Correspondence
The Causes of Prehospital Delay in Myocardial Infarction: Well functioning lay system
Dtsch Arztebl Int 2008; 105(41): 705. DOI: 10.3238/arztebl.2008.0705a
The authors complain about the fact that patients with myocardial infarction alert the rescue services too late, that they ignore symptoms, and that they seek help from all the wrong parties (family, general practitioner). This complaint is ubiquitous, and, aware of how unsuccessful all efforts thus far have been, we should think about whether the problem is articulated in the right way.Everyday, we notice physical signals; these include pain stimuli for which no clear explanation exists. We either ignore these stimuli, apply plausible explanations, or treat them with household remedies or self medication. We may talk to partners or friends, whose advice may help us cope. In this layperson's system, most health problems are successfully dealt with.
Once we have reached an age when coronary heart disease becomes common, we have applied these strategies for many years and with great success, and that includes chest pain. All ailments have disappeared, even without consulting a(n) (emergency) doctor. What the authors are complaining about is thus an extremely limited number of cases in which the functional layperson's system fails owing to misinterpretation. If we want to lower the threshold for people to seek professional help we will also do so for people who are not ill; we should think long and hard about this (the authors are familiar with the problem of somatization).
The current data do not allow the conclusion that the decision is delayed if general practitioners are consulted. This is a scenario of "confounding by indication": people choose this path especially in case of uncertainty. Since they fear calling out the emergency rescue services, and no campaign in the world will change that, a call to the general practitioner will in fact accelerate the alarm. DOI: 10.3238/arztebl.2008.0705a
Prof. Dr. med. Norbert Donner-Banzhoff, M.H.Sc.
Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin
Philipps-Universität Marburg
35032 Marburg, Germany
Norbert@med.uni-marburg.de
