The other day I had a patient who presented complaining of chest pain. She was a young adult and had been experiencing this pain in increasing frequency, and it usually happened after she ate or when she was lying down.
When I asked her to describe it to me, she described it as an epigastric, centralized, nonradiating pain that had a burning sensation.
“I want to know what it is,” she told me, “because I know it’s not heartburn.”
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“How do you know it’s not heartburn?” I asked.
“Well,” she said, “it’s in the middle of my chest and my heart is on my left side, so I know it’s not heartburn.”
I looked at her quizzically for a second and then I asked her to tell me what she thought heartburn was. After giving me an explanation about stomach acid and the lining of the heart, I realized this patient needed some education as to what exactly heartburn was.
As I was driving home that day, I started to think about that incident. To me, I’ve always known what heartburn was, and known that it wasn’t a literal term. But I also had the world’s coolest toy crash cart at the age of three and grew up with a lifelong fascination of anything and everything pertaining to the human body. To those that aren’t interested in medicine, however, they hear certain terms that pertain to it and continue on without giving the specifics of their health a second thought.
It’s like me and cars. I’ve heard the term carburetor before and I can tell you what I think it does, but I’m going to be way off. I have absolutely no idea where it is in your car (I’m guessing under the hood) and to be honest, I don’t really care what it means. All I care about is that my car works.
I realized that this is how a lot of patients function when it comes to the human body. I go to the mechanic if I have a problem, they tell me what’s wrong (as I politely smile and nod because it’s way over my head) and then they fix it. All I care about is that it gets fixed. It is the same thing with a lot of patients — they come to us because something is wrong, we tell them what it is, many of them don’t have an interest in the mechanics of it (unintentional but thoroughly appreciated pun) and all they care about is that it gets fixed and their body keeps on running.
As I thought about the incident, I thought about all of the patients whom I have told they have heartburn. Did they know exactly what I meant? Or did they just say “okay”, too afraid to admit they didn’t know what the term meant, or not interested enough in medicine to want to understand it?
This incident has since changed how I practice medicine. No matter how small the injury or the issue, I now make sure to explain to patients exactly what is going on. In this way, they don’t have to worry about being afraid to ask what it means and I am ensured they don’t walk away with a completely wrong of their ailment. It’s a win-win situation all around.
Jillian Knowles, MMS, PA-C, is an emergency medicine physician assistant in the Philadelphia area.
