Let’s Get Some Things Straight.

WARNING: RANT IMMINENT! DANGER, WILL ROBINSON, DANGER!

-When your doctor reaches out to take your pulse, he already has his hand in position to do it properly, taking into account where your hand is and in what orientation. Helpfully holding out your hand and turning it face up only complicates matters.

-A female hospital worker is not automatically a nurse. A male hospital worker is not automatically a doctor.

-Your ER doctor doesn’t give a damn about what drugs you took last night, except to know how it will affect your medical condition, and whether or not she should keep an eye out for withdrawal symptoms. She’s not going to tell the cops that are hanging out in the ER to protect her. They probably don’t give a damn either.

-Your doctor doesn’t care how much you weigh, except to the point that it affects your health and therefore makes more work for him to keep you healthy.

-Your doctor can smell whether or not you smoke, and probably even how much. You may as well just tell her.

-Your doctor sees entirely too many people over the course of his day to bother spending the emotional energy to make value judgments about you or any of his other patients. I guarantee it.

-The information in the article about your medical condition that you helpfully printed out from that website is probably information that your doctor memorized in his first month of medical school. Or it’s completely wrong. Your doctor will look over it and smile graciously at you if he’s in a good mood.

-Doctors don’t have any influence over nursing staff. Doctors and nurses are colleagues, at the same level on the pecking order, and with completely different jobs. If you have a problem with a nurse, don’t complain to the doctor. Complain to the nurse’s boss.

-Being obnoxious or demanding does not improve your care or your family member’s care. You may get what you want this moment, but you’re far more likely to be unconsciously neglected later, and you’ll have to keep on being obnoxious and demanding in order to get the normal level of care that you would otherwise receive. Nurses and doctors are human, even though they aspire to greatness and have to act professional; they don’t like being yelled at and pushed around any more than you do. The effect that you have on them will likely be inadvertent…but it will likely decrease the quality of care regardless. PS: Medical students spend more time with friendly patients. And get better histories. And tend to advocate more for them. That effect should also not be overlooked.

-Just because you’ve never “had to see a doctor” doesn’t necessarily mean you’re healthy. That’s like saying that your car runs perfectly because you’ve never let a mechanic look under the hood. For (insert your age) years.

-You can’t put anything in your body without side effects. That includes herbal/”natural” substances as well as mainstream medicines. There is no such thing as a miracle cure.

-The people who are most likely to complain about how long they had to wait past their appointment time are most likely to be the people who expect the doctor to spend extra time with them. You know, making the next patient wait past her appointment time.

OKAY, ALL CLEAR! AWOOGA, AWOOGA, AND ALL THAT.

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Published in: on March 15, 2011 at 11:33 pm  Comments (20)  
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  1. Rant away, it’s your blog! But, two things:

    -Surely homeopathic medicine has no side effects? Seeing as how it has no effects generally?:P

    -I have been *asked* to bring articles about at least one health condition (Ehlers Danlos Syndrome) by every doctor I’ve had. Well, except the one who told me they’d never heard of it, so the doctor who diagnosed me was making it up. I know a lot of other “zebras” who’ve had the same experience. Doctors know a lot, but it seems unrealistic to expect a GP to know as much about rarer conditions as someone who lives with it as daily experience and often has spent years gathering data from specialists, being in clinical studies, and just accumulating daily information.

    • -homeopathic medicine is potentially toxic, seeing as there’s no regulation and you never really know what you’re taking into your body.

      -Ehlers Danlos is commonly used as an example when teaching first year medical students about the structure and function of collagen fibrils. That’s not to say it’s not helpful to have an occasional reminder, though.

      • Good point about homeopathy. There’s little or no regulation of it in a lot of countries, and there can be huge differences on what is labeled “homeopathic product”. Sometimes, this stuff contains non-negligible quantities of herbs or minerals, so you can have problems with allergies, overdoses, etc. Wasn’t there a problem a few years ago with a so-called “homeopathic remedy” for cold that actually contained a lot of zinc? And that it was eventually withdrawn from the market after causing a number of people to lose their sense of smell?

  2. I LOLed, I Liked, I shared.

    (yesterday’s fresh story – a family bursts into the Oncologists’ office yelling at her – “Why did you give our sister cancer? you will die because you infected her, and every cell in your body will turn into cancer too!” lovely, ain’t it?)

