Correspondence (reply): In Reply

Professor Donner-Banzhoff is correct: Patients in the acute early stages of myocardial infarction fear calling out emergency rescue services and "no campaign in the world seems to have been able thus far to change that particular behavior." Population wide campaigns actually have resulted in measurable successes, but the effects are often disappointingly small and only short term. The expectation that affected patients in their acutely threatening situation may realize the core symptoms of myocardial infarction seems misplaced. In order to be able to help patients in acute, life threatening crisis situations, we propose paying more attention to the psychological and emotional aspects of decision making behavior in response to the aversive acute symptoms (1). As so often, many paths lead to Rome. However, the general practitioner plays a central role in his or her structured advice to high risk patients–long before anything actually happens (which symptoms are present, what is the correct behavior, what is the emergency services’ telephone number, which typical mistakes are made, and which "false" thoughts spring to mind?). This would be an important step towards a shared decision making process," which is crucial in terms of patient satisfaction and may therefore also support adequate risk avoidance behavior (2).

The suspicion that sensitizing affected patients can turn them into "cardiac anxiety neurotics" may be well founded at first glance–but for a psychoneurotic development into a somatoform disorder, the reason usually is that a patient suffers with an irresolvable conflict in his or her life’s reality and not that they know the disease symptoms or some such. Studies of the cost-benefit effect of campaigns have shown that the benefits gained from the timely admission of genuinely positive coronary patients to hospital outweigh the disadvantages of false positive emergency doctor call-outs (3).