Tuesday, August 12, 2014

Why Come To The Doctor In The First Place?

William was doing great.  His C Diff  was finally gone after a month taper of vancomycin.  He was stronger.  The nursing home staff reveled in how much progress was being made over such little time.  It seemed every one was ecstatic, except for, of course his family.  Every step this octogenarian took forward was accompanied by a litany of concerns and complaints from his daughter.

If he was not gaining weight, she wanted to know why.  If he then put on a few pounds, she wanted his diet restricted.  Through each "emergency" I calmly talked her down.  I often spent thirty minutes a day defending each minute order that was placed. And through all the commotion, I was able to withstand the barrage because I knew that William was getting better and would go home soon where his daughter could torture him instead of me.

A few days before discharge, I received yet another panicked phone call.  William had cloudy urine and his daughter wanted me to put him on an antibiotic for a urinary tract infection.  I dutifully hurried to the bedside and asked a series of questions.  He had no burning, no pain, no frequency, no hesitancy and no fevers or back pain.  I called his daughter and explained that cloudy urine, and even bacteria in the urine, are not indications of infection, and given the history I believed an antibiotic would do more harm than good.  This answer while appeasing for a moment, quickly became unsatisfactory the next day.  So there were more phone calls, and more discussions reiterating how it was inappropriate to treat with antibiotics when there were no active signs of infection in this elderly high risk patient.

But William's daughter was smarter than I.  She waited till the night before discharge and called the doctor covering for me.  He, faced with little information and an agitated family member, was easily convinced to call in a antibiotic prescription for discharge.  I never even found out about it.

Until, that is, when I ran into his primary care physician while rounding at the hospital.  William was back in the ICU.  He suffered severe dehydration and sepsis do to (you guessed it) C. Diff.  A complication of his recent and unnecessary antibiotic use.

These type of situations happen all the time.  And while I am a big proponent of empowered patients and families, lately it seems that many really want to be managing their own care without the benefit of our experience and years of training.  In other word, they just don't want to listen to us.  This is fine.

But why come to the doctor in the first place?


Anonymous said...

Here's the problem patients face:

talking about doctors is suppressed in a number of ways. We have no way to say this doc has common sense, or this doc is willing to read medical research, or this guy practices according to guidelines.

So what happens is those of us who are educated (and I don't mean by Oprah but UpToDate/ClinicalKey types), do tend to tell some of these docs what the story is. Lets face it if you have a doc who isn't "on his game" and you are, um there are things we have to have you all for. So that's why we show up. We're not your enemy. Actually we can be your best if you let us.

I can tell you having experienced a number of different docs, that the reason why about 1/2 or so of us dictate is past bad experiences with doc screw ups or we truely are on a good par in terms of medical knowledge with some and the docs are threatened by it.

The other is not listening. If I have a history of a certain type of problem, and a doc goes off on a tangent ... I'm much more likely to question them.

I've seen some diagnostic skills needing serious help. The worst? Not knowing bloodwork and interrelationships. I have one MD/PhD who when it comes to that, can equal me. I've seen some docs quote me stuff that I can pull out research from the last 10 years and call them out for being wrong.

Seriously ... not trying to be nasty but just realistic.

TrishaGal said...

Jordan, I'm in the trenches with you. Hang in there. -a family doc in TX

jimbo26 said...

Wouldn't the other Doctor look at his notes before prescribing ?

tracy said...

I haven't commented to you in a very long time, just wanted you to know how much your writing means to me.

Thank You.

Sara Buscher said...

I think this daughter had an experience that has caused her to mistrust health care professionals. She now feels the need to check on and control everything to avoid another mistake. This must be very frustrating for the good doctors who are trying to care for her father.

Susannah said...

What Jimbo said....exactly. Wouldn't there be notes about all of this that some doctor on call could read? It's the 21st century, it's all computerized. Listen, I hear you and sympathize about the crazy lady and her dad...some (many) people are just difficult. If he'd bothered to read about the man from your notes he never would have prescribed the antibiotic at least not without speaking with you first. But nobody reads anything it seems to me. MY cardiologist told me last year when I was in the hospital for my 4th cardioversion (had to wait for insurance for an ablation) that it was time for me to go on a blood thinner. I said I'm ON a blood thinner! You put me on xaralto last year! I know he didn't have my records in front of him but come on! What if I were a dumb ass and said "duh okay" anyway, there are just too many pages and not enough people on the same one.