Insured 50-year old man goes to the hospital with chest pains

[Horse with no Name]

Gets full cardiac workup and most likely admitted.
Insured 50-year old woman goes to the hospital with chest pains...gets Zantac and gets sent home.
This happened Friday to one of the clerks at a local business.
Her funeral was today. May she rest in peace.

[Pab Sungenis]

1. Universal insurance isn't the only problem.

It's also a question of training and who gets what care.

[Dorian Gray]

92. There are studies done on this....

It has nothing to do with insurance, but with preconceived prejudices doctors have about women and men seeking healthcare. It's really tragic that something like this could happen, as well. Especially since I think most women I know are pretty hard nosed and would only go to the emergency room if it were a real emergency.

[appal_jack]

117. True 'dat

A (female) friend of my sister's was visiting once, and began complaining of severe abdominal pains. We took her to the ER, and a doctor (thankfully) began running tests, and also gave a painkiller (can't remember which, but some sort of opiate). When the painkiller did NOTHING to reduce her discomfort, he began asking questions about her drug use, and basically implied that she was a smack-addict if she was still feeling pain. Well, a scan or two later, it turned out that some internal organs had gotten tangled (sorry for lack of detail: it was >5 years ago, and I'm no MD, and she was more my sister's friend than mine, so I didn't pay as much attention as I could have) to the point that circulation was being cut-off and tissue-death was impending (hence the pain that one dose of opiates would not suppress). Fortunately, there were more doctors on-duty than just the errant-drug-warrior, so the friend got the painkillers and then shortly thereafter the surgery that she needed. She came through it OK, thankfully.

But what an awful thing to be in the midst of a painful crisis and have some doc with misplaced priorities accusing you baselessly. :mad: To me, this reflected more a bias against youth than gender, but there were definitely elements of sexism in that doctor's conduct as well.

-app

[xultar]

2. Same thing happens with minorities. Makes me wonder if this place is really ready

for a woman or a black president.

We have institutional sexism and racism. That shit don't change overnight.

[Horse with no Name]

6. She was black.

She was a black, middle-aged, slightly overweight woman with a history of high blood pressure.
Heart Disease is the #1 killer of women.
You would have thought her risk factors would have at least scored her an EKG or some lab work :(.

[xultar]

9. Nope. I've read many articles on the lack of equal healthcare for women and minorities.

It is basic shit like that occuring every day that makes me wonder about this fucking place.

[kikiek]

16. Has it been determined there were no tests? That would be my 1st question.

There are problems with ER's downplaying cardiac symptoms in women. It is difficult to understand why the ER doesn't do its part. The campaign to women to not ignore the symptoms has been widespread and ongoing. What good is it if the MD's ignore them? I was trying to reserve judgment until I heard if any tests were run though.

[Horse with no Name]

20. Yes. We know her family.

They said "no tests were done. She was given a prescription and sent home". They still had the prescription because she died before she could have it filled.

[kikiek]

26. No excuse for that lack of treatment. I am very sorry to hear about this. We have such a long

way to go. I would say I hope they sue the hell out of them, but at this point that has no meaning. Money won't replace her. My deep condolences.

[liberalhistorian]

69. I may be white, but as a woman, I can personally attest to the

fact that women are often not taken as seriously as men when it comes to medical treatment. I'm not sure if it's unconcern and uncaring, or deeply entrenched sociocultural gender perceptions and stereotyping, or a combination of both. Women are often seen as more dramatic, more prone to hype and hysteria, etc.; just pat them on the head and send them off to bed with a pill permit and a glass of water and they'll be just fine. This used to especially be the case among gynecologists, before women became OB-GYN's in large numbers and women now prefer female GYN's, so that most men don't enter that specialty anymore (thank God-no offense, guys, but it really is preferable to have a woman as your gynecologist).

This is, unfortunately, especially true when it comes to the fact that women often will manifest different symptoms than men in many common health problems, especially heart attacks and heart disease. Yet, male symptoms are often the only ones considered and if she doesn't have them, well, tough luck, she's just a hypochondriac. I've personally both witnessed and experienced such differences in attitude among the health care profession. I think it's even worse with minority women, sad to say.

[kikiek]

79. I agree. And despite the information that women have just about caught up to men

when it comes to earlier onset of cardiac or vascular diseases. Mind boggling that the medical professional will not heed their own warnings.

[raccoon]

81. Especially if it's something you can't SEE. nt

[Book Lover]

116. I have to speak up as a woman who received excellent care

About ten years ago I was having awful, debilitating stomach/chest pain. My husband drove me to the ER and I was admitted. First thing they did was a X-ray, then a blood workup. Kept me there for over an hour until they determined I was not having a heart attack.

And for what it's worth, I prefer having a male OB/GYN. For me, I prefer my gynecologist to have dispassionate critical distance as opposed to someone who might say to herself, "Oh, what the hell is with this one? I had *insert whatever here* and I turned out just fine."

[sentelle]

90. i read somewhere...

Within the last two years that reaserchers discovered the nasty little secret about women and heart disease. This is due to the nature of the plaques that women get, which are more even and interrupt the blood stream than the plaques in men. Because of this, EKG's are less likely to see heart disease in women than in men.

[Midlodemocrat]

91. No kidding. That is really appalling.

When my husband was in 'step-down' after his bypass, there were two 20 something African American women who had just had bypasses as well. Truly frightening. The hospital you're referring to really dropped the ball.

[notadmblnd]

41. Same thing happened to my husband and he had insurance

he collapsed at work. They took him to the hospital and they told him it was gas. he was sent back to work. Luckily for him at the time he didn't listen, he came home and went to a cardiologist. He was immediately admitted to the hospital for triple bypass. Not listing to the quack in the ER is what gave him the 12 extra years he had.

on edit: BTW he was black

[live love laugh]

57. OMG. He collapsed and they diagnosed gas???!!! You should've sued. nt

[notadmblnd]

78. We couldn't sue

because he did not actually have a heart attack and die while being treated in ER.

[DemBones DemBones]

60. A friend of mine was told her pain was gas

but it turned out to be kidney cancer. The ER doctor sent her home from the hospital, after telling her it was just gas, and a day or two later she was in worse shape and had to go back.

About fifteen years later, the same ER doctor sent her 93 year-old mother home, saying she was fine when it was obvious to the family that she'd had a stroke. She couldn't speak or sit up and he said she was fine! She ended up dead a few days later. I'm watching out for that doc in the ER, believe me! Every time one of us has to go to the ER, I pray he's not there.

