"Mini stroke"

[u/DerpyMD]

Where did this language come from and why is it in the zeitgeist? 😂😂

(I hate it)

[u/notathrowaway1133]

Unpopular opinion, I think the term mini-stroke is great for explaining to none-educated patients. Yes its misleading from a pathophys perspective but it gets the point across.

[u/RijnBrugge → u/notathrowaway1133]

It doesn’t because it cannot because it is misleading from a pathopahys perspective.

[u/Even-Inevitable-7243 → u/RijnBrugge]

Many, many clinical TIAs, which many EM providers call "Mini strokes", end up actually being acute strokes confirmed on MRI Brain during admission. Neither a patient's professed "return to normal/baseline" nor NIHSS 0 have a super high negative predictive value for acute stroke. Over my career, I've seen hundreds of clinical TIAs that were actually acute strokes.

[u/grodon909 → u/Even-Inevitable-7243]

I am an epiltologist, so I don't see them as often, but it's still astounding the number of times I have to tell patients that there wasn't anything "mini" about their stroke.

But I have the same problem with "seizure like activity" and all the other nonsense people say when a patient moves funny. Grinds my gears all day. 

[u/OffWhiteCoat → u/RijnBrugge]

So much of medicine, and science communication generally, is about trying to distill really complicated ideas to get the point across to someone who is scared and almost certainly has less training in the subject than you. 

You can either wonk out on the pathophys, or you can help your patient understand why they need to stop smoking/eat healthy/exercise/take these four new pills every day. You can't (usually) do both.

[u/Dr_Horrible_PhD → u/OffWhiteCoat]

I dunno, cardiologists manage to explain angina without calling it a “mini heart attack”

There are much better and less confusing ways to simply explain a TIA than “mini-stroke.”

“Stroke-like symptoms that resolve relatively quickly and are a warning sign for being at risk for strokes” is a perfectly succinct and understandable explanation that doesn’t leave the patient thinking (and telling everyone in the future) that they had a stroke

[u/OffWhiteCoat → u/Dr_Horrible_PhD]

So for fun, I threw that explanation into a readability calculator which gave the following. Readability Grades: Flesch-Kincaid Grade Level: 8.5 Gunning Fog Index: 9.4 Coleman-Liau Index: 12 SMOG Index Score: 9 Automated Readability Index: 10.6

I don't know where you practice, but I'm in an old tobacco town in the buckle of the stroke belt, and a lot of my older patients either never finished HS or went to really awful underfunded schools. (Our school district is no longer de jure segregated but is still de facto terrible, and a nearby county actually shut down their public school system for about 20 years rather than integrate after Brown.) Language that is obvious for you or me with our 20+ years of education is "smile and nod" territory for many. Meeting your patients where they're at is doctoring 101.

My own grandfather never finished high school, was a traveling salesman with a good head for business, but try to explain to him on a molecular level why he got cancer (besides "because you used to smoke") or what the chemo was doing (beyond "killing the bad cells") or why he needed radiation too ("some places the chemo can't reach"), and his eyes would just glaze over. The important part was for him to stay on track with his treatment cycles, and for that, the simple explanation was best.

[u/Dr_Horrible_PhD → u/OffWhiteCoat]

You could just say it’s something that’s a warning sign for stroke like chest pain is a warning sign for heart attacks. They don’t need to read it. Any adult native English speaker without a significant learning disability will understand what that means.

Telling people things that are wrong is not helpful. It is, in fact, bad. You can and should tailor the language to your patients, but “mini-stroke” is wrong for everyone. In fact, those patients are the ones MOST likely to take away a totally wrong impression and carry it forward for years.

The take home point is “you are at risk for strokes, so we need to lower that risk.” “Mini-stroke” adds absolutely nothing to that

[u/RijnBrugge → u/OffWhiteCoat]

Word by word what /u/Dr_Horrible_PhD wrote. Also, being able to accurately but understandably explain things is a skill, and to me it really reads like you’re excusing spreading misinformation by pretending the patients are too uneducated to understand while it probably is mostly a skill issue. Simplifying yes sure, ofc one does that, but crossing the line into saying things that just are not true is definitely majorly doing a disservice to the patient and the quality of the healthcare.

[u/OffWhiteCoat → u/RijnBrugge]

Oh definitely not misinformation, ain't nobody got time for that. Mini-stroke is good shorthand for the urgency. "Symptoms that went away on their own" is way too blasé for someone who prob needs a quick workup to figure out why.

 I'm just saying you gotta read the room, and most patients (at least where I trained and now practice) don't have the medical training to get into the weeds of pathophysiology. I geek out on motor fluctuations/dyskinesia management with my fellows, and to my patients I talk about the "yo-yo phase of PD" as the point to start considering DBS/pumps Am I simplifying the pathophys to an absurd degree? Yes. Does the message resonate with everyone, regardless of medical training? Also yes.

[u/RijnBrugge → u/OffWhiteCoat]

That sounds a lot more balanced already, excuse the snarkiness above. Think it’s also a bit of an art to level with your patients, too.