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Do you judge your patients?

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biogirl215

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When you're dealing with patients, do you judge them (including doing so silently) based on things like obesity, smoking, drinking, etc. ? If so, do you think it affects your treatment of them, personally or medically?

Just curious...
 

Tiger26

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When you're dealing with patients, do you judge them (including doing so silently) based on things like obesity, smoking, drinking, etc. ? If so, do you think it affects your treatment of them, personally or medically?

Just curious...

Yes, it doesn't affect how I do what I need to do, but I certainly have less respect for some than others (i.e. so why exactly are you smoking crack in between your dialysis appointments and just how much alcohol do you drink on the weekends?)
 

Blesbok

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Anyone that says that they don't is a liar. Maybe not based on the things that you mention, but everyone judges everyone. If someone comes in diabetes and heart failure and smells like cigarettes and fried chicken, you are going to judge them whether you want to or not.
 

primadonna22274

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Sure I do. Subconsciously sometimes. I try not to when I realize this is what I'm doing, but still:
1. Patient calls Sunday clinic wanting to be treated for chlamydia "again". Can't afford her $20 copay. Mad that I won't treat her without an exam (I don't know this patient and come on, it's Sunday). Pissed off when I suggest she go to the health dept on Monday because she'll have to wait with all "those hos".
2. Treat a guy yesterday for a particularly nasty case of otitis externa. See his wife today after he got enraged after popping a few Vicodin (really, it looked miserably painful, I usually don't give narcs for an ear infection) and a few beers and his wife "tripped and fell". Um, that explains the perfectly regular 7cm laceration on her forearm. Admits then he cut her with his fishing knife because she hid his Vicodin. So I am judging her for being the victim of domestic violence and judging him for being an abuser. Sure am not feeling any sympathy for him today.
We're human. As such, we have to work to suppress our human responses about things that offend our own values in order to care for the person in front of us. I've gotten myself in trouble many times by saying what I think when I probably should have shut it. Sometimes though I think the patient NEEDS to hear the truth: 1. Your knees hurt because they're tired of carrying around 350# on a 5' frame. 2. You have bronchitis AGAIN because you won't stop smoking. Or your kid has another bronchitis because you won't stop smoking. etc.
Hard not to judge.
 

SamusLives

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I don't know if I necessarily "judge" my patients. I certainly get frustrated. Many patients want a magic pill that will undo their years of smoking, drinking, and poor diet; they don't want to stop their bad habits. I am very frank with my patients (not to be mean, but to be honest):
1) Told a 39 year old lady who killed her liver by drinking that if she kept drinking she would very likely die soon (poor transplant candidate)
2) Told several PVD pts that they would loose limbs if they didn't stop smoking.
3) Told many diabetic patients that they would go blind and kill their kidneys if they didn't stick to their diets and take their insulin.

I don't tend to judge patients who hurt themselves. However, when they hurt others...yeah, I do judge them. But I still give them the same level of care as anyone else. Doctors don't exist in a bubble, you can't help feeling the way you feel.
 

Mayhem

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We all judge people to some extent. It just depends on what sets you off and what you do about it. Yesterday, we had a COPD patient come into the ED on the verge of death. We stabilised her as best we could and then my resident began to take a quick history from her. Turns out she has a 60 pack year history of smoking and her last cigarette was this morning. When the resident heard this she rolled her eyes and her tone of voice changed. The questions were much less friendly. Now let's be real you can't smoke with COPD and be shocked you're in the hospital but unlike the resident I think smoking can be an addiction so I wasn't going to make an issue out of it. I simply offered to continue the history and the resident left.

Of course, when our friendly neighborhood drunk driver dropped in for a visit I was less than pleasant. I remeber at one point the dude was crying and I just stood there staring at the wall. My classmate was in the cubicle and kept trying to calm him down -- "At least, you didn't hurt anybody." I patched him up and got him a follow-up appointment in ortho clinic but he's lucky she was there because I was more than prepared to stand there in silence till he pulled himself together. I truly could not have cared less about his feelings at that time.
 

