My cardiologist: "the devil himself?"

Letters to the Editor, Victoria Times Colonist, Wednesday, June 24, 2009

‘Dress codes in hospital should respect patients’

Dear Editor,

'In May, I had to stay in the Royal Jubilee Hospital cardiology ward. At that time they decided to do a cardio conversion. Then in walks the devil himself to do the task. He wore tight jeans, a shirt of some ungodly print and had curly hair hanging down past his bum. Not OK. I am a 66-year-old woman with a serious heart condition and I just wanted to get up and run.

Whatever happened to dress code? A white coat and clean hands gives a person a feeling of confidence. Is it some kind of infringement on these people’s rights? One seldom knows if they are talking to the janitor or head nurse. I feel I deserve better than that in the hospital."

Sincerely,

Mrs. M.A., Victoria

*********
Letters to the Editor, Victoria Times Colonist,
Friday, June 26, 2009

Dear Editor,

Re: ‘Dress codes in hospital should respect patients’, June 24, 2009

"I’m pretty sure that 'the devil himself' — as the letter-writer described the doctor who helped her in cardiology wearing tight blue jeans, a “shirt of some ungodly print” and long curly hair — was the same cardiologist who saved my life a year ago.

Two weeks earlier, I’d been sent home from that same hospital's Emergency department by an older, white-coat-wearing, officious, über-confident, old-school kind of physician whom your letter-writer would have certainly preferred.

This white-coat clad doctor did not introduce himself, did not make eye contact and made it clear that I was wasting his and his colleagues’ valuable time.

He told me with absolute certainty and the superior tone that comes from decades of wearing white coats that I merely had acid reflux (despite presenting with textbook heart attack symptoms like crushing chest pain, sweating, nausea and pain radiating down my left arm).

Then he sent me home, feeling extremely embarrassed for having made a fuss over nothing, with instructions to go see my family doctor, who would prescribe antacids for my indigestion.

Fast forward two weeks of increasingly debilitating symptoms (but hey! at least I knew it wasn’t my heart!) until I finally presented myself again in Emergency in extremely serious condition.

This time “the devil himself” was called in, and immediately administered a 30-second non-invasive cardiac assessment test*** (pressing on my abdomen with both hands while observing my abnormal jugular pulse) and, after checking my EKG and cardiac blood enzyme test results, announced that I had “significant heart disease.”

I was taken from E.R. to O.R. immediately. Later, when three cardiology residents came to examine me as I lay recuperating in Intensive Care, I learned they had all come to Victoria just to study under the cardiovascular mentorship of “the devil himself.”

I’ll take “the devil” any day - “ungodly printed” shirts and all."

Sincerely,

Carolyn Thomas, Victoria

© Copyright 2009 The Victoria Times Colonist

** NOTE ** The brief diagnostic procedure that my cardiologist performed is called an abdominojugular test (previously known as hepatojugular reflux). Jugular veins bring de-oxygenated blood from the head back to the heart. Healthy people undergoing an abdominojugular test will have a temporary increase in the internal jugular pulse for just a heartbeat or two before the venous pressure returns back to normal. But a skilled physician can observe in the sick patient’s jugular vein and earlobe pulse the characteristic double flicker of a sustained elevated jugular venous pressure – a sign of active or impending heart failure.

****
PS The cardiologist described here is of East Indian descent - sadly, my hospital pals and I are pretty sure Mrs. M.A.'s objections were largely racially-based, e.g. "these people", her insinuation that his hands were not clean, and her apparent confusion between him and one of the hospital janitors, most of whom are also East Indian.

XOXOXO

http://www.myheartsisters.org

By kk_stl
Posted July 4, 2009 at 7:38 am
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Yes, it's sad but so true that older generations of people have been brainwashed into age, gender and racial bias. I had to learn to accept my mom's biases and work around those issues. As silly as it sounds, confidence in your doctor, whether deserved or not, plays a big role in the pysche road to recovery. I think her recent open heart surgery though has somewhat opened up her eyes. Unfortunately, she doesn't remember much about it, and she'll probably revert back to her old habits. Fortunately, these biases are becoming a thing of the past with each new generation.