  3. Heh… people can be so… interesting…

    Or you could be lucky enough to live in the middle of BFE nowhere and consequently be stuck with doctors who have never even heard of your particular disorder. Seriously, when I first got here, one nurse in the entire hospital plus the three private practices in town had ever heard of LQTS, and that only because she was on the same medication I take. I actually had a doctor accuse me of being a hypochondriac and/or making it up for attention. You should have seen his face when I dumped Mom’s six-inch thick file on his desk. Granted, the man is old enough that they probably didn’t have a name for it when he went to medical school, but still.

  4. Whenever anybody encourages me to take a particular herb because “it’s natural”, I always say, “So’s arsenic.”

    MA

    • Oh, I like to say “so’s ebola”. But I like yours better.

  5. Nice! And not necessarily all stuff a right-thinking but not-medically-savvy person would know. Which is weird because, you know, I’ve watched a lot of House. Anyway, off to Twitter … !

    • Oh, I’m totally doing a post about House someday.

      • You’re doing a post about House MD??? Yay! My dreams have been mostly answered even though the show is probably barely medically correct. 😀

  6. I’m a female physician. In medical school, I was taking care of an eight-year-old boy in with an asthma exacerbation. He was confused about how I could be both a doctor and female, and wanted to know what the difference was between a doctor and a nurse. I explained that doctors generally round once a day and make decisions about diagnosis and treatment, while nurses are there all day and do most of the hands-on treatment for patients in the hospital. He thought it over and said that when he grew up he wanted to be a nurse. I was charmed.

    • Awwww! I bet he’ll be a great nurse, too!

      I don’t have the patience or the fortitude to be a nurse. One of my best friends was going through nursing school while I was going through medical school, and the stories she told about poop-apocalypse cleanups and sexual harassment and the pettiness of the power structure in some places just makes me feel grateful to be where I am in the hospital environment.

  7. I get most of this, I really do. But for a new Doctor, especially when going to the ER, you can damn well bet I’ll have a print-out of what medications I’m on, what I’m allergic to, and basics about the various illness I’m living with.

    Giving me the wrong treatment probably won’t kill me (unless it’s something I’m allergic to, which has nearly happened but I refused to take the contrast stuff), but I’ll pay for it for at least a week if you make the wrong choice. EDS may be something you were taught about in med school, but not all the weird illnesses some of us have are used as examples. And not all doctors have been to medical school as recently as you have.

    And my current Doctor (who I love – he actually listens to me, and doesn’t treat me like some drug seeking nutcase) does research on the web, and happily takes my print-outs to discuss. I have so many co-morbid illnesses that I’m hard to keep up with, and he sees too many patients to spend time following the clinical trials and other research reports to see what’s new for all of them.

    Sometimes being an informed patient is necessary, and that means being prepared to provide medical staff with the relevant information so they don’t hurt you. Please don’t judge all patients who bring you written documentation as difficult and/or stupid; we have to live with this every day, and we may know our own bodies better than you do.

    • You are absolutely right in that it’s vitally important to be an informed patient, and I wish deep in my heart that everyone who came to me was as prepared and on top of things as you are. But I gotta tell you, people like you are the exception rather than the rule, though that’s probably due to the fact that I practice urban underserved medicine and very few of my patients have much more than a high school education.

      But people get so incredibly ego-involved with their own pseudo-research that it (more often than not) interferes with patient care. With this type of person (and I’d like to be sure to point out that it doesn’t sound like you or Carapace are one of them), they walk in assuming that I’m a dangerous idiot who doesn’t know anything about their (more likely than not) very typical medical issue, and if I don’t do what it says on their little paper (no matter where they got it), I’m automatically trying to kill them. A lot of that is related to culture and power differentials and all of that, but when I only have fifteen minutes to meet, interview, diagnose, and make a treatment plan for a patient, and THEN explain it to them in a way that they can understand, I really, REALLY don’t want to spend any of that time explaining that, no, that random “ask your doctor if ______ is right for you” medication has nothing to do with their actual situation, and no, just because you have a stomachache does not automatically mean you have pancreatic cancer, and no, bicarbonate is not a miracle drug to TREAT cancer, it’s baking soda.