primadonna22274

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I have absolutely NO tolerance for drunks, and no empathy for them. Drunk drivers, drunk motorcyclists, drunk ATVers...none. They infuriate me and endanger others. In particular I am very put out with our friendly South Carolina law enforcement who refuse to arrest said drunk driver who just rolled his truck and miraculously didn't hurt anybody else...they just give 'em a ticket. In Oregon a drunk driver loses his/her license AND his/her car. How exactly do we just give them a ticket in SC? Ugh. :mad:
 

colbgw02

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I'm particularly judgmental of smokers. I pity them because it's tough to quit, but I also automatically deduct about 30 IQ points as soon as I see them smoking or, more likely, smell their stench. Nowadays, no one starts smoking without knowing exactly what will happen, so I really have no tolerance for it. I also won't socialize with smokers also, again, mostly because of the odor. And this is coming from someone who has had multiple family members die of lung cancer.
 

taylor6902

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I'm particularly judgmental of smokers. I pity them because it's tough to quit, but I also automatically deduct about 30 IQ points as soon as I see them smoking or, more likely, smell their stench. Nowadays, no one starts smoking without knowing exactly what will happen, so I really have no tolerance for it. I also won't socialize with smokers also, again, mostly because of the odor. And this is coming from someone who has had multiple family members die of lung cancer.

did you socialize with your family members before they died?
 

disheveled_dave

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I'm particularly judgmental of smokers. I pity them because it's tough to quit, but I also automatically deduct about 30 IQ points as soon as I see them smoking or, more likely, smell their stench. Nowadays, no one starts smoking without knowing exactly what will happen, so I really have no tolerance for it. I also won't socialize with smokers also, again, mostly because of the odor. And this is coming from someone who has had multiple family members die of lung cancer.

I smoke occasionally, so please excuse me if this post is incoherent due to my low IQ. I guess in my own simple way, I try not to automatically associate smoking / drinking / drugs / etc. with intelligence. Sure, there's correlation, but it's never as simple as "You smoke, therefore you're stupid." There's always a bigger picture.

Of course, being smarter than me, you've probably already thought of this. :rolleyes:
 

digitlnoize

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I smoke occasionally, so please excuse me if this post is incoherent due to my low IQ. I guess in my own simple way, I try not to automatically associate smoking / drinking / drugs / etc. with intelligence. Sure, there's correlation, but it's never as simple as "You smoke, therefore you're stupid." There's always a bigger picture.

Of course, being smarter than me, you've probably already thought of this. :rolleyes:

As a former smoker, I am wondering? Why do those of you in health care who smoke continue to do it?

At this point in your education, you certainly know the details about what it does to your body...

I quit cold turkey over 10 years ago and although it sucked for about a week, the cravings pass, you save TONS of money, and you don't die as much.

Just curious...anyone?
 

Blesbok

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I smoke occasionally, so please excuse me if this post is incoherent due to my low IQ. I guess in my own simple way, I try not to automatically associate smoking / drinking / drugs / etc. with intelligence. Sure, there's correlation, but it's never as simple as "You smoke, therefore you're stupid." There's always a bigger picture.

Of course, being smarter than me, you've probably already thought of this. :rolleyes:
What bigger picture? Are you smoking because you are forced to? Is the act of smoking keeping terrorists from killing your family?

I don't automatically think someone has a lower IQ for smoking, but you have to wonder what the hell someone is thinking when they know damn well it is going to kill them in the future if they don't quit.
 

lilnoelle

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What bigger picture? Are you smoking because you are forced to? Is the act of smoking keeping terrorists from killing your family?

I don't automatically think someone has a lower IQ for smoking, but you have to wonder what the hell someone is thinking when they know damn well it is going to kill them in the future if they don't quit.

I think the hard thing is exactly that.... its a warning of FUTURE problems. Same goes with being overweight/obese. Its easy, intellectually, to promise yourself during "strong" moments that your going to do the right thing from now on out in order to increase your quality/quantity of life. The difficulty comes when you are weak - the warning of future (as in ten years later or more) doom doesn't seem strong enough to withstand temptation when one is weak.

I don't know anything about smoking because I've never tried it. I also rarely ever drink alcohol (maybe once or twice a year). I do have a bit of experience with eating problems and weight issues, and so I can understand why its difficult for people (even smart people) to give up bad habits.
 

Blesbok

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I think the hard thing is exactly that.... its a warning of FUTURE problems. Same goes with being overweight/obese. Its easy, intellectually, to promise yourself during "strong" moments that your going to do the right thing from now on out in order to increase your quality/quantity of life. The difficulty comes when you are weak - the warning of future (as in ten years later or more) doom doesn't seem strong enough to withstand temptation when one is weak.

