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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  • http://www.facebook.com/profile.php?id=100000727893470 Sherri Schultz

    Boo-hiss. What this articles fails to take into account is that communication is a two-way street. I cannot tell you how many women (and men) who have sat in front of a doctor only to be dismissed and to be treated as if they are either crazy or to be blamed for their illness, when the doctor who is supposed to be knowledgeable but is not able to intepret the patient’s symptoms and/or sometimes is not qualified to interpret the lab results. I see this over and over again. Patients who are abandoned by the medical community because of a lack of knowledge or interest in the patient. Many patients that I work with often have illnesses that are little understood or rarely recognized and who have been left to suffer on their own.

    What this article does is to reinforce the idea that the doctor knows best and that we are to be obedient even if it kills us. Time and time again, doctors dismiss the value of the patient’s interpretation of what is happening to their own bodies and the patient’s capacity to learn. How could we ever possibly be good patients when the doctors dismiss us and belittle us and leave us out of the conversation. This article exemplifies the medical community’s attitude by presenting worst case scenarios regarding a patient’s knowledge and thereby placing the doctor on a pedestal. Is it not the medical community’s responsibility to have informed patients?

    Friends, start talking to your loved ones about their personal experiences. Were they listened to? Did the feel as though they were in a partnership with the doctor? Was the doctor interested in pursuing a full diagnosis or was the patient ignored and finally dumped?

  • Dinah

    I am a physician and I found this article offensive. It has a mocking tone that is condescending and disrespectful of patients. In the first example, you wonder why no one at the hospital spoke with the patient about his metal staples and the protocol for their removal. The other examples are of people doing stupid things (a coffee enema? Black Flag?) not necessarily as an in-your-face to medicine, but perhaps they believed it would be helpful. I’m not sure their poor judgement says anything about patients and their relationships with their doctors beyond highlighting that there are people out there with false beliefs and poor judgement. And it’s surprising that a patient with side effects stops a medicine? Maybe I missed something….halfway down, I thought oh, he’s mocking the health care system for not communicating, not the patients, but then I wasn’t sure.

    • RJones

      I disagree. I did not find the article mocking in any way.

  • Dbmd

    Actually I thought it was funny. Lighten up. I once had a family diligently put a full teaspoon of zyrtec up a 2 year old’s nose for months. They came back because the medicine was making him more congested. The prescription clearly said by mouth along with my verbal directions.

  • Dinah

    Perhaps I am…I think if I read it as an article about common sense and people who do bizarre things, I would not have been offended, it was the “remember you are the patient and the doctor is the doctor”, repeated a couple of times…and the story of patient stopping the heart medication and fainting (neither funny, nor bizarre) that distracted me from the common sense themes of don’t spray yourself with Black Flag, give yourself a coffee enema, remove your own staples, or stick the zyrtec up the kid’s nose. At any rate, there’s something in the sarcasm here that was not clear and could be interpreted as condescension, but perhaps I got it all wrong.

  • http://www.facebook.com/people/Tom-Fitzsimmons/1405121136 Tom Fitzsimmons

    Dinah, this is the least of it. The tone was not THAT condescending. What scares me is the tone most docs assume in more serious articles. You’d think they were treating chimps. No offense to the chimps intended.

  • rxwench

    Hmmm…maybe I should write a condescending article about all the stupid prescribing decisions I’ve seen as a pharmacist. Or should I just “let the physician do his job?”

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