      You’re right about doctors having different experiences, levels of education, and distance from medical school. So you’re right, it’s desperately vital to be an informed patient who enhances their own medical care through careful research in partnership with their physician. But the vast majority of people just do not have the tools or the education to do so…….but that doesn’t stop them from going through the motions as if they did, and getting really pissy if I tell them that their self-diagnosis is just plain not the case. People come in predisposed to trust the internet more than they trust their doctor.

      Anyway, all of that was to say, I hear what you’re saying. And I agree…..but to a point.

  8. You know, the thing about miracle cures disturbs and frightens me. I cant tell you how many times people at work take advantage of the ‘lemonade diet’.

    Seriously. Who needs to flush their system of toxins? You’d think we didnt have an entire system for waste removal or something.

  9. Dr. Grasshopper,

    I’m posting this comment late because I wanted some time to let the stem stop coming out of my ears.

    Over the last few years I’ve had to take family members to the ER a number of times. Knock woodlike substance, I haven’t recently had to use their services much myself.

    I hope I’ve never been obnoxious, but when my aged mother was about to fall out of the ER bed, and I didn’t have the physical strength or techniques to keep her there, I stuck my head out in the hall and yelled for help. It worked.

    I later discovered the call button on the wall, completely hidden by cords to various machines.

    I’m allergic to sulfa. It’s the most common drug prescribed for a recurring problem of mine, and after getting it by mistake a couple of times you’d better believe I ask if what they’re giving me is a sulfa drug.

    I assume that most of the medical professionals I deal with are educated, caring and sensible. I also assume that many of them are run off their feet, and if it’s the first time I’ve met them I do double-check things.

    I know how to do research. Please don’t be offended if I ask about something I’ve read–after all, I am asking for the benefit of your expertise.

    Sorry, but sweetly trusting the authorities is just not a good option.

    I hope you had a better day after the day you posted the rant!

    • My friend, again, there is a UNIVERSE of difference between what you’re describing (read: normal-person/rational-actor behavior) and what I’m talking about.

      I’m trying to think of examples in movies and TV shows that would illustrate the level of absurdity I deal with on a day-to-day basis (patients throwing shit-fits because I didn’t immediately leave the side of an actively-coding patient the second they felt the need to have me describe their treatment plan to them the TWENTY-SECOND TIME [no, not an exaggeration, I counted], patients insisting that I prescribe medications to them that will undoubtedly kill them, and accusing me of just wanting to prescribe a more expensive drug to them so I can get their money, family members just casually dropping it into conversation that one of their siblings is a lawyer so I better fucking watch my step with their beloved grandma or they’ll do everything in their power to destroy my life, patients not taking their heart failure medications because there was a public-interest piece on the news that told them not to, and then threatening to sue me for malpractice when they go into congestive heart failure [I kid you not] etc,etc,etc….) but I realized that no TV program would ever show these things because people would say it’s an unrealistic, overblown portrayal.

      Listen. Every single person I encounter over the course of my day job is in the process of having THE WORST DAY OF THEIR LIFE. It’s expected. There are predictable patterns of human behavior that manifest under stress. I can deal with that; it’s part of my job. If every patient and every family member acted in the reasonable, rational way you just described…..I could die happy.

      But the vast, VAST majority of people act solely and solidly against their own best interest. And they almost always have the “research” to back it up. I’ve never met you, so I clearly don’t know how good you are at separating the crap on the internet from the UNBELIEVABLE CRAP on the internet….but there’s a very large noise-to-signal ratio going on right now, and laypeople don’t always have the education, suspiciousness, or even vocabulary to sort through it all. Please try not to take that observation personally; I just call it like I see it.

      Wouldn’t the world be excruciatingly boring if everyone had the same opinion?

      Thanks for writing!

      Dr. G

  10. Oops. That should’ve been “steam” not “stem”.

    Sigh. Nothing quite like a typo to undermine a nice long counter-rant.

    It does show the perils of relying on a spell-check program.

  11. Too true about the irrationality of way too many people. I see a lot of it in my day job, but at least we librarians aren’t directly involved in providing medical help–however much people try to get us to prescribe!

    I have, under protest, bought some books that I think are dangerous nonsense. Why would anyone want to get medical advice from an ex-con?

    You have my sympathies, Dr. G. May the fates send you at least one rational person as patient today.


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