I'm really glad that your husband had that extra 12 years with you. He was smart to go to a cardiologist right away.

[Warpy]

42. Her family might have a case

and they need to contact a lawyer ASAP to look into it.

It's not that difficult to rule a heart attack out or in. It requires an EKG and serial blood tests, two of them at least, 8 hours apart. That means a slightly longer ER stay, but to do less is to fail to meet the standard of care.

If she got discharged quickly with a prescription for something she could have bought OTC, you can't tell me this standard was met.

Again, get a LAWYER. It's the only way to kick the crap out of hospital policy makers and get this shit taken seriously.

[shireen]

61. totally agree, this case deserve legal attention!

[liberalhistorian]

70. See, that's the thing. A lot of the time the ER staff doesn't

want to be bothered with doing even fairly routine tests, and studies have actually shown that minorities and women are especially unlikely to get tests that are clearly needed and often fairly simple and routine. They just don't want to be bothered. Cultural, gender and racial perceptions and stereotypes still play a large role in medical care, especially ER care, whether the medical profession likes it or not or even recognizes it or not. Same can be said for the legal profession; I'm a paralegal, so I'm well aware of that.

[Warpy]

106. I have to say that I've seen cardiac rhythm problems

dismissed as anxiety in women a lot. I have never seen actual chest pain ignored to this degree.

Her family needs to talk to a lawyer now. Make sure that blood work was done and that the standard of care for a person with chest pain was met.

The only way to counteract these stupid stereotypes that cause women, especially women of color, to be patted on the head and given a do nothing pill is to SUE when standards of care are ignored, as I feel they were in this case.

[uppityperson]

3. k&r with sadness.

So many reasons for this from misogyny to heart attacks in women often having different signs then in men. No matter the reason, it is inexcusable. RIP.

[TheDebbieDee]

4. What? Oh, how sad........

I've read articles in the past about how heart attacks can be mistaken for acid reflux, gas or indigestion. I'm so sorry for your co-worker and her family.

[Individualist]

5. Inexcusable and unforgivable,

especially considering that heart disease is the #1 cause of death in women. Too many doctors are too quick to dismiss womens' complaints as "all in your head".

[liberalhistorian]

71. That's one of the many reasons why I'm SO glad

that most gynecologists nowadays are women, unlike when I first started seeing gynecologists in my late teens. The first GYN's I went to in the late 70's were older paternalistic men who, in reality, didn't know dipshit about women and it was just a "matter of the mind." I've had women gynecologists since the mid-90's and will never, ever again have a male gynecologist. Not that they're any less competent or caring, of course, but they just KNOW, if you know what I mean, and it's so much more comfortable.

[iwillalwayswonderwhy]

76. I once had a gynecologist tell me...

I was a single mom of 3 children. I had been plagued with recurring ovarian cysts for years and really needed a hysterectomy. He told me he didn't want to do it because, and I quote, "What if you get married again one day and your new husband wants children?"

What? I'm being denied what I need because of some mythical man?

[Mythsaje]

99. My wife has the same problem

and she's infertile on top of it. Yet the doctors wouldn't do the hysterectomy for years. She's planning on getting one soon, now that she's found a doctor who'll okay it, but she's waiting for the best time to deal with being out of work in the aftermath.

[gateley]

7. I thought a lot more attention was being paid to the fact that the incident

of women's heart attacks was on the rise.

I know it doesn't bring her back, but I hope her family sues big time.

[Horse with no Name]

8. It's Texas

She was a minimum wage worker. Our "tort reform" won't allow her family to recover enough money to make a lawsuit worthwhile for any attorney to accept.
Suing is only a privilege of the wealthy. Their incomes are bigger therefore their lives are worth more.

[gateley]

12. Shameful and heartbreaking.

I wish that incidents like these could be put right in the hands of our candidates and of each and every member of Congress. They live in their insulated worlds.

I'm so sorry for her family.

[mike_c]

10. ok, that's a tricky issue and not nearly as clear cut as your OP...

...seems to want to make it. Chest pain is not a primary heart attack symptom for women-- only something on the order of 30 percent of women presenting for heart attack in the ER report any chest pain at all, and the excruciating chest pain typical of male infarction is rarely seen in women. Stated another way, most women presenting with bad chest pain really do have some other condition, including indigestion or acid reflux, hence the Zantac.

That said, it IS also true that female heart attacks slip through the cracks more frequently than male heart attacks, but again that is at least partly because the symptoms women present the most are fatique and sleeplessness if I'm not mistaken. In other words, an easy diagnosis of heart attack is MUCH more difficult in most women. It stands to reason that more difficult diagnosises will fail more frequently than easy ones, and a women presenting with fatique is simply not as clear cut a signal as a man clutching his chest and yelling "This is the big one!"

There probably is a gender issue in there somewhere, but as I said, the medical issue is just not as easy to resolve as your post seems to imply.

[Horse with no Name]

13. Yet she was having classic chest pain

I have been a nurse for 20 years and I know the differences that CAN and most often DO occur in women.
However, her chest pain was CLASSIC. It was hard to miss.

[mike_c]

14. but it's not a classic symptom in women....

If I present with abdominal cramps no one is going to give me Midol (I'm male). Just because the symptoms are the same, men and women often express them for different reasons. As a nurse you're probably aware that this is a real ER concern most places-- I mean the significant differences in the way males and females present with heart attacks.

[Horse with no Name]

19. I have LITERALLY gone fist to fist (verbally) with a doctor

I had a patient (years ago before protocols were in place). She was admitted with chest pains.
However, had no pains after admitted. Her 3rd day in the hospital, I went in to do my assessment.
She was pale, sweaty, short of breath, and said she had enormous pressure in her chest.
She looked like a poster child for an MI.
It was a Sunday, I called the doc at home. He ordered Maalox.
I waited 1 min after giving it...no pain relief, called back and told him no relief.
He ordered Maalox with Xylocaine.
I told him that I didn't think he understood what I was telling him, I thought she was having a heart attack.
He said nonsense. I asked if I could get an EKG...he said yes...BUT not to bother him again because he was watching the Cowboys game.
Anyway...her EKG showed a lateral wall MI in progress.
So...one of the Internal Medicine docs was on the floor at the time--I asked him to please read it. He looked at the timestamp and called ICU for a bed and told me to get her up there fast.
He asked if I called the doctor and I told him "No, he gave me an order not to bother him" :evilgrin:
Anyway...the lady was flown out and had angioplasty that night and recovered just fine.
But women are NOT treated the same way regardless how classic (or not) their symptoms are.

