Heart patients must listen to professionals

From: Staten Island Advance, NY - Dec 22, 2003

There are patients who hear -- and understand -- but do not follow the directions suggested by their doctors

Monday, December 22, 2003

Recently I was asked to provide some thoughts on treating hearing impaired patients that would be included in a book on the attitudes of hearing people toward the deaf. It was a wake-up call to normal healthy people, alerting them to understand the problems of being deaf and the need to utilize better methods of communication with them.

There was a short medical section detailing, for health care workers, how to elicit symptoms. It also spelled out the legal rights of the deaf to be provided with an interpreter to facilitate communication.

I emphasized the void that existed when communication with the deaf is inadequate and the fear, the unease and the abandonment felt by the deaf patient as a consequence. I suggested that the health care worker schedule more time with each patient and that he actively solicit questions rather than settle for the usual brush-off, "Any questions?" as he exits the room.

A tremendous amount of anxiety is relieved and confidence built up by the expression in the normal speech patterns. This verbal body language is completely lost on the deaf patient and must be made up by physical contact -- an arm around the shoulders or squeezing the hands -- intimate enough without being perceived as overstepping the social bounds of patient-doctor relationship.

I finished my advice by discussing the absurd lengths we are forced to go in the new privacy act known as HIPAA. The merest hint of medical information which is discussed or revealed without the patient's consent constitutes a heinous federal crime with significant penalties. I warned that raising one's voice for the benefit of a hearing-impaired patient sharing a room with another patient could, theoretically provoke a lawsuit.

SELECTIVE HEARING

As I concluded my assignment, the thought kept growing on me that one does not need to be deaf in order not to hear. In fact, I know of countless patients who have a selective hearing impairment. They cannot hear their spouses or mothers or, even worse, their doctors.

I want to emphasize this last point. There are patients who hear but do not believe enough or comprehend enough to follow out the directions suggested by their doctors. They admit, with a laugh or a shrug, that they haven't carried out the previous suggestion, be it more exercise, less food or cessation of smoking. They focus much more on the fact that it is difficult (too difficult) rather than it is essential. Their doctors repeat the requirement, the patient promises to obey but at the next office visit, nothing has changed.

The doctor should try again and again but there comes a time when the doctor must admit that he is doing the patient no good. He is unable to institute the necessary remedy and becomes frustrated and angry. At this point, it is best to walk away, to tell the patient that he needs a new doctor, one who can effectively change, for the better, the patient's attitude to the medical needs. The threat of losing his doctor will occasionally work the transformation into a compliant patient. However, I have -- at times -- carried out the threat, not legally abandoning but confessing inability to help the patient.

WORKING TOGETHER

Heart patients, even with the worst family histories and galaxies of risk factors, have so much they can do to avoid trouble that noncompliance is incomprehensible to the involved, concerned cardiologist. Patients tend not to realize that treating them must be a pleasant cooperative experience for the doctor. When the doctor is repeatedly denied this satisfaction, there is no wonder that he will lose interest and commitment. There is so much to do for patients whose illness is not of their own doing and doctors are so busy attending to appreciative patients and deriving satisfaction from their joint efforts that it is no wonder that their interest and concern disappears when confronted with patients who repeatedly are unconcerned about their own health and disinterested in following the doctor's advice.

This is the very worst form of deafness and there is no psychological hearing aid that I know of that can restore this type of audibility.

As the New Year thunders (and rains and snows) down upon us, recognize how precious is time and how in maintaining our health, we can not squander this moment. Putting off the medical advice to another day may find that day not there!

But this is a time of renewal and hope and the message of Chanukah and Christmas deserves to be heard. It does not require an interpreter to translate this message into a resolve for a happy and, above all, a healthy future. That is my wish for all my readers at this joyous but ever-so-rapidly- passing moment.

Dr. Dennis Bloomfield is a cardiologist affiliated with St. Vincent's Medical Center and is president of the Staten Island Heart Society. His column, Heart on your block, appears Mondays in the Health & Fitness section. Questions and comments can be addressed to him in care of the Advance.

Copyright 2003 The Staten Island Advance.