I found the ICU nurses as a vital link to understanding the specifics of what is going on at the hospital. If it weren't for them, the communication from the doctors (because of limited time) and the residents/fellows (because of attitude) would have been less than satisfactory. They are also the vital link to getting your requests communicated to the doctors. They are the unsung heros of the profession. On a regular hospital floor, forget about getting time from the nurses with their patient load ratio and/or lack of dedication.

Probably the biggest lesson I learned through all of this is that any healthcare situation is operated on a triage basis. It's up to you (or more likely a family member) to convince those treating you that your needs require attention. It's tough to accept that comfort or patient/family education takes a backseat to other demands of the hospital staff. Of course, it doesn't help matters that nurses are over burdened with documentation requirements, etc.

There is more to medicine than just looking at the numbers and I found it amazing that doctor rounds are done without much interaction with the patient (or family member, when present). Understanding what is normal behavior for a patient vs. them just speculating from a textbook does take more time but seems to be a vital missing link. And yes, there are simple non-invasive cost effective tests, like you mention, that can be done to further assess a situation vs. just looking at test numbers.

I hear complaints over and over again how most hospital doctors barely put a hand on the patient, even in the ER to diagnose problems. Is it from poor training?! I get the frenzy of ordering tests in our lawsuit driven society but failing to use physical patient assessment tools in conjunctin with diagnostic tests is very disturbing to me. You have to get the full picture and you don't get that from numbers alone.

Sorry, but I guess you struck a nerve when you explained your first ER experience.

On a side note, I found it humorous to how much attention my dad paid to looking at a surgeon's hands. Did they have long slender looking hands or short stubby fingers? So biases can take on many variations.

The cardio interventionalist who did my mom's catheterization test alarmed me when it looked like his hands were all beaten up with scabs, etc. I never said anything but you can believe me it increased my anxiety level. I also paid attention to their vision (could they read charts without straining their eyes) as silly as it sounds.

Having a doctor that can speak to me and answer questions is vital for my comfort level but I have learned to work through the new crop of ESL doctors and just to keep asking them to explain something when I can't understand their pronunciation or choice of words. With my lack of proper pronunciation of medical terms this just adds to the communication complexity! lol I've found most of them don't mind re-explaining something and if the second try doesn't help, I ask them to spell what they are trying to say and apologize for my hearing deficit.

Anyway, thanks for sharing this abdominal jugular procedure. I don't think I've witnessed it being done during my mom's health journey. I barely see them checking her carotid arteries which I think should go hand in hand when a patient has known cardiovascular problems.

KK

By martzj
Posted July 4, 2009 at 10:20 am
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"This time “the devil himself” was called in, and immediately administered a 30-second non-invasive cardiac assessment test*** (pressing on my abdomen with both hands while observing my abnormal jugular pulse) and, after checking my EKG and cardiac blood enzyme test results, announced that I had “significant heart disease.”

I was taken from E.R. to O.R. immediately. Later, when three cardiology residents came to examine me as I lay recuperating in Intensive Care, I learned they had all come to Victoria just to study under the cardiovascular mentorship of “the devil himself.”

Powerfully written Kenna! I still marvel at the simple yet definitive technique that 'the devil himself' used to spot your cardiac distress. And I'm guessing 'the devil' has been given copies of your letter to the editor. Hope it makes him grin. : ) Often!

Spent most of my adult life working with intelligent, curious, savvy mavericks (I'm a maverick too)...So I instinctively trust them. Just my luck I got 'Doogie Howser' (his voice actually squeaked)...and the poor lady above felt she got 'the devil himself'...Just goes to show what an intensely personal and terrifying experience heart attack is for women. It isn't a rational state of affairs fighting to stay alive on a cath table, extremely vulnerable and helpless. We are all so different...My mom sees 'white coat on male' and thinks 'authority figure-I trust him'...All I see is 'a dude in a white jacket-show me what you got'. : )

Very much enjoying your elequent journey back towards a more heart-balanced life......spreading the word as fast as you can go now!

Time to watch Tour de France kickoff in Monoco now!!! Gorgeous ariel views. Lance Armstrong is BACK. All the titans are in this epic race.

salute',
Jaynie

By Kennarina
Posted July 4, 2009 at 11:04 am
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But hasn't the word 'maverick' (previously a perfectly fine word that we all intuitively understood) now undergone a fatal blow after the whole Sarah Palin association? :-) We'll have to think of a new word to replace it....