[mike_c]

27. good on ya' sister....

I totally agree that she should have been profiled (the OP). It's just that in a busy ER, people waiting, often for a LONG TIME, ER physicians sometimes HAVE to make quick judgements. This one was clearly wrong-- I'm not arguing otherwise, but I wasn't there and don't know the circumstances. But I do think it was an understandable call, given the statistics for female heart attack symptoms. More often than not (at least 70% vs 30%) that would likely have been the right diagnosis.

[readmoreoften]

74. Why would her physician have to make a quick judgement? Did they have a gala ball to attend?

If there's a 30% chance someone is having a heart attack you do a goddamn work-up on them. It's his job to make sure his patients don't drop dead. That's the whole point of being a doctor.

And your menopause metaphor was terrible. No, you're never going to be diagnosed with menstrual cramps, "mike", but women die of heart attacks regularly and their doctors should look for the symptoms.

And you are defending the doctor. Your whole rationale for posting this is to defend the doctor. You can say you're not, and hem and haw, but that's what you're doing. You're defending the doctor. You're making excuses.

People aren't statistics and 30% chance of death is too much of a chance to take--and it's disturbing that this needs to be pointed out.

[mike_c]

80. I give up....

No one in this subthread seems to give a damn about the facts, only the emotionally charged message in the OP. I posted a link to the NIH study on women's heart attack symptoms below (#65). Check it out if you're interested in moving beyond the emotional bluster.

There is no question that the ER doc screwed up. The patient died, for crying out loud. Read the NIH report to put that screw up into medical perspective. It is enlightening.

Put yourself in the doctor's position. MOST of the time, when women present with chest pain they are NOT having a heart attack, so if ER docs routinely keep them in the ER for 8-10 hours for serological testing, run expensive EKG measurements, etc-- and they get a BIG bill for those services people will be even more pissed off, not least the majority of women who really were experiencing heartburn or indigestion instead of a heart attack. Not to mention the folks who were kept waiting with their own emergencies while those unnecessary services were being delivered.

I've also said up thread that we need health care reform that will make the question moot by freeing people from most of the costs of for-profit medicine that make that situation so egregious.

[havocmom]

56. Pisses me off that so many women have developed bad heart disease before it is even suspected

too damned often.

These learned men of science sure have some odd notions that women don't really get sick. Damned narrow minded of them.

[DemBones DemBones]

58. A fucking football game was more important than a woman's life.

Some doctor! A GI cocktail works wonders for gastritis but does nothing for an MI.

You won't be surprised to know what happened when an older friend of mine had chest pain. It was pretty severe and she was nauseated, too. Of course it was nighttime and her doctor wasn't on call so the new doc in the office called her back. He didn't know her at all and from what I heard her saying on the phone, he didn't ask her about any medical conditions or her age. Maybe he was watching the Cowboys, too. She was 83 at the time so I was kinda concerned, you know?

He told her to take Rol-Aids or Tums. She started vomiting but didn't want to be a nuisance, wanted to be a good patient and follow the doctor's advice. After throwing up/ having dry heaves for two hours, she agreed to calling an ambulance. It turned out she was having a gallbladder attack and ended up in surgery but it could have been her heart and she could have died because the doctor blew her off. I was concerned that the vomiting would induce a heart attack. I was wiping her face all that time, wondering if I could remember how to do CPR if it came to that, swearing at the doctor mentally.

[shireen]

63. was that idiot doctor reprimanded?

What an arrogant asshole!

That lady owes her life to you!

[raccoon]

82. Good for you, Horse. nt

[grasswire]

18. even so, a quick blood draw....

...and stat cardiac enzymes and a 12 lead EKG ought to show something.

[mike_c]

24. absolutely-- I totally agree....

It's just that the judgement call wasn't NEARLY as egregious as most of the poorly informed outrage here is making it seem.

[Horse with no Name]

25. I am not "poorly informed" in the least. AND YES, it was EGREGIOUS n/t

[mike_c]

28. I didn't say that you were....

I was talking about some of the replies up thread, which simply followed the lead you established in the OP because it sounds so horrible and unfair. I don't think you're uninformed-- just the opposite, which is why I'm having a hard time understanding why you seem to be trying to blow this case out of proportion. Diagnosing women's MIs from presentations simply IS more difficult than diagnosing mens'. It simply IS more likely to result in bad calls. Women don't usually present with as clear a syndrome as men do. That's not a matter of gender inequality-- which I'm NOT arguing was absent here-- it's just the physical truth.

[Horse with no Name]

32. I disagree with you 100%.

As long as there are people WILLING to buy into your argument and excuse it, then this will happen over and over.
Heart Disease is the #1 killer in women.
ANY TYPE of chest pain--TYPICAL OR ATYPICAL--should be investigated and assessed thoroughly.
It IS a matter of gender bias and buys into the argument that women have histrionic personalities.

[mike_c]

no you don't....

You're WAY over stating my comments.

"ANY TYPE of chest pain--TYPICAL OR ATYPICAL--should be investigated and assessed thoroughly."

We agree 100 percent about that one.

I've never said anything about "histrionic personalities" nor is there any indication that such predjudice played a role in this instance. It might very well have, but that was never the issue I've been discussing.

You have never really replied to my comments about female MIs being genuinely harder to diagnose from presentations than mens' or about chest pain being a relatively poor indicator of MI in females. As a nurse I expect you know these things are true.

[Horse with no Name]

39. THIS is the case we were discussing

She had CLASSIC chest pains.
I'm not talking about some vague, generalized symptoms here or the symptoms in general. This woman WAS symptomatic. She should have been treated as such.

[iwillalwayswonderwhy]

77. That being the case

You'd think heart attacks would be the very FIRST thing to rule out in women, right? Since MI's are harder to diagnose in women it should be the very FIRST thought of possibility. How about ruling out the MI before the Zantec?

Me? No matter what chest pain symptoms, I plan to describe it as "crushing" with pain radiating down my left arm.

