Like many physicians, Sandeep Jauhar, MD knew from a young age that he wanted to be a physician. And one event started his journey of becoming a cardiologist.
15 years before Jauhar was born, his grandfather suddenly passed away from a heart attack. He had been told his grandfather was in good health. So it made him wonder: who’s to say it won’t happen to me?
And Jauhar was faced with that question sooner than he anticipated.
He shares that he had recently found out that he had plaque buildup in his coronary arteries - the vessels that supply blood to the heart. He knew that if this continued, it could cause him to have a heart attack. Just like his grandfather. This discovery evoked fear but also a great deal of curiosity.
Was there a way to prevent this from worsening? If so, what would it take?
In his most recent memoir, Heart: A History, Jauhar walks us through his path of sacrifice, discovery, and, ultimately, clarity.¹ He explains that since the middle ages, there has been an understanding of the importance of the heart. Only over the last several hundred years has there been an advancement in knowledge and treatment methods of the heart.
These advancements in cardiology were made alongside a great deal of time, effort, and sacrifice. Jauhar discusses the great lengths that brilliant minds went to in order to develop many of the treatments and devices that we so heavily rely on today, such as:
Heart-lung machines that allow open heart surgery
Angiograms, which open blockages in the blood vessels that feed the heart
Pacemakers, which regulate electrical issues in the heart
Implantable defibrillators that correct dangerous heart rhythms
Cardiopulmonary resuscitation (CPR), which can be used to restart the heart
In the end, Jauhar discusses that even despite these remarkable advancements in medicine, we may very well be at the limits of treating and managing diseases of the heart.
"Cardiology in its current form might have reached the limits of what it can do to prolong life."
In order to continue to advance in the field of medicine as a whole, there needs to be a shift from treatment to prevention. And when it specifically comes to the heart, there needs to be a greater focus and consideration of mental-emotional well-being.
The Importance of Keeping in Touch With Our History
Throughout the book, Jauhar takes us back in time as he reviews how we came to learn all that we know about the heart. Until the 17th century, the understanding of how the heart works to pump blood around the body was based solely on theory and belief, not fact.
It wasn’t until William Harvey, an English anatomist, challenged an existing theory about the structure of the heart that advancements were able to be made. At that time, going against the beliefs surrounding the structure of the heart were considered sacrilegious and, frankly, dangerous. It was because of this that Harvey waited 13 years before he published his findings.
Initially his theory surrounding the anatomy of the heart and the path blood takes through the heart and the lungs was rejected and harshly criticized. People had refused to accept his idea because it was new and went against ideas that were already accepted.
But his “theory” is now scientific fact.
While this is just one example, it has reminded me that our knowledge and understanding of the heart has only come as far as it has because of a few brave thinkers that decided to think outside of the box and test their theories.
Today, we present science as if it is a fact inscribed in stone, but we forget that medicine is also an art. Without creative thinkers, like Harvey, to test new ideas and ways of seeing health, we would have never come up with the scientific facts that we understand to be true today.
We unfortunately do not embrace newer thoughts and ideas easily, especially in medicine. We see the Semmelweiss reflex happen far too often.
The Semmelweis Effect
The Semmelweis reflex or "Semmelweis effect" is a metaphor for the reflex-like tendency to reject new evidence or new knowledge because it goes against established norms, beliefs, or ways of thinking.
The Semmelweiss reflex was named after Dr. Ignaz Semmelweis who challenged practices around hand washing. When he was working at a maternal clinic in a hospital in Vienna, Italy, he noticed higher death rates in women who were treated by doctors also performing autopsies.²
He theorized that these higher death rates were because doctors were performing autopsies and then delivering babies without washing their hands or equipment. When he started to have doctors wash their hands and instruments with chlorine, a disinfectant, maternal death rates improved significantly.
But even then, his theory continued to be rejected, and he was rejected from the medical community. It took more than 100 years for his “theories” to become “science.”
I continue to see examples of the Semmelweiss reflex today in the medical community, especially surrounding the importance of mental-emotional well-being when it comes to many medical conditions.
The Significance of the Emotional Heart
Brave thinkers have gifted us with the knowledge we now have surrounding the physical and structural heart. But the significance of the emotional heart has still not been entirely accepted by the medical community.
Jauhar discusses this throughout his book and concludes that there may not be much more we can do to improve patient health and reduce mortality rates by only looking at the physical heart. We can only continue to make progress by also considering mental-emotional factors.
“What [many physicians] have concluded is fully consistent with what I have learned in my two decades in medicine: that the emotional heart affects its biological counterpart in multiple mysterious ways.”
Jauhar discussed one example of this phenomenon, which is called broken heart syndrome. Broken heart syndrome is also referred to as Takotsubo cardiomyopathy, and it’s a condition where the muscle of the heart itself changes shape when a person endures a significant amount of mental-emotional stress.
It’s most often seen when a person has gone through a tragedy, such as the loss of a loved one. However, there have also been observed cases in multiple people who have experienced a tragedy in their community. The effect on the physical heart can be so significant that it often causes symptoms that mimic a heart attack.
For my entire career, I’ve loved observing and have been mesmerized by how the physical body changes with mental-emotional shifts. And I’ve seen how it can affect my patients, such as with broken heart syndrome. That’s why it’s imperative to not only treat the body, but the mind as well.
The Need for Integrative Medicine
Despite the overwhelming evidence that mental-emotional health can affect the physical heart, there continues to be a lack of acceptance by the medical community. Many of my patients have told me stories of how previous providers have shrugged off and disregarded different ways of treating their medical conditions because they weren’t largely accepted.
Even though Jauhar discusses that new avenues need to be taken to continue to move forward with our understanding of the heart, he unknowingly gives us an example of the current prejudice in medicine.
He discusses how one of his patients with advanced heart failure was hesitant for years to take medication and receive what Jauhar believed to be proper treatment for his condition. When his patient voiced his concerns and sought out alternative approaches for his heart, Jauhar disregarded him.
He stated there was no other way.
But how do we know this? This sounds awfully like the doctors that questioned Semmelweis’s theory for years, which is now one of the foundations of medicine today. Despite his dismissal of his patient’s ideas for alternative treatment, Jauhar does realize there needs to be a change with how we approach medicine.
Because how else will we continue to advance our understanding of the body?
"We will need to shift to a new paradigm, one focused on prevention."
And Jauhar eventually accepts this in regards to his own personal health. He accepts the limitations available to treat his physical heart but realizes there is so much he can do for his emotional heart.
I envision and hope for there to one day be a world where modern medicine has more acceptance and humility around its limitations. And by doing so, it will allow medicine to transform into something more openly dynamic and creative, which will better benefit patients and the medical community as a whole.
Citations
1. Sandeep Jauhar. HEART: A History; 2019.
2. The Doctor Who Championed Hand-Washing And Briefly Saved Lives – (npr.org)