I don't know anything about smoking because I've never tried it. I also rarely ever drink alcohol (maybe once or twice a year). I do have a bit of experience with eating problems and weight issues, and so I can understand why its difficult for people (even smart people) to give up bad habits.
It just boggles my mind, because I don't usually think of med students and doctors as being weak minded when it comes to discipline of their daily lives. However, I guess this is an unrighteous assumption since there are still quite a few doctors with drinking and drug problems (not that I am saying smoking is on the same level as performing surgery while drunk, etc).
 

cpants

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It just boggles my mind, because I don't usually think of med students and doctors as being weak minded when it comes to discipline of their daily lives. However, I guess this is an unrighteous assumption since there are still quite a few doctors with drinking and drug problems (not that I am saying smoking is on the same level as performing surgery while drunk, etc).

Smoking is fun, it makes you feel good, and it is highly addictive. Doctors are no more immune from addiction than any other person. Most people with addictions know that their behavior is destructive, but they are unable to quit.
 

lilnoelle

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It just boggles my mind, because I don't usually think of med students and doctors as being weak minded when it comes to discipline of their daily lives. However, I guess this is an unrighteous assumption since there are still quite a few doctors with drinking and drug problems (not that I am saying smoking is on the same level as performing surgery while drunk, etc).

Well, just because an individual has a weakness doesn't mean they are undisciplined. In fact, I think the fact that we are medical students indicates we ARE disciplined people - however, its difficult to be disciplined about EVERYTHING. I think probably everyone has weaknesses and areas of their lives they sacrifice in order to be successful in other areas of their lives. The fact that we are rather successful maybe even predisposes us to be "sloppy" in other areas of our lives.

For instance.... (since overindulgent eating is what I know) I spend a lot of my time sitting at my computer studying. I consider that disciplined. I also find myself snacking on junk food at the same time. Its hard to be disciplined at everything, sometimes something has to go. Another example of my "lack of discipline" is my messy house. Its not that I don't have time to clean, but with all of the studying that I do, and when I've fed my kids, gotten them ready for bed, etc, at the end of the day, I don't want to clean, I want to relax. Cleaning is not the huge priority to me, and so it takes back burner.
If I were a smoker, I would probably do so to help relieve some of the stress of med school and it would be a lot to expect me to be a great student AND give up my source of comfort.
I'm not saying we shouldn't strive to do our best in every area of our life, but we should also be understanding of why people do the things they do.
 

digitlnoize

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Smoking is fun, it makes you feel good, and it is highly addictive. Doctors are no more immune from addiction than any other person. Most people with addictions know that their behavior is destructive, but they are unable to quit.

I would argue that smoking DOES NOT make one feel good. Perhaps on a superficial level, but not overall. Smokers have a higher incidence of URI's, breathing problems, cancer (of all types), dental problems, etc than non-smokers. These things do NOT make you feel good, and anyone with real education about the effects of smoking knows this.

I (sort of) understand the general public attitude...where they know that smoking is "bad for you"...without the details. Doctors and nurses know the details, and see the grusome effects on a daily/hourly basis.

Watching someone die of emphysema should be enough to cause anyone to give it up...I don't care how addicitive it is.

I've been there. It's just a mind game. There is a physiological addiciton, but it's broken pretty fast. The worst of it is over in a few days. It's become a big mental problem to overcome due to the media's hype of how "hard" it is to quit smoking. Now everyone thinks they can't do it, so why try?

My step-dad quit cold turkey too. He had to fly to Austrailia, and said, "well I can't have one for that long, so I might as well quit now." He's been clean for 3 years now.

I think caffeine is far more difficult to give up, IMO.
 

SltatryDduction

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I think this (hijacked) thread answers the question. I also used to be a smoker, and it was very difficult for me to quit, but I did it cold turkey. If anything, I think it makes me understand more the difficulty and have more empathy for a smoker's situation, not less. I also don't feel that it indicates that I am less intelligent, perhaps less stong-willed. But I digress...

I actually thought a lot about this just last week. We were interviewing psych patients and the patient spoke a lot about her faith. I realized that without knowing it, I had mostly shut down to what the patient was saying. I don't necessarily think I was judging her, but my own personal values/beliefs were definitely in the way of me acting as a neutral interviewer. At my old job we were taught to identify what your values are so you are able to leave any judgements at the door. More easily said than done, but certainly something I need to work on.:rolleyes:
 

dynx

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Yes, I judge every patient. Most of them suck and don't care for themselves. (Im on the trauma service right now), if this is the case: I perform exams quickly and without much empathy, they get the standard of care, and the minute they are ready they get booted out the hospital without mercy. There is no staying because thier pain is a 7/10 when they can walk outside to have a smoke. I've delived D/c papers myself when the nurses have refused to send someone home, and more than once i've had security escort patients to the curb.