[Individualist]

115. Hear, hear!

I'd had plaque buildup in my coronary arteries for years, and three years ago was awakened at 4 am one morning with excruciating chest pain. It was angina rather than a heart attack, but heart disease is heart disease (as you already know). I have no doubt you'll agree with me that ANY time a woman has chest pain, cardiovascular disease should be considered as a possible cause.

[spooky3]

35. According to one of my physicians from the past

the research just has not been done to clearly delineate female symptoms of heart problem and that it's entirely possible that for many women the symptoms are similar to those of men. *If* that is still true, then you aren't correct to conclude that this is "not a matter of gender inequality"; instead, we can't rule that out. If we don't know what the "women's symptoms" are, then given what the OP has said, the patient should have been given the benefit of the doubt; the error should have been made on the side of doing MORE tests, not fewer. Had the patient gone into the ER with a mild headache, fatigue, etc., your reaction and theirs would be more understandable.

[mike_c]

40. well I mostly agree with you, but the irony is that if she had presented...

...with severe fatique instead of chest pain she WOULD have been a much more likely candidate for an EKG. Something like 60+ percent of women who have heart attacks present with fatique rather than chest pain, I think. Chest pain is just not a common symptom for women having heart attacks.

But yes, there has been less research into female heart disease, and while one can argue that's gender inequality-- I mean, it IS unequal-- the reasons are not as simple as that argument implies. Historically the death rate from heart attack has been much higher in men than in women if I'm not mistaken (don't have the stats in hand and it's getting too late to search for them now, so I'll rely on my admittedly poor memory). And again, part of the problem has always been the relative ambiguity with which women present the symptoms when the ARE having a heart attack. Research tends to follow the clear and easier path to success. One might also argue that research in male breast cancer lags far behind that for women. Another inequality, but also another one that's easily explained without invoking gender bias.

[spooky3]

43. My argument was not simply that unequal research could be

viewed as gender bias, but also that the patient's presenting serious symptoms and being dismissed without adequate testing could also be. Your statements seem to imply or state explicitly that gender bias COULD NOT account for the reactions. My argument is that the burden is on the person making that type of claim to show that that is true. It's like saying you are ruling out a suspect because s/he could not have been responsible for the crime. It's been my experience that life rarely provides controlled experiments. When gender bias is a possibility in a given incident, one can ALWAYS argue that other factors present could have accounted for the result. But when you look at a set of incidents, you often get a very different picture; we know this from controlled study in social science, for example. Therefore, it is really inappropriate to say you can rule out gender bias as accounting for a result in a given incident, especially without a lot more info than you have here.

[mike_c]

50. agreed, 100 percent....

I didn't mean to give the impression that I'm ruling out gender bias in the OP at all. I think there's a good possibility that there was some-- it's just that the matter IS also complicated by the relative rarity of severe chest pain in women having heart attacks, and the glaring obviousness of it in men.

Of course, the opposite is equally true. One also cannot reasonably assume that gender bias was a factor without "a lot more info than you have here" for exactly the reasons you've articulated.

[proud2BlibKansan]

31. I hope if I ever face such a health crisis

that a nurse like you is there to help me.

I have been blessed with good health but the few times I have been in the hospital I learned right quick that the nurses were the ones who were taking care of me, and really seemed to know what was best for me. I cannot begin to relate to what you do and what motivates you to do it but I sure appreciate knowing you are there. :hug:

[Horse with no Name]

33. Thank You Proud!

:hug:
As an aside...about 6-7 weeks after this happened, I was walking down the hall at work and some woman came up and hugged him--REALLY hard.
I was like...uh...who are you???:wtf:

Anyways...it was this woman. She knew that I risked my job going against the Doctor that day and was appreciative.
But...to give fair credit...the Doctor also thanked me as they were putting her on the helicopter. He knew I saved his ass.
This was long before Texas ever heard of George W. Bush and his Tort reform. His ass would have been sued.

[spooky3]

36. Yes, she said it well - thank you for your conscientiousness and caring.

It's a hard job and so important for all of us.

[Horse with no Name]

37. Well...as I demonstrate on here from time to time

I don't mind being loud-mouthed and belligerent.:D

[El Pinko]

23. But doesn't it also make the point about less-than-thorough diagnosis in general?

The whole, get-em-in, give-em-a-pill, move-em-out thing?

[mike_c]

34. probably, but in an ER, explain that to the other folks waiting...

...and to the insurance company reps who call the hospital administrator when ER docs order unnecessary tests "just in case." I'm not arguing that that's right, or excusable-- we need a health care system that puts patients first. But it's a tough position to be in-- everyone getting pissed because they're waiting, society getting pissed because ER visits get more and more expensive while the care gets worse, the bill payers complaining about every unnecessarily cautious lab order.

I do agree that the relative difficulty of diagnosing female heart attacks DOES argue for greater caution-- but I totally understand why an ER doc might go with experience when a women presents with symptoms that are rarely associated with heart attacks in women. The doc made a mistake. I think it's an understandable one under the circumstances.

[Hoof Hearted]

52. Not rare at all. Not understandable. Not a mistake, an egregious failure.

You yourself say 30% of women present with chest pain and then try to call it "rare." Either you hold novel notions of what constitutes a significant statistical occurrence or you have some other emotional investment that prevents you from seeing what is obvious to every other person on this thread, professional and non-professional alike. You have conceded every other relevant point.

[mike_c]

65. read these stats from the NIH....

Damn, I'm taking a drubbing in this thread for trying to be reasonable. Here, read this:

Women's Early Warning Symptoms of Acute Myocardial Infarction.

http://usgovinfo.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=usgovinfo&cdn=newsissues&tm=21&f=20&tt=2&bt=0&bts=0&zu=http%3A//circ.ahajournals.org/cgi/reprint/01.CIR.0000097116.29625.7Cv1

The OP is angry because the ER didn't react to the woman's symptoms as though she was male. Sheesh!

Edited to add link to the original report instead of a news story about the report. I mis-remembered above-- according to the table on page 3 the highest proportion of women presenting with chest pain was about 14 percent.

[Horse with no Name]

94. But Mike...EARLY signs and presenting to the hospital

with full-blown cardiac symptoms are two different things.
I've been forced to work in ER's (not something I enjoy) and the protocols are ANYTHING that might be deemed cardiac is worked up as such. Anything.
They have these gadgets in the ER that are called "triages" that are very good indicators of a heart attack. It takes 90 minutes to run the series. I KNOW for a fact that this particular ER has this testing available.

http://www.research.va.gov/news/press_releases/heart-attack-091401.cfm
It simultaneously checks the blood levels of three cardiac enzymes, or "markers," which are released by distressed heart tissue during an actual heart attack. The enzymes are troponin I, creatine kinase-MB, and myoglobin. In the San Diego study, the triple-marker test, commercially known as the Triage Cardiac System, was 100-percent accurate in ruling out heart attack when combined with an electrocardiogram and patient history.

