When patients stray from the common sense approach to health care

It turns out that the practice of medicine is just common sense.  If someone has fallen and their hip hurts, it is probably related.   If someone does not have an infection, do not give an antibiotic.  Exercise and good food are, well, good for you.  If it is not broken, do not fix it.

Usually, patients understand this basic idea.  The best chance of becoming and staying healthy is the simplest action.  Take your medicine.  Get plenty of rest.  Most important, remember that you are the patient and the doctor is … the doctor.  Let the physician do her job and you do yours.  Unfortunately patients, at times, seem to stray from the common sense approach to health care.  When they do take medical matters into their own hands, strange things may occur.

Bill had part of his colon removed.  The surgeon was successful in curing his cancer. However, Bill was astonished when he got home to find a neat row of metal staples still sticking out of his belly.  So Bill, ever industrious, used needle nose pliers and wire cutters to remove most of the offending pieces of metal.   He was surprised when part of the wound opened up again.  Back to the hospital went Bill.  Lesson learned; let the doctor finish the job he started.

There was the gentleman with the feeding tube.  A gastroenterologist had placed this tube, under careful sterile conditions.  It entered a small incision in the skin, dove through muscle layers and ended in this gentleman’s stomach.   This allowed liquid nutrients to be given directly, while he was recovering from neck surgery.  One day he rolled over in bed and the tube was pulled out.  In a moment of questionable judgment, he shoved it back in.  This action became significantly painful when he poured feeding solution into the tube, which now lay in a space next to, but not in the stomach.  Lesson learned; nothing is quite as simple as it seems.

One of my favorite patients, Lillian, was receiving medication for her heart.  Unfortunately, it gave her diarrhea.  However, always resourceful, Lillian came to a clever solution.  She only took the vital heart medicine when she was constipated.  Lillian called to complain of fainting spells.  Lesson learned; medication side effects are not a good thing.

In the emergency room, I saw a patient with extensive burns along his legs and abdomen.  It turns out that he, unfortunately, had developed an infection with scabies.  This bug causes a rash and itching.  Most unpleasant.  However, the burns were because of his innovative solution, liberally supplied.  Black Flag Insect Spray is not recommended for medicinal use.  Lesson learned; there is a difference between people and bugs.

Every doctor has seen patients cut off a cast far too soon.  After all casts can become heavy, itchy and hot.  Take my word that an electric power saw is not the recommended tool.  Steve required 52 stitches for three separate lacerations.  The lesson learned here is one that every first year surgical intern knows too well; when the patient starts to bleed, stop.

Common sense judiciously mixed with an abundance of communication goes a long way.  Do not take someone else’s medicine.  Do not make your own diagnosis.  Get training on how to take care of wounds, and not from the Internet.  Do unto your body as you would unto someone else’s body that you really loved.  Do not hesitate to call your doctor for help.  Your body does not have interchangeable parts, is a very complex machine and it is irreplaceable.

Not long ago a patient of ours was admitted to the hospital with a ruptured bowel.  In order to “purge” his body of toxins he had liberally used an old useless folk remedy, the coffee enema.  Unfortunately, the pressure and irritation from the enema caused his colon to burst requiring an emergency colostomy.  The lesson learned here was best explained by one of my partners.  Sitting at the bedside, holding the patients hand, looking into his eyes, the doctor said, “Next time use decaf.”

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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