People make poor decisions about when to call their physicians when they are faced with new or worsening symptoms regardless of their level of education.  I came close to making a similar mistake about 8 years ago that could have cost me my life.

It was early in the Fall of 2003 when I started having symptoms of an aching pain in my left shoulder.  It would come and go, and I thought it was due to some sort of musculoskeletal strain of that shoulder or referred pain from a neck problem.  I started noticing it would occur when I was walking or doing other exercise.  My wife & I were on vacation, and during a round of golf I noticed it when I had to walk across the fairway to my ball.  Again, though in the back of my mind I thought it could be my heart, I denied that possibility.  I thought it was due to the fact I hadn’t swung a golf club in years.  What made me face the possibility of something more serious occurred about a week later.  When my wife & I were walking our dog on a Sunday evening it became clear that the pain was brought on by walking.  Adding to my concern and suspicions of something more ominous was an accompanying profound tiredness and shortness of breath relieved by rest.  I called my primary care physician the next morning.  He suggested I call a cardiologist since I would probably need a stress test or possibly a cardiac catheterization.  I immediately called one of the cardiologists I knew, and he scheduled a stress test for me the next day.

The next day I had the stress test with an accompanying echocardiogram.  The echocardiogram shows how the different portions of the heart are functioning under the stress of exercise.  As I was exercising that left shoulder discomfort began and persisted throughout the rest of the test.  My cardiologist was there the whole time and said the EKG (elctrocardiograph) portion of the test looked good, but he had some questions about what the echocardiogram was showing.  He was going to speak with one of his partners about it.  He wanted me to get dressed and would see me in the exam room.  I changed back to street clothes, and went to an exam room.  There the nurse checked my blood pressure and found it to be a bit low, so she had me lay down.  My doctor soon came in and said he wanted to do a cardiac catheterization that day to determine why one of the walls of the heart was not moving normally.  (When your coronary arteries are blocked, certain areas of the heart wall don’t get enough oxygen-carrying blood and will move abnormally.)  Of course I agreed, but wanted him tell my wife, Mary.  She soon joined us, and as he started to tell her, everything went black and I had a cardiac arrest.

They made three attempts at electrical defibrillation before finally bringing me back with the fourth. The first thing I remember is a nurse lifting the oxygen mask from my face and asking, “Are you back with us?”  I guess I still had my sense of humor because I replied, “I didn’t know I had left.”  Everyone was relieved and all the staff involved with my resuscitation laughed.  Mary, who was waiting in the hall, heard the laughter and started to breathe a little easier.

My point in relating my experience was to show how even a doctor who deals with these signs and symptoms every day with his patients can be in denial about his own situation. If not for my finally facing my symptoms objectively and the good fortune of having the cardiac arrest in the absolutely best place, I probably would not be writing these words.  It’s better to be overly cautious about new or worsening symptoms.  Let your doctor assess them, because they can deteriorate in an instant.

In future posts I’ll share more of my experiences with the health care system.   I’ll talk about surviving two hospitalizations and making lifestyle changes to prevent another heart attack.  In the next one I’ll give some pointers about how to handle new and worsening symptoms.

For Your Health – Dr. Bob

I truly believe that a lot of smart people don’t understand and don’t apply some basic concepts about wellness, illness, treatments, the roles of the members of the health care team and how to interact with these pieces.  Throw into the mix the varying levels of coverage health insurers provide and the rules they have in place, and it’s no wonder many people are confused about what to do when they face a medical situation in their lives.

This gap in health care literacy is costly in terms of people’s health and additional cost to the system when they make choices that are ill-informed from the viewpoint of basic health principles.  Some may make a distinction between health literacy and health care literacy.  Health Literacy would be defined as the knowledge of wellness, illness, managing one’s acute and chronic conditions and responding medically appropriately when things change with one’s health.  Health Care Literacy might be defined as the knowledge of how to use the health care system, including where to get care when necessary and efficiently and effectively using your health care insurance benefits.  For simplicity, I’ll use Health Care Literacy in this blog to include both of these concepts since they are closely related.

So what are we talking about here?  In a recent (March 1, 2011) Washington Post article, Sandra G. Boodman from Kaiser Health News, cited several examples of low levels of health literacy, such as, misunderstandings of discharge instructions leading to the development of life-threatening infections, or individuals not using prescribed medications properly because they don’t understand the directions.  I would add to this list instances where people misjudge the severity of their symptoms and wait too long to contact their physician.  The delay often allows their condition to deteriorate further so that when they do seek care, the physician is forced to send them to the emergency room or admit them to the hospital.  Antibiotics that could have been taken by mouth if begun earlier must now be taken intravenously, often in the hospital with added risk of complications, poorer outcomes and higher cost.  I have personally heard about examples of this happening many times.  And these incidents add up.  Boodman references a 2007 study that estimated the cost of this problem to the US economy could be as much as $238 billion annually.   This problem is widespread as demonstrated by a 2006 survey published by the U.S. Department of Education which found that only 1 in 8 adults has the skills to deal with complex health material.

I plan to publish posts to help improve a person’s health care literacy.  They’ll talk about some basic approaches a savvy health care consumer can take to optimize their health, minimize the impact of illness and save money.  I welcome comments about this post as well as suggestions about related topics of interest to help guide the discussion.

Regards,

Dr. Bob