[El Pinko]

54. Well, I can only speak as a layperson, but I have used the system in Japan and the one in the US...

...in Japan, the monthly insurance premuims were reasonable. The copays at the dr.s office were reasonable (under $10) and prescriptions were dirt cheap. I never had to make an appointment there, just went to a dr. office - ANY dr. office as long as I had my insurance card, and would be seen after a very short wait. The doctor actually spent a reasonable amount of time with you and the service was excellent. If I got a prescription, the price for drugs was generally less than $5, no matter what the medication. Oh, and dental is fully covered.

By contrast, here in the states, there are only a few doctors I can choose from on my HMO plan (which costs about 3 times more even though my employer pays half the premium). I have to have an appointment to see the dr. and even then there's a huge wait because they apparently all triple-book now, and when I finally do see a dr. I'm whisked in and out in no time and given a prescription for something (usually some new and expensive drug) that costs a fortune at the pharmacy. Dental's not covered, so I buy a separate dental policy, which despite billing itself as "insurance" is more like a discount card, covereing between 20-50% of the cost of most dental procedures (and only covers amalgam fillings which are full of MERCURY).

Oh yeah, when my wife delivered our kids in Japan, the cost of the delivery was totally covered, and she was able to stay and recuperate in the hospital for a full week. I hear that in the states now, they kick women out after a day or two. NICE.


It's no wonder infant mortality is so high here in the States, the medical system seems like nothing but a corporate greed factory that does its damndest NOT to treat people.

Off topic, but when all the overweight baby boomers become seniors and a lifetime of crap food starts to really take its toll on their bodies, I wonder what will happen to the US' life expectancy.

I doubt my generation (born in the late 60s/early 70s) will be any better.

[liberalhistorian]

72. MIke, that may be the case, but

they should at least have done the fairly routine, simple tests to indicate any possible heart problem especially since she did have the classic heart attack type of chest pain and had a history of hypertension.

Oh, and hi, been wondering how you've been! :hi:

[mike_c]

83. I know, but it's a balancing act....

Those tests require an extended ER stay-- 8 to 10 hrs I think-- plus they're VERY expensive. Most women presenting with chest pain would therefore be tremendously inconvenienced and angry about the cost because they really do have heartburn or indigestion. Not to mention the insurance reps crawling down everyone's throat because of the "unnecessary" expense.

The situation really is a bit different for men because chest pain is a good indicator of heart attack all by itself, but ONLY in men. I posted a link to a recent NIH report that discusses some of these issues up thread.

I'm doing fine, but I'm a bit overwhelmed this semester. I'm at maximum task density already, more-or-less, and getting a bit further behind each week. Hope you're doing well! Give my best to C.

[totodeinhere]

11. That is totally unacceptable.

I hope that the lady's family sues their asses off.

[JerseygirlCT]

15. Yes. I've heard of this happening to friends

Fortunately, they weren't harmed. But instead of looking into their symptoms, the ER staff assumed they were suffering from anxiety (or reflux, in the OP example) patted them on the head, and sent them home.

I'm so sorry for your loss. It's shameful that it had to happen.

[happyslug]

17. Typical, There has been more research on male heart attacks then Woman heart attacks.

The primary reason is Women go through severe stress during Child birth. The level of stress would cause a heart attack in males, but being female the body hormones prevent such heart attacks during birth. The problem is this same hormone also prevent heart attacks at other times. Thus when research is done on heart attacks it is almost always exclusively males, for you can predict when the heart will have a heart attack, but you can NOT for women.

Thus men have Seven to Eight heart attacks and then die from something completely unrelated, women have one and it is massive, so massive they bury her the next day. This "fact" that women heart attacks tend to be both rare and massive, while men heart attacks tend to be more common and milder. Men have a heart attack and take it as a warning and change their life style to reduce future heart attacks, women almost never have such warnings.

Sad and true, but probably why the hospital did what they did, the hospital dismissed the woman's chest pain as severe heart burn (Thus the Zantac) NOT a heart attack. A tragedy.

[Madam Mossfern]

21. Something similar happened to me

I was 46 years old, a vegetarian, in good shape and on the way our of my driveway, I felt a nuclear explosion in my chest. I made it back into my house and my daughter called the EMS. When they got me into the emergency room, they assumed that I was having an anxiety attack. I was adamant that I wasn't and wouldn't stop screaming until they actually diagnosed me. Yup..if was a full blown MI. Thankfully they were able to give me TBA which broke up the clot that was totally blocking a main coronary artery. I lost 15% of my heart. The EMS workers were really pissed, they knew that I wasn't treated properly because I am a woman and they assumed that it was merely "hysteria".

I wonder if I weren't so stubborn and annoying if they would have just given me a sedative and left me to die.

[EFerrari]

38. Yup. Women are supposed to take care of themselves or

not need care or some dangerous damn thing like that.

I wonder how many women haven't had a similar experience. :(

[renate]

66. wow--good for you!

If I were a 46-year-old female vegetarian in good shape, I would have assumed it was something other than an MI, too. (In fact, that description is pretty close to being a description of me, and an MI is the absolute last possibility on my mind.) I guess your instincts were telling you something different... anyway, good for you for insisting on your rights and for not dismissing your own symptoms because the MI scenario was so unlikely. And good for you for not being a "good" patient!!!!

[El Pinko]

22. That's horrible. Then there's all the millions who can't afford insurance...

Who knows what kind of run-around they get.

terrible. What a waste. My wife's mother died at about 62 of a heart attack in the bathtub. Unfortunately, by the time her husband found her there it was too late.


:cry:

[supernova]

29. This is a well-documented phenomenon

women's heart disease is less aggressively treated than men's. And when we do have a cardiac episode, the symptoms are much more subtle.

Double minus points that she was also a woman of color.

horribly sad.

[GreenPartyVoter]

30. My mom had no idea she was even having a heart attack the week she died. They are harder

to diagnose in women than in men. For that very reason the hospital should have aggressively checked the lady from the OP for heart problems.

