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by
Theodore Dalrymple

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January 29, 2014 - 11:30 am
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It is a hard lesson in life that many of the most important things that happen to us are beyond our control. Indeed, a large part of wisdom consists of the willingness and ability to distinguish what is and what is not happenstance. The distinction, however, may be very difficult: and while too little fatalism leads to fruitless struggle, too much leads to acceptance of the avoidable.

A recent study from the Mayo Clinic published in the British Medical Journal examines patients with myocardial infarction (heart attack) presenting to hospital out of hours and those who present during normal working hours. They pool the data from all the studies that have been done around the world, and come to the conclusion that patients presenting at nights and weekends have a 5 percent increased risk of death. It therefore seems best, if you must have a heart attack, to have it during regular hours, though this is difficult to arrange for yourself.

Interestingly, subsidiary findings are first that the difference between the death rates has been increasing of late; and second that the difference is less in the United States than in Europe, where it is less than in other parts of the world. Could this mean that, at least in one respect, the American health care system is better than others around the world?

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All Comments   (9)
All Comments   (9)
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33 weeks ago
33 weeks ago Link To Comment
Thanks, Theodore. Now instead of just worrying about having a heart attack we can now worry about whether it's during business hours or not. At least it'll make people wear pajamas.
34 weeks ago
34 weeks ago Link To Comment
aharris, Congratulations. You're correct and you're right that it is counter-intuitive. I've seen University Statistics professors get this wrong and argue about it with their peers.
34 weeks ago
34 weeks ago Link To Comment
If it ever comes to a heart attack, I'm screwed. I have a bone spur in my neck, and it mimics all the early pain symptoms of a heart attack thanks to the pressure it puts on the nerve in my left shoulder. I always have some degree of pain in my left shoulder, arm, chest, back, etc. By the time I figure out it's not that stupid bone spur, it'll be too late.
34 weeks ago
34 weeks ago Link To Comment
In other news, water is wet
34 weeks ago
34 weeks ago Link To Comment
Could it also be the doctors stuck working the night shift are newer, less experienced and haven't even figured out how to avoid the night shift yet let alone treat a heart attack victim?
34 weeks ago
34 weeks ago Link To Comment
Missing entirely from the report, and the real reason most would take the time to read it, is which is the likeliest time frame of having the heart attack - during the day or night? The result given (ever so slight increase of death at night) was not news. Time to get an ambulance to a residence, reduced staffing at night, overuse of off-hour emergency rooms for non-emergency care, etc., make the 5% higher death rate at night almost seem too small.

If the study used data from so many studies, tell us something more useful. What was the percentage difference between heart attacks occurring during the day compared to one's presenting overnight?
34 weeks ago
34 weeks ago Link To Comment
5% isn't much. What was the margin for error? Bet it was much greater than 5%. And the statistics themselves sound suspect; to use a one time study of a relatively small cohort of cases to derive a 5% could be due to all sorts of variables, none of which are related to time of day.

For those who consider themselves probability and statistics savvy, try the Monte Hall problem: 3 doors, fabulous prize behind 1 door only, you choose 1 door, before the curtain is opened, Monty opens one of the other two doors to show it doesn't have the fabulous prize, then he asks you do you want to stick with your first choice or switch to the one other remaining unopened door. Which answer, stay or switch, gets you a higher likelihood of winning the fabulous prize? The answer might surprise you.
34 weeks ago
34 weeks ago Link To Comment
I watch Mythbusters. Switching gets the better chance of winning. It seems counterintuitive, but it's true. The math all works out, and it's very, very odd.
34 weeks ago
34 weeks ago Link To Comment
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