining the cause.   When one gets evaluated there are many different areas of anatomy where the cause may be from.

 

Here is a list of many different causes for chest pain:

  • the chest wall including the ribs, the muscles, and the skin;

Possibilities: A rib in poor alignment, shingles, pulled muscle, cartilage between the ribs being inflamed,

  • the back including the spine, the nerves, and the back muscles;

Vertebra alignment, pinched nerve, shingles,

  • the lung, the pleura (the lining of the lung), or the trachea;

Recent cold/cough, bronchitis, blood clot, pulmonary embolism, pleurisy, pnumothorax – collapsed lung,

  • the heart including the pericardium (the sac that surrounds the heart);

Pericarditis, aortic dissection, angina, heart attack, blood clot

  • the aorta; aortic dissection
  • the esophagus;  Acid reflux, narrowed esophagus, regurgitation
  • the diaphragm, the flat muscle that separates the chest and abdominal cavities; 
  • referred pain from the abdominal cavity including organs like the stomach, gallbladder, and pancreas, as well as irritation from the underside of the diaphragm due to infection, bleeding or other types of fluid.

Gastric bleeding, septicemia, blood infections, gastric ulcers,

 

The symptoms of heart attack  for men or women.

Heart-Attack

 

references:

http://www.medicinenet.com/chest_pain/article.htm#what_are_the_sources_of_chest_pain

Congestive Heart Failure Patients finally Get Cardiac Rehabilitation

Congestive Heart Failure Patients finally Get Cardiac Rehabilitation

This is great news. I worked for many years petitioning our Congress and Senate to urge CMS to cover Cardiac Rehabilitation services for Congestive Heart Failure patients. There is a large subset of patients who can be much better served and monitored through cardiac rehabilitation to prevent readmissions. Congratulations to the AACVPR for helping attain this coverage from CMS, that is a very big deal.

 

 

 

WASHINGTON — Medicare has proposed covering cardiac rehabilitation services for patients with chronic heart failure 4 years after saying there was little evidence to support doing so.

The proposed coverage decision would expand access to rehab for a wider range of heart patients. Medicare currently covers rehab only for patients who have had an acute MI in the preceding year, coronary artery bypass surgery, heart or heart-lung transplant, or other major events.

The Centers for Medicare and Medicaid Services (CMS) came to the determination after reviewing literature on the rehab service from 2006 to August 2013. It announced the decision online late last week.

“Since chronic heart failure often results from coronary artery disease and hypertension, evidence on behavioral interventions in the treatment of these conditions provide additional supportive evidence,” the agency wrote. “With the accumulated evidence that supports the benefits of the individual components of cardiac rehabilitation programs, the evidence is sufficient to determine that participation in these multi-component programs improves health outcomes for Medicare beneficiaries with chronic heart failure.”

The agency is seeking public comments on the proposed decision and will post a final determination later.

Under the proposal, the agency would pay for rehab services — exercise, behavioral risk factor reduction, health education, and personal counseling — for patients with left ventricular ejection fraction of 35% or less and New York Heart Association class II to IV symptoms with at least 6 weeks of heart failure therapy.

The American Heart Association praised the CMS announcement.

“We are gratified that the agency recognized the evidence that pointed to the need for this expansion, and look forward to the day when this coverage will enable millions of heart failure patients to reap the benefits of cardiac rehabilitation,” AHA President Mariell Jessup, MD, said in a statement.

The AHA, along with the American College of Cardiology, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Heart Failure Society of America had asked CMS to consider adding CHF for coverage of cardiac rehab.

The CMS decision follows a study of nearly 2,300 patients that showed that aerobic exercise is safe for heart failure patients and effectively improves clinical outcomes. The patient population CMS is including is effectively the same as that in the trial, Ileana Pina, MD, professor at Albert Einstein College of Medicine in the Bronx, N.Y., told MedPage Today in a phone interview.

“Even though we knew all the good things exercise can do, a lot of physicians were not recommending it because the patients would have to pay out of pocket to go to a cardiac rehab program,” Pina, vice chair of the clinical cardiology council at the AHA, said.

She said many patients without this rehab option end up going to skilled nursing facilities because of their condition.

Roughly 17% of those age 65 and older have heart failure, according to CMS.

Tweak you Week! Make your day HARDER!

This is too good not to share. I found this posted by Carolyn Thomas on  http://myheartsisters.org/  She is a wonderful advocate on women and heart disease. This is a 4 minute video on a movement to “Make your day HARDER” due to our generation of sitting. I think of my children as I watch this, are we subjecting are youth to heart disease? We have better knowledge of the effects of smoking and have worked hard to improve diet, however they spend the majority of their youth sitting. Sure they are involved in sports but the vast percentage of the time our children sit. How do we go about changing this to ensure they have a  healthy future?

http://www.youtube.com/watch?v=whPuRLil4c0

http://www.youtube.com/watch?v=whPuRLil4c0

 

 

Delay in seeking medical attention for heart attack changes life

Don’t delay in seeking medical attention if you are concerned about a heart attack

Time is muscle if the heart is not getting the proper blood flow to the muscle, the muscle dies. The muscle is unable to repair itself and eventually that portion that dies is converted to scar tissue. Scar tissue is not flexible and doesn’t push the blood out of the chamber of the heart. If the blood is not pushed through the heart the amount circulating through the body is reduced. This can lead to serious heart related complications, including congestive heart failure, angina, shortness of breath and limited ability for physical activity.  This creates complications for many things including returning to work, or causing early retirement as the article above discusses.

Discomfort, squeezing, pressure, heaviness, aching…in the chest, between the shoulder blades, the neck, jaw or down the arms are the classic symptoms. If accompanied  by shortness of breath, nausea, profuse sweating the condition is all the more urgent. Chew up 325mg aspirin and call 911.