[truedelphi]

44. When Oprah, who is worth close to a billion dollars, has to run

from doctor to doctor, hearing repeatedly that her sleeplessness, weight gain, lack of energy etc are only stress related, and FINALLY after months of this she finds out it is her thyroid going wrong, you start realizing how pervasive the dismissal of women's health problems are.

[EFerrari]

45. I almost bought the farm when my doctor kept insisting that

the staph infection I got from the tubal ligation he botched was only "nerves".

Too bad women don't have seven lives like cats. We pretty much need them!

[Horse with no Name]

46. I had severe gallbladder disease

That ended up putting me in the hospital for a month--yet up to the day that it nearly ruptured...I had only been given Xanax for my CLASSIC gallbladder symptoms. But, I was just a hysterical female...I couldn't REALLY be sick...could I? :mad:

[EFerrari]

48. Omigod. You know, my mom tells me that when she was a teen

in El Salvador, her doctor used to say, "But, it's nothing."

That was in the early fifties. The more things stay the same. :grr:

[DemBones DemBones]

109. Well, you're a woman AND a nurse, so no male doctor

will listen to you. They resent nurses because nurses often save their asses, as you did with the shithead who thought watching the Cowboys play with a ball was more important than saving his patient's life. THEY went to med school and you didn't, so what could you possibly know?

In fact, nurses have always known a lot more than they're given credit for. You learn from day to day observations of sick people. If med schools required students to go to nursing school and work as a nurse for three years before they could even apply to med school, we'd have much better doctors and the money-grubbers would be weeded out of the profession, or at least they'd be money-grubbers who'd paid some real dues. They'd have a whole lot more respect for nurses, too, might even stop calling you their "girls."

[truedelphi]

47. Thank you for once again proving how tough a cookie you are

Staph often does people in even when promptly and properly diagnosed!

[Viva_La_Revolution]

51. VivaMom went through the same thing after my little brother was born.

Gained weight eating nothing and the old town quack refused to believe her. Took her years to even get it mildly under control. :(

[Missy Vixen]

64. Believe it or not

those of us with long-time thyroid disease had been begging Oprah Winfrey to talk about thyroid disease on her show for YEARS prior to her diagnosis. To say that she not only ignored the pleas of those with thyroid disease, she was slighting on her show about the issue, makes me unhappy at the least.

I don't wish TD on anyone. At least she's been diagnosed, and perhaps she'll now countenance discussing it. Thyroid disease is one of the most underdiagnosed chronic conditions there is.

Julie

[Manifestor_of_Light]

68. You are correct.

I've argued with several doctors about my Armour Thyroid, how much of it and what kind to take. One doctor took me off of thyroid completely and I almost died after five years. After five years I could only get out of bed from sheer willpower. The doctor I saw then, in my desperation, said I had the worst case of myxedema he'd ever seen, and that I would have gone into a coma and died within a month or two! And this was in a hot climate.

Check out this excellent website: www.stopthethyroidmadness.com

[truedelphi]

107. Thank you very much for this site.

It is really really informative.

And answering a lot of my questions.

[truedelphi]

73. Oh I believe you. I don't worship Oprah in the slightest

But I did think it interesting that even with her being a rich, celebrated human being still did not help her much in terms of an adequate diagnosis (Though having lots of cash did mean she could go to a lot of doctors until she finally got some answers.)

[Pacifist Patriot]

49. THE MISMEASURE OF WOMAN by Carol Tavris...

I am going to keep recommending this book until every literate person in America has read it.

[AZBlue]

53. Unfortunately many, including some in the medical profession, don't know

that the symptoms of a heart attack in a woman are very different than the "stereotypical" symptoms for men.

[DemBones DemBones]

55. They still don't realize how differently heart disease and heart attacks

affect women. A friend of mine had pain in her back which was a heart attack.

Women, we have to insist on EKGs, 2-D ultrasounds, thallium stress tests, even cardiac catheterization if we have unexplained chest pain or anything weird going on.

Do NOT count on your doctor to look out for you. Some will, some won't.

Do NOT count on ER doctors to look out for you. Some will, some won't, as is obvious from this story.

It's your life so look out for yourself.

[EFerrari]

62. More, do not go to an ER alone. ALWAYS have someone with you

to witness and to advocate.

[shireen]

59. i've encountered some of the worst doctors in emergency rooms

My doctor calls it "hit or miss" where emergency room doctors are concerned. I've met a few good ones, but most have been either mediocre or bad.

It's so sad to hear about that woman. I hope her family sues -- this is one case where medical legal action is well-justified!

[TXDemGal]

67. My SIL's aunt got the same treatment

The aunt is dead now, too. WHEN will the so-called experts (docs & others) realize that womens' heart attack symptoms are "atypical"?? And the whole description of women's symptoms as atypical pisses me off. They're not the same as mens', but they are typical for women.

[moondust]

75. What tests were done?

What medications were administered in the hospital?

More information about the actual treatment she got is needed before passing any kind of judgment.

You are, of course, aware of noncardiac chest pain?

[DemBones DemBones]

86. Why not read the thread, or at least the posts by the OP?

Your ASSumption that the OP, who is an R.N., does not know about noncardiac chest pain is insulting to her and to DUers in general, who are well-informed about many topics.

Doctors, especially male doctors, have a bad habit of not looking at the whole picture, especially when the patient is a woman.

Are you a male doctor or do you just play one on DU?

[Horse with no Name]

89. Uhhh..let me start over

1. No medications.
2. No tests.

And yes..thanks for the insult that I don't know anything about non-cardiac chest pain.
Notwithstanding the fact that I have been certified in ACLS for the last 10 years. :eyes:

[IowaGirl]

84. I recently read on......

on some medical website that women have a higher threshold of pain than men and that confuses the issue. I have had some extremely bad gas pain in my chest that I was concerned was my heart but figured out it was from the Xylitol in my sugar-free gum, especially if I chewed it in the evening. Then I would wake up in the am with severe pain and fullness in my chest. Much more severe than the pain I had with my gall bladder attack which resulted in emergency surgery.

[Tracer]

85. This site is just full of people who love to tell medical horror stories.

I don't deny that they happen, but wonder if the preponderance of horror stories outweighs the GOOD outcomes.

On a Sunday, during a snowstorm this past December, I had severe chest pains.

I called 911 and they were there in a flash. The EMT hooked me up to a portable EKG and determined that -- yes -- I was having an MI.