If a patient is interested in getting better I go the extra mile, I don't just cross the t's and dot the I's. Im there talking to them for awhile on afternoon rounds, I call insurance companies to advocate for extra days, a better nursing home etc.

F-not judging. I don't have time to treat everyone the same.
 

disheveled_dave

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What bigger picture? Are you smoking because you are forced to? Is the act of smoking keeping terrorists from killing your family?

I don't automatically think someone has a lower IQ for smoking, but you have to wonder what the hell someone is thinking when they know damn well it is going to kill them in the future if they don't quit.

First, I apologize for contributing to the threadjack. Let's see if we can't get it back on track. Blesbok, I know just as well as you do the dangers of smoking and no, of course nobody is forcing me to smoke. But then again, I don't need to defend my actions to you.

You assume doctor's aren't weak-minded just because they are disciplined? We are all highly disciplined in terms of the work we need to get done. But that doesn't necessarily mean we are disciplined in other areas of our lives. How else do you explain the alarmingly high percentage of anesthesiologists hooked on fentanyl and sufentanil? Nobody else knows the mechanisms and danger of those drugs like they do, but the stats are there. Are you saying you have no weaknesses?

What I was getting at by saying there's always a "bigger picture" is that, even though it may be in our nature to be judgmental and prejudiced, there are reasons why people smoke / drink / do drugs / etc. If I were a perfect person, I'd be able to consider those reasons instead of just "wondering what the hell they are thinking." But I'm human just like you, so of course I'm judgmental. I just try to be better than that when I can.
 

sgglaze

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I would only judge a patient based on his political/religious beliefs. Is that wrong?
 

Tired

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Not only do I judge them, I make fun of them to the team and ancillary staff after I leave the room, and frequently give them nicknames that mock their physical/mental/social infirmities.
 

taylor6902

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As a former smoker, I am wondering? Why do those of you in health care who smoke continue to do it?

At this point in your education, you certainly know the details about what it does to your body...

I quit cold turkey over 10 years ago and although it sucked for about a week, the cravings pass, you save TONS of money, and you don't die as much.

Just curious...anyone?

how much can one person die?
 

Blesbok

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I would only judge a patient based on his political/religious beliefs. Is that wrong?
I judge them based on the their pubic hair. Everyone gets treated equal until they drop their drawers. Damn hippies and their long hair.
 

colbgw02

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I smoke occasionally, so please excuse me if this post is incoherent due to my low IQ. I guess in my own simple way, I try not to automatically associate smoking / drinking / drugs / etc. with intelligence. Sure, there's correlation, but it's never as simple as "You smoke, therefore you're stupid." There's always a bigger picture.

Of course, being smarter than me, you've probably already thought of this. :rolleyes:

Are you kidding me?

This thread is about judging others. Did you really need me to provide a caveat that judging others is wrong? I might have thought that was self-evident. I provided an honest answer and admitted my own biases; wasn't that the entire point?
 

cpants

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It really is impossible not to judge people. The important thing is to recognize when you are doing it, and go out of your way to make sure that it doesn't compromise care or make you miss a diagnosis.

One of our psychiatry professors told a great story in class the other day. A known schizophrenic frequent-flyer came into the ER agitated and c/o "things crawling all over him and eating him alive". The residents barely even looked at him before calling psych and walking away. Psych came down and made the body lice Dx within thirty seconds.
 

la petite mort

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Harmful, destructive habits point to at the very least self-indulgence or deeper emotional issues, which have to be factored into treatment.
 

dynx

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It really is impossible not to judge people. The important thing is to recognize when you are doing it, and go out of your way to make sure that it doesn't compromise care or make you miss a diagnosis.

One of our psychiatry professors told a great story in class the other day. A known schizophrenic frequent-flyer came into the ER agitated and c/o "things crawling all over him and eating him alive". The residents barely even looked at him before calling psych and walking away. Psych came down and made the body lice Dx within thirty seconds.

And the moral of the story is: If you don't give a crap if some freak has body lice you can save yourself a bunch of time and perhaps get some sleep during your call night...the end.
 

