Staying Up-to-Date: Heart Attack Guidelines

Every year the rules change. The one constant about sports is that during the off season and sometimes during the year, the commissioner, the president, or the owners will sit down and tinker with the way the game is played. Doesn't matter which sport, it happens to all of them. The referees and players get updates and adapt their play to the new rules. Ever diligent, the fan follows along, learns, and adapts to the changes. How else can the referee or umpire be second-guessed, except by those who really care about the game?

But the rules change for the world outside sports as well, and never more frequently or dramatically than in medicine. Every aspect of medicine from diagnosis to treatment, medications to technology, is exposed to newer and potentially better ways of doing things.

Heart attack is a good example of what was - and what is. Twenty-five years ago the treatment for a myocardial infarction or heart attack was hospitalization for two or three weeks followed by a gentle exercise program that limited walking to a few feet per day. Now patients who had bypass surgery are up and walking out of the hospital in four or five days.

We learned about intravenous medications to stabilize hearts. TPA was discovered, and medical care changed from being reactive to proactive since a clot-busting drug could be used to reverse heart attacks. Then came emergency angioplasty and stents to open up blocked heart blood vessels as the heart attack was occurring, aborting the attack and fixing the problem at the same time.

So how does your doctor learn this stuff? Hopefully not from TV news programs - and not from this article. Reading is one key to stay current, and but there are so many medical journals and so many articles that it is easy to feel overwhelmed. Textbooks may be outdated even before they are published. Websites are becoming more useful, and online information is often updated daily or weekly.

Conferences can shape a doctor's practice and spread the word on what's new and exciting in medicine. Lectures lead to question and answer periods and discussions in hallways. Speakers spend as much time answering questions as they do giving their speech. In the past, the medical conference had earned a bad reputation. The perception was that docs headed to fancy resorts, got wined and dined, and spend little time learning anything at all. It was a dodge to get a tax-deductible vacation.

Perception isn't reality, though. There is so much to learn and so little time. While some doctors practice in larger teaching hospitals and have access to the latest and greatest research and tools, many are isolated in smaller towns or inner cities, where resources are slim and there is limited opportunity to interact with colleagues. Medical conferences are hard work and exhausting.

When the American Academy of Emergency Medicine stages a scientific assembly, lectures usually begin at 8am and lasted until 5pm. Most of the time is spent at in lecture halls with hundreds of other emergency doctors...learning medicine. Some of it is stuff I know, but some is brand new.

The American Heart Association and the American College of Cardiology had just released new heart attack treatment guidelines at the end of December 2007, for example, and there I was, in a classroom in Florida, hearing about them four weeks later. And three days later, I was sharing these same new guidelines with my emergency colleagues, so that we could put them into practice. This information explosion was likely happening in hospitals around the country. New guidelines and new ways of getting patients the care they needed was being spread virally, one doc at a time, to thousands of ears.

There are no fans in the ER holding my feet to the fire when I practice medicine. My patients expect me to be just as good as the referee on the field who is expected to make every call, the right call. The fans expect the umpire to know the rules, and I expect my patients to care enough to ask me questions, to explain what I'm doing, and to always ask why. If I'm lucky enough, I may know the answer; if not, I have some reading to do and will get them the answers they want and need.