We quickly arrived at the hospital ER and there was a CROWD of doctors and nurses waiting for me. Although I went downhill pretty fast in the ER, they quickly stabilized me --- and beleive it or not --- had a Lifeflight pilot waiting to take me to a specialty hospital that does Cardiac Catheterizations. It was snowing too hard to fly, so I was rushed by ambulance to the second hospital, where there were two doctors WAITING FOR ME. I had an emergency angioplasty and a stent.

I was treated so quickly and so efficiently, that there was NO damage done to my heart.

I can't describe the kindness, professionalism and speed with which I was treated. I owe them my life.

I'm a middle-aged, white woman.

[moondust]

87. Great outcome!

Thanks for sharing your story!

[Horse with no Name]

96. I'm glad you had a good outcome.

Many women don't. That is the POINT of this OP--and it isn't a "horror story"...it is real life.
Being a nurse for 20 years, I can tell you amazing HORROR stories of things gone bad--where people died, Doctors and Nurses lost their licenses, Lawsuits...but I don't. You would undoubtedly be shocked. My purpose is NOT to scare people.
My purpose is to point out that WOMEN do NOT get the same care as men even when we present with the same symptoms.
You forget that MOST women do NOT call an ambulance when they have these pains. The fact that YOU did probably saved your life.
The EMS routinely runs EKG's on any type of chest pain and generally runs on protocols that are not so different than you see in large medical centers.
IF the diagnosis is made in the field, the teams are activated and are READY and WAITING. That is the way it works. It was not an anomaly that it happened that way for you.
However, had you not been a smart patient and called 911...and instead drove to the nearest ER, there is a very good chance that the team wouldn't have been assembled and waiting, and there is a very good chance that you might have died waiting your turn.

[Tracer]

97. Yes. I understand that very well.

The frightening part is that I now realize that if I HAD waited -- even a half hour or 40 minutes -- before calling 911, I would have died --- because I went into cardiac arrest while the doctors in hospital #1 were working on me.

I don't know why it's true that women don't call for help as quickly as men. It's really puzzling.

[Horse with no Name]

98. It's a vicious cycle

I wasn't a nurse when I had trouble with my gallbladder.
I went to the Doctor many times for severe, unrelenting epigastric pain that radiated into my shoulder.
What I NOW know to be classic gallbladder pain.:eyes:
Anyway...after being dismissed MANY times, I finally just stopped going and suffered through it at home. I found out very quickly that the Xanax they gave me didn't work for the pain. Again, the :eyes:
Luckily I had a bout that didn't quit hurting. Again I ended up at an Emergency Room and there was a Doctor that recognized that SOMETHING was very wrong.
After all of the X-rays and tests, I had emergency surgery. The surgeon said I was very lucky I came in because the gallbladder was very scarred from all of the previous attacks and was weakened and on the verge of rupture.
I was in the hospital for a month. When I went home, I still had tubes that drained the bile to the outside of the body for another 3 weeks.
I think that sometimes women get so tired of being brushed off, that even when they THINK something is terribly wrong, they are generally very reluctant to call for an ambulance.

[Tracer]

101. Then I must be an anomaly.

For the past 2 1/2 years, I've had an unrelenting series of medical problems -- and NOT ONCE have I been brushed off or had my symptoms ignored.

What to attribute this to? A series of excellent doctors, for sure -- and the good fortune to live in an area with great medical facilities.

[Horse with no Name]

Do you have GOOD insurance?

that is a factor many times as well.

[Akoto]

102. I had a good story as well.

My mother had really bad pains and went to the doctor. The doc gave her something, said she was having a heart attack and called for an ambulance. There were there in a flash and she was treated with equal speed. No damage to her heart.

[DemBones DemBones]

111. Isn't that nice that you weren't sent home with Zantac?

The POINT of this thread is that many ER doctors, and other doctors, are incompetent or don't care about their patients, especially if they are female, black, or both.

Many of us are trying to draw attention to the frequent misdiagnosis of women's heart problems so that women who read it will know not to allow an ER doc to blow them off with Zantac or Xanax when they think their problem is more serious.

There are other serious health problems that can kill women and that doctors routinely misdiagnose. Read the "horror stories" and you might learn something that will save your life the next time you have a medical crisis or chronic problem that your doctor ignores.

[we can do it]

88. This Happened All the Time When I Was A Fire/Medic

I've been retired for ten years, and with our caring insurance companies I'm sure its worse now.

[melm00se]

93. this is not confined

just to the USA.

http://www.heartzine.com/726-Female-Heart-Patients-Ignored-In-Treatment.html

But back on point, this is an issue that is finally getting more attention as studies are uncovering this hole in the medical care field:

http://www.med.umich.edu/opm/newspage/2004/womenheart.htm
http://www.voanews.com/english/archive/2007-10/2007-10-04-voa21.cfm?CFID=265285732&CFTOKEN=15499355
http://www.americanheart.org/presenter.jhtml;jsessionid=RUSVFKX020KFACQFCXPSCZQ?identifier=3028550
http://seniorjournal.com/NEWS/Health/6-07-10-WomenStillGet.htm
http://query.nytimes.com/gst/fullpage.html?res=9D0CE7DE1F3DF930A25752C1A967958260

[napi21]

95. That's not how I was treated 2 years ago when I went to ER for

the same thing. They did ALL the tests, and kept me overnight for observation. I honestly think it depends on what facility you go to and what the drs. there USUALLY DO.

[Horse with no Name]

100. We are thankful for that!

:hug:
You are correct. This was a rural facility where sometimes old ideas die hard.
They have the technology but all of the technology in the world isn't good enough if the gatekeepers refuse to use it.

[Eurobabe]

103. Sometimes they give an RX for anti-depressants and send you home

It happened to a friend of an aquaintence, and THEN she had a heart attack at home. I kid you not.

[slackmaster]

104. This 50-year old man shakes his head in disgust

:argh:

[nolabels]

105. Another problem is that women often bring the children to the doctors too

The doctors already have a false sense of security because of that. They assume (even if it's just subconsciously) that if the diagnosis is incorrect the patient will just come back later because it's probably not that serious. In essence, no need for a lot of thought about it as far as the doctor is concerned. The other part about the majority of physicians being male is probably the main reason but there is never exact absolutes in what causes what.