AmoryBlaine

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I actually find myself feeling amazingly tolerant towards most patients even ones that do incredibly stupid things.

The one exception is parents that are hosing their kids. I saw a mom bring her two sons to the ED one night, one of them was in mild resp distress from asthma. All he needed was a neb treatment and a steroid burst but while momma was out of the room the aunt told me that momma just refuses to fill out public aid forms for the kids. Consequently the two kids with asthma get by on the albuterol their asthmatic aunt can spare for them and make frequent trips to the ED for exacerbations.

What was in Mom's shirt pocket? You guessed it - Marlboro Lights. It was all I could do not to say to Mom, "you know between your irresponsibility and your smoking you could quite literally kill this child."
 

Doctor J

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It was all I could do not to say to Mom, "you know between your irresponsibility and your smoking you could quite literally kill this child."

Sometimes patients need to hear that. I would have said it to her.

There goes my Press-Ganey score.
 

Nodelphi

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I try to hate all my patients equally. I don't always succeed though.
 
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45408

Sure. You have abdominal pain, nausea, vomiting, and a headache? Let's see, it's 4am on a Saturday morning. Were you drinking earlier? Yes? Now you want to go to the ER? IT'S A HANGOVER, YOU BIG BABY. Normal people go to work when they're hung over, but you have to call 911?
 

Blesbok

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I actually find myself feeling amazingly tolerant towards most patients even ones that do incredibly stupid things.

The one exception is parents that are hosing their kids. I saw a mom bring her two sons to the ED one night, one of them was in mild resp distress from asthma. All he needed was a neb treatment and a steroid burst but while momma was out of the room the aunt told me that momma just refuses to fill out public aid forms for the kids. Consequently the two kids with asthma get by on the albuterol their asthmatic aunt can spare for them and make frequent trips to the ED for exacerbations.

What was in Mom's shirt pocket? You guessed it - Marlboro Lights. It was all I could do not to say to Mom, "you know between your irresponsibility and your smoking you could quite literally kill this child."
This is the sole reason I want nothing to do with peds. I am pretty sure I would be in prison before the end of my career.
 
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45408

What was in Mom's shirt pocket? You guessed it - Marlboro Lights. It was all I could do not to say to Mom, "you know between your irresponsibility and your smoking you could quite literally kill this child."
That absolutely merits a call to Child Protective Services, and I don't think you would have been out of place at all to point out the obvious - that her smoking is very harmful to an asthmatic child.
 

Bananas Foster

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as an ambulance driver i personally detest patients with poor mobility, morbid obesity and live on the third floor of a building with no f---ing elevator. I mean seriously, if you're over 300lbs live on the g--d---ed ground floor!
 

mjl1717

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Sure. You have abdominal pain, nausea, vomiting, and a headache? Let's see, it's 4am on a Saturday morning. Were you drinking earlier? Yes? Now you want to go to the ER? IT'S A HANGOVER, YOU BIG BABY. Normal people go to work when they're hung over, but you have to call 911?

Although you mentioned him as "a Big Baby"... It is commendable that you had the presence of mind and were able to use "Neutral Objectivity".... (I hope) in diagnosing and possibly treating this drunk.. [that's what its about, making good decisions -regardless of the case]
[ I think it comes down to muffling the weak, lame, emotional, judgemental, human aspect and using "Neutral Objectivity"] Just my opinion..:thumbup::thumbup:
 

Blesbok

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as an ambulance driver i personally detest patients with poor mobility, morbid obesity and live on the third floor of a building with no f---ing elevator. I mean seriously, if you're over 300lbs live on the g--d---ed ground floor!
So you would rather fat people become even lazier? I think people who are morbidly obese should have special license plates. If they don't park in the fat people parking on the absolute furthest part of the parking lot they get their cars towed and then they are required to ride a bike everywhere for a week before they can get it back.
 
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45408

So you would rather fat people become even lazier?
They're usually bed-ridden by this point, so it's not like they're walking up and down those stairs. You're just carrying them down those stairs.

Knock on wood, I've only once had to carry an obese individual down a flight of stairs.
 

Tired

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One of our psychiatry professors told a great story in class the other day. A known schizophrenic frequent-flyer came into the ER agitated and c/o "things crawling all over him and eating him alive". The residents barely even looked at him before calling psych and walking away. Psych came down and made the body lice Dx within thirty seconds.

Your psychiatry professor is a dirty liar.

Psychiatry residents never perform physical exams.
 

