Explaining cardiac interventions: Using analogies to improve communication

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Dr KK Aggarwal

The doctor-patient relationship is the foundation of practice of medicine. And, communication is the key factor that decides the interaction between the doctor and his/her patient and influences outcomes.

Doctors are bound, both ethically and legally, to provide adequate information to the patient so that the patient can participate in the decision making process and are in a position to take an ‘informed’ decision.

Any information given to the patient should be in a language, using words or using terms he/she can understand.

But do patients really comprehend the information that is given to them during the process of informed consent? The science of medicine is abound with complex concepts. Medical terminology uses technical words and jargon that are unfamiliar to the patient and difficult to understand. This may hinder the effectiveness of communication.

One way to improve communication and enhance understanding of medical information is by using analogies. The dictionary meaning of an analogy is a ‘resemblance between two situations, people or objects that are otherwise unlike, especially when used as a basis for explanation’.

Analogies are situations that are familiar to the patient and so easily understood. The information is also better retained. Hence, using analogies to explain complex medical terms or concepts can improve doctor-patient communication.

This is how I explain cardiac interventions to my patients. I take the example of traffic management, a situation familiar to all.

For any traffic management, following are the options:

• Placing traffic signals can be equated to dos and don’ts of lifestyle management.
• Posting a traffic inspector on the crossing. This can be equated with a clinical cardiologist.
• Diverting the traffic from main road to side roads. This can be equated to opening collaterals by drugs and/or exercise.
• Hiring an architect to make maps. This can be equated to an angiographer (cardiologist) doing angiography.
• Looking for the possibility of widening the roads. This can be equated to balloon angioplasty.
• To prevent encroachment of widened roads to place railings around the widened roads can be equated to placement of metallic stent.
• To prevent mishandling of railing, safety grills are put. This can be equated to drug-eluting stents.
• When the roads cannot be widened, flyovers are made, which can be equated to bypass surgery.
• Flyovers can be made by stopping the traffic. This can be equated to open heart bypass surgery.
• Flyovers can be made without disturbing the traffic, this can be equated to heart bypass surgery.
(Disclaimer: The views expressed in this write up are entirely my own)

Every arthritis is different with different treatment methods

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A combination of diet, medication, and exercise can help in reducing inflammation and pain

New Delhi, 12th October 2017: As per statistics, arthritis affects about 15% of the Indian population, which is over 180 million people in the country.[1] Women are more prone to develop arthritis than men as evident in a recent survey, which showed high erythrocyte sedimentation rate (52.07%) and Rheumatoid Factor (13.08%) in women as compared to men.[2]

Arthritis is an inflammation of the joint and can affect one or multiple joints. While arthritis is most commonly seen in adults over the age of 65, it can also develop in children, teens, and younger adults. There are several different types of arthritis, each with different causes and treatment methods. Osteoarthritis (OA) and rheumatoid arthritis (RA) are the two most common types of arthritis.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “OA is caused by the normal wear and tear of bones. This natural breakdown of cartilage tissue can be further exacerbated by an infection or injury to the joints. RA, on the other hand, is an autoimmune disorder, which occurs when the body’s immune system attacks the body tissues. RA invades and destroys a joint and can eventually lead to the destruction of both bone and cartilage inside it. OA can be compared to rusting of a door joint and RA can be likened to termites affecting the joint. While OA, also called as green arthritis, may require only painkillers and rehabilitation exercises, the red inflammation arthritis called RA, if not treated early and aggressively, can end up causing serious deforming complications.”

The most common symptoms of arthritis are joint pain, stiffness, and swelling. Arthritis also decreases the range of motion and a person can also experience redness of the skin around the joint. Pain is worse in the morning in people with OA.

Adding further, Dr Aggarwal, said, “Treatment of arthritis revolves around reducing the amount of pain and preventing additional damage to the joints. Some people find relief with heating pads and ice packs while others can use mobility assistance devices such as canes or walkers, which can help in taking pressure off the sore joints. Doctors usually suggest a combination of treatment methods for best results, including medication and physical therapy.”

Here are some other things one should consider.
• The best exercises for osteoarthritis are brisk walking, aerobics, cycling, and swimming.
• One should not give painkillers in osteoarthritis for more than three months. It is always better to try methods which can omit painkillers. It is a myth that glucosamine helps. In acute arthritis, one can try cold fomentation and in chronic cases, hot fomentation.
• Weight loss and maintaining a healthy weight can help reduce the risk of developing OA and reduce existing symptoms.
• It is important to consume a healthy diet for weight loss. A diet rich in lots of antioxidants, such as fresh fruits, vegetables, and herbs, can help reduce inflammation. One must also avoid fried and processed items, dairy products, and high intake of meat.
(1) http://www.arthritis-india.com/
(2) As per survey conducted by a leading diagnostic chain