[warren pease]

108. I wonder how big a role gender role stereotyping played in this case...

Could this be a result of gender role stereotyping, where we're all socialized to believe that men are more important, have more credibility – and therefore have more intrinsic worth – than women of comparable status in western cultures (and just about all others, as far as I can tell)?

So they just blow off the woman's chest pains and treat the man as if his problems are the only things going on in the entire ER that rate immediate attention. I'm pretty sure the fact that she was black didn't help her cause much, either, so race and gender may both have played key roles here.

In my view, this society clings to these archaic, discredited gender roles as if they were the keys to understanding the fine points of human behavior and, as a result, reflexive, pre-installed biases take over and overwhelm the ability to see everyone as a distinct individual.

As a result, the dominant culture – which is still unfortunately defined and enforced by relatively uninformed white males – gets a pass when it marginalizes women, disrespects them, ignores them when possible, humors them when it isn't, refuses to take them seriously in traditional male-oriented situations, acts as though they're completely helpless in a crisis, still regards them as passive sex objects and assumes they can't handle anything more complex than scheduling a manicure or shopping for shoes.

Not that there aren't more than enough women to keep that stereotype alive. And mass media amplifies their influence through their incessant stalking of idiot D-class celebrity females, waiting for the inevitable drug and alcohol-fueled run-in with the law, reporting breathlessly on these screw-ups – which seem to happen every other day – and causing unknown numbers of otherwise sane people to throw the remote through the screen.

Because quiet competence and living an orderly life aren't particularly exciting to TV news producers and assignments editors, it completely ignores the overwhelming majority on the other end of the spectrum – the tens of millions of highly competent, successful, self-reliant, smart, courageous and tough women who actually inhabit this country. So it's either drunken Paris and Britany and their pecan-sized brains or the Norman Rockwell version of rosy-cheeked America where women are called homemakers and spend most of their time dusting, vacuuming, cooking, washing and generally making life ever more wonderful for hubby and the kids.

So after all that blather, sociologist and author Janet Saltzman Chafetz lists seven areas of human functionality and the ascribed gender role stereotypical traits for each area that combine to make up a "normal" American male.

1. Physical — virile, athletic, strong, brave. Unconcerned about appearance and aging
2. Functional — breadwinner, provider for family as much as mate
3. Sexual — sexually aggressive, experienced. Single status acceptable
4. Emotional — unemotional, stoic, the proverb says boys don't cry
5. Intellectual — logical, intellectual, rational, objective, practical
6. Interpersonal — leader, dominating, disciplinarian, independent, free, individualistic demanding
7. Other Personal Characteristics — success-oriented, ambitious, aggressive, proud, egotistical, moral, trustworthy, decisive, competitive, uninhibited, adventurous.

Here's a list of a few ascribed gender role stereotypes that carry a positive connotation. The interesting thing is if you switch the columns of attributes and put the masculine traits in the feminine column, and vice versa, all but two of the masculine positives translate to feminine negatives in pop culture and could all be replaced with something like "bitch," "ball-breaker," "battle-axe" or "shrew."

Similarly, if you move the feminine traits under the masculine heading, translations include "wuss," "wimp," "sissy," "momma's boy" and any of the dozens of ways to call a non-stereotypical male a queer.

Feminine Masculine
tactful aggressive
quiet independent
aware of feelings of others dominant
need for security competitive
easily express tender feelings active
ambitious
make decisions easily



Here's an essay by some guy who claims to be confused by gender stereotypes, but it's actually written by a pro and available for a modest fee from echeat.com, a site that sells all kinds of essays, term papers and the like to college kids who have more money than research and writing skills. "What are the gender role stereotypes, how are they created."

Here's a piece on ascribed female gender role traits by a pre-doctoral psychologist. Stillerman Says – Features

Here's a list of various personality traits ascribed to both genders. Gender Roles and Stereotypes

And here's a serious, scholarly treatise on all this stuff (which is way over my head). Masculinity and Femininity in Contemporary American Society: A Reevaluation Using the Bem Sex-Role Inventory - Statistical Data Included - Polling Data


I'm curious to see if others think this is relevant to the situation described in the OP, or if I'm just full of pseudo-science shit once again.


wp

[DemBones DemBones]

110. Sex-stereotyping literally kills women, like the woman

in the OP. But some people here don't want to talk about that. They want to argue that the woman's symptoms were atypical for a heart attack in a woman so it's not the doctor's fault when the doctors in the ER did NO tests at all, or that they are women who got good care so what's all the fuss about?

The fuss is about all the women who don't get good care, many of whom die because they don't.

Thanks for a great post, warrenpease!

[RadiationTherapy]

112. I refuse to defend this situation, but I want to argue.

My brother was dismissed, misdiagnosed, referred and run around before, AFTER EIGHTEEN MONTHS, someone (else) looked at his 12 month old CAT scan (head xray??) and saw the HUGE malignant tumor in his head that was causing non-stop headaches and uncontrollable nosebleeds; the other 2 doctors "missed" it. radiation therapy ensued.

Never once did I think he was run around for any other reason than incompetence. Why is incompetence being hoisted up as sexism? How can we KNOW this had to do with her being a woman? And, most importantly, how could a person dismiss someone's potentially life threatening issue based on gender or any other qualification!?!?

This is absurd, whether it is true as perceived by the OP or not.

[Manifestor_of_Light]

113. Malpractice can happen to anyone.

I got a story for you:

A friend of mine has a sister who is poor, black and elderly. She went to the small town local white male doctor. She was dizzy and confused. He asked her if she was drinking and told her she needed a psychiatrist. He also did not examine her thoroughly.

She went home and got worse, and her family called around in desperation. They called the only charity hospital in the state that takes anyone, and they asked if they could drive her there -- a distance of 200 miles. They drove there.

A woman doctor saw her there and examined her eyes. She had blood clots in the back of her eyes, which the white male doctor had not checked. The lady doctor said that the man who examined her before "must be an amateur or a student". The white male doctor is about 70 years old and has been practicing for about 40 or 45 years.

The lady had had a stroke, and that's why she had blood clots in her retinas.

I'd say that the white male doctor is racist, sexist, and/or just doesn't give a shit about some people.
:eyes:

[Maine-ah]

114. I guess our hospital is way better than the one she was at

A few years ago, when I was 30, no insurance. Went to the emergency room with chest pains and they admitted me immediately, hooked me up on the machines, chest xrays...the whole work up. Come to find out though, it was all originating from a back problem.