Jwax

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Quite a bit actually. I was just being funny...:D You guys don't watch enough Buffy around here...
:laugh: :thumbup:

So you would rather fat people become even lazier? I think people who are morbidly obese should have special license plates. If they don't park in the fat people parking on the absolute furthest part of the parking lot they get their cars towed and then they are required to ride a bike everywhere for a week before they can get it back.

:thumbup: Great idea! Although, I imagine the obese person living on the 3rd floor probably just never leaves, and thus they don't make use of those stairs.

As far as judging patients go... heck yes. I cannot stand some of the things they choose to do and some of the things they just don't notice (i.e. brushing teeth isn't that difficult or costly). Today, I saw my first patient who is literally going to die within the next few months because of their ignorance and stupidity. I volunteer at a community clinic and we had a patient with likely malignant inflammatory breast cancer... She had a mammogram 10 years ago & had pre-cancerous lesions removed... then decided to not get another mammogram. So... now her breast is all swollen and ulcerated (and inverted nipple). It was sad, but it pissed me off because she could have been just fine if she had just bothered to keep up on her mammograms. :thumbdown: That's even more pathetic than a person who is addicted to tobacco and can't quit, IMHO.

My other thought that I figured I'd throw out there is that we all have our vices. None of us are perfect. Some people maintain better health than others, some people drink more than they should, some people rely on chocolate to get them through tough times. We all have our vices, and the problem is usually only found when we rely on them to excess.
 

Bananas Foster

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They're usually bed-ridden by this point, so it's not like they're walking up and down those stairs. You're just carrying them down those stairs.

Knock on wood, I've only once had to carry an obese individual down a flight of stairs.

Only one? That is lucky. We actually have one client who is bedridden and addicted to pain pills. She calls CFD about every 3-5 weeks complaining of SOB to be taken to the hospital the try and manage a new narc Rx after the SOB thankfully goes away on its own. When the ER kicks her out we get to take her back home to the third floor.

She's a nice lady though...:rolleyes:
 

MicDundee

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I'd say it's good to notice additional things, and probably helps with the overall assessment of them.
 

LadyWolverine

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When you're dealing with patients, do you judge them (including doing so silently) based on things like obesity, smoking, drinking, etc. ? If so, do you think it affects your treatment of them, personally or medically?

Yes. I feel like I judge people so much more now than I did before I started medical school. I'm not sure how much of it is a product of being in the role of "doctor," and how much comes from living in Baltimore. The number of drug-, HIV-, and crime-related cases that we see every day are truly staggering. I see patients regularly who are covered from head to toe in scars from skin-popping because they don't have any veins left. Who continue to smoke cigarettes and use crack while pregnant, and wonder why their baby is born with defects or stillborn. Who come in to the already-packed ER because they need a "form signed" or some other not-even-remotely-emergency complaint. Who refuse to be compliant with HAART, heart meds, or quitting smoking, and come in repeatedly for CHF and COPD exacerbations, PCP, and other related illnesses. I saw my first case of neurosyphilis + HIV in my second month of medical school - a patient who had numerous opportunities for treatment and follow-up thrown at them, but didn't comply, lost their job due to illness, and likely ended up relying on taxpayers for very costly (and very preventable) late-stage care. I get very angry and even disgusted inside, at times. Mostly because there's nothing I can do to break the cycle, or to make these people see reason. I don't let it influence how I speak or interact with the patients that I see, but sometimes I feel it eating away at my soul.

Perhaps I feel this way because I have never struggled with addiction the way that these people have. I was not born into the extreme, utter poverty of many of this city's denizens. I had opportunities that most of these patients never even dreamed of, and probably didn't even realize existed. I did not have to choose between trying to get on welfare/disability or selling drugs and guns. But I find myself asking, more and more, where do we draw the line? When do we start making people responsible for their actions? How much can we blame "the state," "the crime," "the drugs," "the neighborhood," "the parents," "the teachers," "the rich," etc.? I guess my problem is that I hold everybody to the same standard. Be responsible for what you have, or accept the consequences, and don't expect anyone else to pay your way when you screw up. But we reward a lot of delinquent behavior in this country. I just never realized how bad it could be until I moved here.

This is something that plagues me, every single day. I often feel like Baltimore is a hopeless, lost cause. I don't mean the crime - Baltimore is a liveable city, and you truly don't feel threatened all the time - I just mean the general lack of caring, of community, of humility, of shame for one's mistakes, of humanity, of responsibility that pervades here. Sure, it makes for some great medical training to see so many problems. But it will rot your soul in the process, if you aren't careful.

