Doctors do more in our society than treat the ill. One of the hardest things for a young doctor to get used to after all the in hospital training with the sick and dying, is the role of the doctor in the community. Most patients are seen at times when they are well for preventive checks. Many of our duties relate to filling out forms about health for school, or for insurance.
Others involve the relationship between medicine and the law with health certificates for licenses, death certificates or court settlements. Sometimes our duties in the legal sphere emphasize important lessons. One such legal case that I was peripherally involved in has some public interest.
An overweight man with high cholesterol had a physically demanding job that was made more demanding by the failure of equipment to operate properly. Over a 2-week period he became increasingly aware of chest and shoulder discomfort from increased muscle work. He alleviated this somewhat by generous applications of Ben Gay. On Saturday (a non-work day) morning, he awoke with further chest pain, and was diagnosed as suffering from a heart attack, despite relatively normal coronary arteries.
The working man will have trouble winning his case, because the heart attack occurred outside of work, and he did not report the chest pain until after the fact.
The most cynical observer would say that he "found the pain" only after the heart attack so that he could relate it to (blame) work, and perhaps be eligible for workers compensation or to file a suit against his employer.
The most ingenuous would believe that he really did not understand that this was cardiac pain, until he was told of the heart attack, and that clearly the heart attack was caused by "physical stress". If he related that someone yelled at him during the week, "mental stress" would also be invoked.
Employers might note that had he documented his problems by advising his superior at work of the nature of the problem, a better solution would have been reached. Family members would undoubtedly distribute the blame both on the man for his weight and cholesterol on the workplace, employer, and the legal system that didn’t protect him.
Lost in legal arguments about the case are the most important lessons. Had the man, his supervisor, coworkers, neighbors, friends or family heeded the warnings, the outcome would have been quite different. Lessons that are relatively easy include:
Know your risk, and learn to recognize and appreciate the risk in others as well as yourself.
Should it really be a surprise if a colleague, friend, spouse, neighbor, employer, employee, or even a stranger who starts noting chest or shoulder pain might have a heart problem? Shouldn’t we all be concerned about this in anyone over the age of 40 who is overweight (and more so if they have high blood pressure, high cholesterol, diabetes, smoke, or have a family history of heart disease)?
Know what to do in an emergency.
Anyone can call 911, even children. Anyone can advise someone to seek medical care right away. Aspirin is available almost anywhere (I would bet that if you asked out loud for an aspirin in any coffee shop in the land or store in the country, someone would have one in case of an emergency). More lives are saved by bystanders who get patients under care quickly than by expensive medical technology. Be a hero, it is a feeling like no other. Learn the symptoms of heart attack and stroke.
If you or someone you care for is at risk, have you prepared for it?
The American Red Cross and the American Heart Association have affiliates in almost every region made up of mostly volunteers. They are eager to teach people first aid, CPR (cardiopulmonary resuscitation) and even advanced courses on life support. I think that these should be required courses in the schools. They are easy, designed to make you more confident, and a better member of your community.