XOXOXO

By Kennarina
Posted July 4, 2009 at 11:09 am
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PS Oh, and the other part of her letter that just choked me was her harrumphing: "I am a 66-year old heart patient" as if that means anything. I said to my daughter: "So she is seven years older than I am?" and Larissa replied: "No Mum - she is 100 YEARS OLDER than you are, and in fact was probably at least 100 years old when she was born!"

By mamaellie
Posted July 4, 2009 at 9:25 pm
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I have had the cute young doc who one moment was incredible and the next totally an ass.
I've had the established older doc was an ass.
I've had the young brilliant surgeon who knew his job and had no people connection skills.

All I want is a well educated doc, who scored at least in the 95th percentile, who can work inside and outside of the box.

By Kennarina
Posted July 5, 2009 at 2:06 am
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Hi mamaellie - yes, docs come in all shapes and sizes, personalities, and levels of people skills (much like the rest of us in fact).

A young friend has just applied to medical school and she says that the application process now no longer focuses exclusively on her undergraduate grades (although these are still important of course) but also with a big emphasis on her volunteer activities, her community involvement, her overall well-rounded life experience. It's no longer enough to be just a brainiac. I guess medical schools have learned that the smartest med students do not necessarily make the best docs.

Here's an old hospital joke:

Q: What do you call the med student who finishes dead last in every medical school class?
A: "Doctor"

I'm very lucky for the past nine years to have worked at a hospital with a number of skilled physicians who are excellent listeners, excellent teachers of young med students, excellent diagnosticians. And I've heard horror stories (mostly from our nurses, who are brutally honest about which docs they love and which docs they don't!) about doctors who are not only arrogant, but downright abusive. Some wear white coats and some don't. My point was that you can't tell the arrogant ones from the wonderful ones by a white coat.

BTW, one reason that even some hospitals are now discouraging MD's white coats in favour of civilian clothing is the germ factor: better to wear clothes that are washed every day as opposed to the white lab coat that you take off and hang on the hook on the back of your office door every night when you leave the hospital and then put on again the next morning.

My cardiologist is a very un-doctor-looking doctor (the letter-writer above is right: he is well-known in our hospital because he wears flamboyant shirts with orchids and other brilliant prints and he is extremely tall with gorgeous long shoulder-length black shiny hair that looks like a spill of spiral ringlets. Women would kill to have that kind of hair!) My first impression of him when I first met him a year ago in Emergency was surprise - I had never met a doctor before who looks like this - he just looked way too cool to be a doc!

But within seconds, I felt so reassured by his friendly yet professional bedside manner, his calming presence and his very obvious clinical skills that I stopped noticing what he was wearing or what colour his skin is or whether his wardrobe was cool or not.

And PS to Jaynie: sorry, you may have invented 'maverick' - but that word's now been forever tainted!! Can we think of a new replacement word for you instead?

XOXOXO

http://www.myheartsisters.org

By arizona1
Posted July 5, 2009 at 10:42 am
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When I started reading the first letter, it reminded me of the movie "Patch Adams" starring Robin Williams.
My immediate impulse was to say " She hasn't seen this movie and doesn't know what unconventional doctors can do" Then I read the second part. That resolved everything.

Kathi

By Ecksunbeam
Posted July 5, 2009 at 11:43 am
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When I worked at Wayne State University School of Medicine, I dated a Japanese med student who had long black hair all the way down to his waist.

As a Sophomore, he won the American Heart Award--given to only one medical student per year in the United States.

His name is Dr. Marvin Sakihara and he is in San Diego, California--if you're looking for a good internal medicine doctor with a subspecialty in cardiology. (BTW, he tells me he has cut his hair!)

May the Blessings Be!

Sherrie

By vrolijk
Posted July 5, 2009 at 1:53 pm
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Hi, Kennarina

I must say, that I would not care what a doctor looked like.
The last experience I had was that a doctor came in. Did not say his name he had a white coat. I actually was awaiting a pulmonologist. (Not a cardiologist) in the emergency room.

The doctor came in he could have been a nurse also I would not have known but he acted like a doctor during the examination.