I don't want to turn my back on a needy public. But I find it harder and harder to hold on to the fragments of my optimistic, liberal youth. And I've never wanted to move so bad in my entire life. :(
 
8

8744

When you're dealing with patients, do you judge them (including doing so silently) based on things like obesity, smoking, drinking, etc. ? If so, do you think it affects your treatment of them, personally or medically?

Just curious...

Yes.
No.
 

sacrament

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As probably the most cynical resident in my program I might be expected to be highly judgmental of the patients who get wheeled in, but my brain doesn't really process it that way. For example, many of my peers would get ragingly irritated at the IV drug user who shows up with the umpteenth gnarly skin abscess that needs draining. "It's his own fault! I don't know why I should bother draining it, he's just going to do it again!"
Sure, but who cares. If not him, somebody else will need something done. In the next fifteen minutes I either drain this skin abscess, or I stick my finger up this other dude's ***, or I look at this guy's CXR and diagnose him with a probable lung cancer... it's a never-ending flow of sh1t, and I don't take the time to worry about whether I've seen this particular kernel of corn before.

You've got to be kidding me. "A$s" is bleeped out now?
 

mjl1717

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Yes. I feel like I judge people so much more now than I did before I started medical school. I'm not sure how much of it is a product of being in the role of "doctor," and how much comes from living in Baltimore. The number of drug-, HIV-, and crime-related cases that we see every day are truly staggering. I see patients regularly who are covered from head to toe in scars from skin-popping because they don't have any veins left. Who continue to smoke cigarettes and use crack while pregnant, and wonder why their baby is born with defects or stillborn. Who come in to the already-packed ER because they need a "form signed" or some other not-even-remotely-emergency complaint. Who refuse to be compliant with HAART, heart meds, or quitting smoking, and come in repeatedly for CHF and COPD exacerbations, PCP, and other related illnesses. I saw my first case of neurosyphilis + HIV in my second month of medical school - a patient who had numerous opportunities for treatment and follow-up thrown at them, but didn't comply, lost their job due to illness, and likely ended up relying on taxpayers for very costly (and very preventable) late-stage care. I get very angry and even disgusted inside, at times. Mostly because there's nothing I can do to break the cycle, or to make these people see reason. I don't let it influence how I speak or interact with the patients that I see, but sometimes I feel it eating away at my soul.

Perhaps I feel this way because I have never struggled with addiction the way that these people have. I was not born into the extreme, utter poverty of many of this city's denizens. I had opportunities that most of these patients never even dreamed of, and probably didn't even realize existed. I did not have to choose between trying to get on welfare/disability or selling drugs and guns. But I find myself asking, more and more, where do we draw the line? When do we start making people responsible for their actions? How much can we blame "the state," "the crime," "the drugs," "the neighborhood," "the parents," "the teachers," "the rich," etc.? I guess my problem is that I hold everybody to the same standard. Be responsible for what you have, or accept the consequences, and don't expect anyone else to pay your way when you screw up. But we reward a lot of delinquent behavior in this country. I just never realized how bad it could be until I moved here.

This is something that plagues me, every single day. I often feel like Baltimore is a hopeless, lost cause. I don't mean the crime - Baltimore is a liveable city, and you truly don't feel threatened all the time - I just mean the general lack of caring, of community, of humility, of shame for one's mistakes, of humanity, of responsibility that pervades here. Sure, it makes for some great medical training to see so many problems. But it will rot your soul in the process, if you aren't careful.

I don't want to turn my back on a needy public. But I find it harder and harder to hold on to the fragments of my optimistic, liberal youth. And I've never wanted to move so bad in my entire life. :(

Very telling post, some of my deeper thoughts..

1)Its good that you are able to empathize and not sympathize..

2)Unfortunately in the real ghetto area many folks do not know how to use the system properly..{This can be a shock to someone who has led a sheltered middle class life, to say it mildly}.... And expect many things to be handed to them..{Ironically Baltimore is where Osler was maybe at the zenith of his carrer}

3)Many will never see a case of neurosyphilis.

4)Seriously dont let it get you too worked up, disgusted, angry or let it get to your soul.. {Unfortunately I think this is part of the mostly unacknowledged toil of being in the medical field..}Being overly sensitive is human... But honestly we can try but we are not going to save the world..
:thumbup:
 
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