Do you judge your patients?

[BrainBuff]

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There's dying and there's dying. Trust me.

OK. Let's just look at this one one more time. Trust... YOU? Why would ANY ONE trust YOU??!! This is one of the most *****ed up lines that frequently you come across in these forums...

There's dying and there's dying. Trust me.

Yep, and I am dying of

 

[mjl1717]

delete

 

[mjl1717]

OK. Let's just look at this one one more time. Trust... YOU? Why would ANY ONE trust YOU??!! This is one of the most *****ed up lines that frequently you come across in these forums...

There's dying and there's dying. Trust me.

Yep, and I am dying of

Good pick up.. I think this would have been avoided if the original stimulus had said "you dont die as FAST".. Yeah, Trust me just added more fuel to the fire.. since we are suppose to be some educated folks here and that would NOT be said to an attending..🙄

 

[ZagDoc]

OK. Let's just look at this one one more time. Trust... YOU? Why would ANY ONE trust YOU??!! This is one of the most *****ed up lines that frequently you come across in these forums...

There's dying and there's dying. Trust me.

Yep, and I am dying of

This begs a question... is dying in hospice from metastatic lung cancer the same kind of dying as a person with a massive internal cerebral hemorrhage? A person with COPD? A person that goes down with an aortic dissection? From cirrhosis? A massive MI?

There are plenty of forms of dying. Sure you end up dead in them all, but some seem so agonizing and tortuous compared to others. I'm sure a person who has been through 3 relapses of metastatic cancer will attest that each bout seemed a little bit like dying. Or the person with emphysema who can never shut off their cerebellar reflex and feel each day like they are slowly suffocating? I'm sure each day feels a little bit like dying.

 

[8744]

OK. Let's just look at this one one more time. Trust... YOU? Why would ANY ONE trust YOU??!! This is one of the most *****ed up lines that frequently you come across in these forums...

There's dying and there's dying. Trust me.

Yep, and I am dying of

Har! Just wait. Dying in bed vs. Dying in the trauma bay an hour after being burned over most of your body with an arm and a leg ripped off. There is dying and there is dying.

 

[8744]

Good pick up.. I think this would have been avoided if the original stimulus had said "you dont die as FAST".. Yeah, Trust me just added more fuel to the fire.. since we are suppose to be some educated folks here and that would NOT be said to an attending..🙄

Whoa. It's not just speed but level of pain. Just wait. (And my attendings say what I said (or some variation) often.)

 

[cpants]

Miracle Max: See, there's a big difference between mostly dead, and all dead. Now, mostly dead: he's slightly alive. All dead, well, with all dead, there's usually only one thing that you can do.
Inigo: What's that?
Miracle Max: Go through his clothes and look for loose change.

 

[SocialistMD]

OK. Let's just look at this one one more time. Trust... YOU? Why would ANY ONE trust YOU??!! This is one of the most *****ed up lines that frequently you come across in these forums...

There's dying and there's dying. Trust me.

Yep, and I am dying of

Good pick up.. I think this would have been avoided if the original stimulus had said "you dont die as FAST".. Yeah, Trust me just added more fuel to the fire.. since we are suppose to be some educated folks here and that would NOT be said to an attending..

Chi-chi.

I agree with Panda Bear, there is dying and then there is dying. I think I actually learned that terminology from an ICU attending (where I definitely learned of chi-chi). The amount of dignity preserved, pain controlled and suffering alleviated all play a part in how good or bad a death is, not just the speed at which it happens.

 

[SalseraDoctora]

This thread is so funny thank you to everybody for entertaining me on a relatively sucky Saturday night. 🙂

I definitely judge patients. I try not to, but I recently shadowed a resident in peds, and one of the patients we saw was a morbidly obese mother, and her 8-year-old child was very chubby, and the resident was asking the mother what she was feeding the child. Answer: whole milk, chips, soda (of course), and the resident said "now you know she is not supposed to have any soda, because that is bad for her, and she needs to be on low-fat milk." And that was the entire conversation. I would bet every dollar I hope one day to earn that the morbidly obese mom and her on-her-way-to-becoming-morbidly-obese daughter went right home and had chips and coke for lunch. So I judge the mom, because seriously who reaches adulthood without knowing that soda and chips aren't great for you, but I also judge the resident for the one-sentence pep talk about nutrition, when it was obvious to all of us that 1 sentence wasn't going to cut it. Maybe 10 sentences, one of them requiring some sort of response from the mother, might have made a difference.