Finally, when he left I asked who he was he said his name. On hearing his name at once I flashed back about 5 years ago. For some reason I did not remembered him like him at all but his name, actually he looked younger now.

Anyway five years ago, He also made a curtain entrance and told me you are going to have an angiogram right now. At that time he never introduced himself at the time either. I said then NO way but they would not let me go.

As I said I do not care what the heck they look like, as long as they have good and have some communication skills, as I have White Coat Syndrome.

My problem is not with high blood pressure, I do get anxious only in medical establishments. I have always low blood pressure, like 90/55 or 100/60 at the highest at home. When in the hospital at once my blood pressure becomes normal, with being there for a while it will drop again to low because I am laying down….. Yes, doctors and hospitals make me anxious because and not without cause! At home you can hardly make me anxious!! Besides after a bad doctor or hospital visit I go nuts and will came down again a day later.

We all have our buttons; yes most doctors are my children’s age right now. I love your story, vrolijk

By Queen_E
Posted July 6, 2009 at 10:09 am
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Ha, this is pretty awesome!
I am sure I would have been taken aback by the outfit, but I'm just a fashion snob.
My first cardiologist had nerdy mis-matched clothes and needed a haircut but was so calm and warm, just what I needed when I was freaking out!
Second cardio is all business, type A; that's OK since I am feeling so much stronger now. And, he's said "Just email me, you don't have to come in" which is super convenient; my primary care doc is the only one I need to see on a regular basis since they are connected thru the HMO system.

By wondering48
Posted July 8, 2009 at 7:30 pm
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This is horrendous! What kind of doctors are running around these days...no respect at all!!!
I would have definitely made a stink about the way
he looked....

By Kennarina
Posted July 8, 2009 at 10:27 pm
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Hi Wondering

Oooops, pls re-read the original post and my response to that first letter to the editor. My point was, and is, that you absolutely cannot judge a doctor's competence by the way he/she is dressed. White coat, no white coat - it's irrelevant, except for more germs on the white coat!

XOXOXO

http://www.myheartsisters.org

By Dee81
Posted July 9, 2009 at 12:48 pm
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I would take the long haired guy who could save my life over some guy who was lucky enough to get a white coat. I don't care what your fashion sense, about your hairstyle...I care about whether or not they care. PERHAPS, he never has time to shop or get a hair cut cuz he is saving people's lives...

I am all for appropriate dress in the office, but in this instance, I could care less...

He is obviously FANTASTIC at what he does, so give the dude a break! lol

By Kennarina
Posted July 9, 2009 at 4:12 pm
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I agree, Dee! In fact, this cardiologist is pretty cool. It's just that his wardrobe (flamboyant printed shirts for example) and his hair (absolutely gorgeous long shiny black spiral ringlets that, as I said, women would KILL for!) is so un-doctor-like when you first meet him.

But it just shows you how different we all are from each other: the letter-to-the-editor writer felt appalled when she first met him because this amazing doctor was not wearing a starched white coat, but when I first met him, I was thinking 'Wow, this guy is unbelieveably cool-looking!'

I'm with you - a doc's clothing or hair styles are no indicator of good or bad bedside manner or skills. This letter writer reminded me of my 81 year old mother - I can just picture her freaking out too if a 'cool-looking' doctor waltzed into her room. She'd much rather have the white coat - even if it was being worn by a burned out, has-been, horror story of a doctor. My mother would also freak out if anybody with an accent speaks to her!!!

XOXOXO

http://www.myheartsisters.org

By Linda_RS
Posted July 9, 2009 at 8:46 pm
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I have a cardiologist that I think very highly of.... a young woman (about 35). A smart, talented woman that is easy to talk to. Interestingly, she likes to wear "fun" earrings that she buys at Kohl's, RiteAid and Target. During a recent vacation, I bought her a pair that I bought from a local artist. I hope that she likes them. I owe her my life.
Linda

By Kennarina
Posted July 10, 2009 at 10:39 am
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Hi Linda

I LOVE that earring example. You know right away when you meet a doctor like that there is a fun, genuine person inside! A doctor with "personality" is not a bad thing, but likely a sign that they can relate more humanely and compassionately to their patients than the starched white coat types.

XOXOXO

http://www.myheartsisters.org

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