Three years ago Sid was taken to A&E with chest pains. There was a flurry of White Coated Doctorly activity, and exercise ECG (negative), Blood tests (all normal), and even, after a brief interval, angiography (wide patent coronary arteries throughout). Despite all of the above he was stuck with a label of Angina and ended up on a plethora of meds, including beta blockers, aspirin, a statin and a diuretic.
The whole process took a couple of months during which he was going to and fro to the hospital, and so was not available for work. This underlined to him the severity of his condition. And yet, throughout it all he carried on smoking twenty a day.
A short while later his heart rate fell catastrophically low, leaving him faint and wibbly all the time. His beta-blockers were duly stopped and he got a lot better. He continued to get chest pains, and so, almost as an afterthought, he was referred to gastroenterologists and had a gastroscopy. This revealed inflammation throughout the stomach and oesophagus-- a common cause of chest pain. So he started more meds for this. The pain got a bit better, but his other meds all continued as before (except his aspirin, given that it causes gastric inflammation) because, after all he had had angina. Still he smoked just as before.
Two years later ( and still with a twenty a day habit) he went to see a new cardiologist. The cardiologist looked at the results, and at the patient, suggested that the pain might not be angina after all, that it would be a good idea if he stopped smoking, and that he might like to see a chest specialist. This really upset Sid, and his wife Joelene. They are convinced he has angina. After all he was told so years ago, and the lack of confirmatory evidence in the interim has no bearing on this. And it's a damn cheek for the cardiologist to tell them he doesn't and then to tell him to stop smoking anyway.
The problem here is the "knee jerk" reaction at the front door of the hospital that attempts to neatly pigeonhole symptoms and channel patients down "pathways" so that independent thought by junior staff can be avoided.
He undoubtedly had chest pain when he went in. It definitely got better after a short interval. Whether the meds truly had anything to do with this is far from proven, but cannot now be disputed after the fact. And now, because his second cardiologist handled his last consult clumsily by daring to mention smoking and not venturing to repeat any of the (previously normal) investigations, rather than being delighted to hear he probably doesn't have angina at all, Sid is now determined to prove the point by seeing a third consultant, and is even less likely to quit the weed.
It's obviously been a cantankerous week, but for me Suid and Joelene, with their millitant smoking habit have hammered in the final coffin nail.