Maybe when I am a resident I will have stopped caring enough to make any sort of effort--it is entirely possible--but I know that this resident could have taken 3 extra minutes to really discuss nutrition with the mom, and she didn't.

Now all the residents and parents who feed their children Coke and chips can yell at me about how judgmental I am. 😳

 

[werd]

yeah i probably do judge quite a few of my patients. i also judge your patients, who, quite frankly, are much suckier than mine.

 

[Bartelby]

I also judge the resident for the one-sentence pep talk about nutrition, when it was obvious to all of us that 1 sentence wasn't going to cut it. Maybe 10 sentences, one of them requiring some sort of response from the mother, might have made a difference.

Maybe when I am a resident I will have stopped caring enough to make any sort of effort--it is entirely possible--but I know that this resident could have taken 3 extra minutes to really discuss nutrition with the mom, and she didn't.

I have never treated patients, but I did grow up around plenty of "coke and chips" sedentary obese people. In my experience the only thing the resident could have done with a longer speech is make the patient resent him/her. These people will only change when they decide to change; you can't talk them into it.

 

[lilnoelle]

I'm definitely not a "coke and chips" parent, but there were quite a few times that pediatricians told me not to give my kids juice for the same reason - and I nodded my head, thinking "yeah, right" while the pediatrician said it.
It wasn't until I started paying attention to my own calorie intake and trying to improve my own diet that I (an educated person) really understood why juice is something that really shouldn't be given to kids regularly.
I'm not sure exactly what a doctor could've said to me that would've helped me realize it earlier than I did.... although its possible that spending more time explaining why juice is bad (for me, this would be telling me what a kid SHOULD eat in a day, including average calorie intake, and then explaining that three cups of juice a day in addition to the correct amount of food will cause a child to be overweight in a relatively short period of time).
My current calorie counting habits have also led to us not eating fast food nearly as often as well.

Now one might say that just knowing whats healthy and whats not should be enough to make the right choice.... well, for many parents who don't think they're kids are overweight, they may not feel the need to make a change. That was my reason for not changing at the time, my kids were, (are) healthy, they're active, they're not chubby at all, why should I get rid of juice - I drink juice regularly (or I did) and I'm fine, whats the big deal?


Education CAN make a difference, but I can understand why it might be frustrating to the educator who might feel like their words go in one ear and out the other.

 

[SalseraDoctora]

I think you make two good points: in this case, the child actually was overweight, so this parent didn't have the "my kid is healthy and thin" rationale. But also your other point about having somebody explain nutrition is sort of what I meant. I think people don't want to be told what to do; they want someone to explain why it is in their best interest to choose to do it.

At the very least, given the morbid obesity of the mom and the chubbiness of the little girl, I would have referred them to a nutritionist. You are right, though, that unless the parent actually comes to you to ask for your help dealing with nutrition/weight, it is pretty difficult to make an impact, no matter what you do. As Dr. Phil (who I still like despite his recent complete lapses in judgement regarding Britney Spears and that teenage girl who beat the hell out of that other teenage girl) always says: you can't change what you don't acknowledge. It does make me angry though when I see parents making no effort to get help with their children's obesity knowing how devastating both physically and emotionally that is.

 

[TheLesPaul]

I'm definitely not a "coke and chips" parent, but there were quite a few times that pediatricians told me not to give my kids juice for the same reason - and I nodded my head, thinking "yeah, right" while the pediatrician said it.
It wasn't until I started paying attention to my own calorie intake and trying to improve my own diet that I (an educated person) really understood why juice is something that really shouldn't be given to kids regularly.
I'm not sure exactly what a doctor could've said to me that would've helped me realize it earlier than I did.... although its possible that spending more time explaining why juice is bad (for me, this would be telling me what a kid SHOULD eat in a day, including average calorie intake, and then explaining that three cups of juice a day in addition to the correct amount of food will cause a child to be overweight in a relatively short period of time).
My current calorie counting habits have also led to us not eating fast food nearly as often as well.

Now one might say that just knowing whats healthy and whats not should be enough to make the right choice.... well, for many parents who don't think they're kids are overweight, they may not feel the need to make a change. That was my reason for not changing at the time, my kids were, (are) healthy, they're active, they're not chubby at all, why should I get rid of juice - I drink juice regularly (or I did) and I'm fine, whats the big deal?


Education CAN make a difference, but I can understand why it might be frustrating to the educator who might feel like their words go in one ear and out the other.

Out of curiousity....why is juice so bad? I gave up all my fizzy drink intake in exchange for 100% juices - is that so bad? I usually drink about 4-5 cups per day, and I'm not overweight at all (or even near overweight). It seems to me that drinking 100% fruit juice (rather than those "juice" drinks) can only be healthy...is that so different from actually eating the fruit?

 

[ZagDoc]

Out of curiousity....why is juice so bad? I gave up all my fizzy drink intake in exchange for 100% juices - is that so bad? I usually drink about 4-5 cups per day, and I'm not overweight at all (or even near overweight). It seems to me that drinking 100% fruit juice (rather than those "juice" drinks) can only be healthy...is that so different from actually eating the fruit?

Sugar. Lots and lots of it. Mostly fructose. 8 fluid ounces of fruit juice countains about 6-8 ounces of fructose. Just as many calories as regular soda and its high fructose corn syrup. Sure they get the healthy stuff from the fruit juice, but its not the lack of antioxidants/etc from soda that cause type II diabetes, its the insulin imbalance from the sugar intake.

That's not to say that fruit juice doesn't play a role in a healthy diet. But like anything involving a healthy diet - all things in moderation. Parents are falsely led to believe that substituting OJ for coke will stave off obesity.

 

[treva]

That's not to say that fruit juice doesn't play a role in a healthy diet. But like anything involving a healthy diet - all things in moderation.

I'm a nutrition / fitness freak that used to be overweight until about 19. I made a big lifestyle change because I was sick of being unfit and unattractive due to my weight, so I changed that.

In my many readings on nutrition and exercise I came across an article written by Dr. John Berardi talking about how you basically should not consume any drink that has calories in it unless it is directly before, during, or after a workout. Basically the idea is that drinking liquid doesn't fill you up, and if you want to eliminate excess calories from your diet the best way to do so is to stop drinking liquids filled with calories. I understand that fruit juice is a better nutritionally than soda, but as pointed out in contains heaps of sugar. I don't follow this religiously, because I do enjoy milk 🙂

The far better alternative is to simply eat a piece of fruit instead. It's less calories and more filling.

As for the topic at hand, I do judge patients. I cannot help but judge overweight and obese patients (and to be fair, I even judge overweight / obese classmates). I'm sure my own self driven fitness "rebirth" is driving the judgment bandwagon, but I don't understand how people can do that to themselves...

 

[TheLesPaul]

That really sucks then! I love juice, milk, and other fruit/dairy based drinks...am I really only supposed to have 1-2 glasses of these per day? Is there a difference b/w store-bought tropicana and orange juice made with a juicer at home?

Finally, if OJ = heaps of fructose and coke = heaps of sucrose, then minus the vitamins (which can be taken with a pill or something), fruit juice is on the same scale as soda?

 

[treva]

That really sucks then! I love juice, milk, and other fruit/dairy based drinks...am I really only supposed to have 1-2 glasses of these per day? Is there a difference b/w store-bought tropicana and orange juice made with a juicer at home?

Finally, if OJ = heaps of fructose and coke = heaps of sucrose, then minus the vitamins (which can be taken with a pill or something), fruit juice is on the same scale as soda?

You know, in all honesty, unless you're at risk of becoming diabetic or are currently a diabetic or over weight, chances are you're not going to die 20 years sooner because you like juice. However if you become a diabetic or overweight, drinks filled with sugar (ie soda, juice) should probably be stopped or at the very least severely cut back on.

Don't get me wrong though, the fact that you're consuming sugar found in fruit isn't necessarily bad. It's the fact that each class of juice is 100+ Cal and 30g - 80g of sugar (depending on the type, Cranberry can be the worst) and you don't feel any fuller after consuming it. If you have a glass of juice with every meal, you can easily add up to 300-500 additional Calories and 90+g of sugar just by drinking.

You are correct though, minus the vitamins juice and coke are basically on par with table sugar in water. As for the differences between fresh OJ and Tropicana OJ (I am assuming the ingredient is just 100% OJ) the differences are probably minimal. But think of the nutritional value of all that stuff you are leaving behind in the juicer!

 

[TheLesPaul]

hmm...like I said, I'm not even close to being overweight, but I do have a family history of diabetes. And I drink juice at every meal, usually about 2-3 cups. I guess it's just hard to accept that fruit juice can be bad. What about the 'naked' stuff, the no sugar added, nothing added juice?

 

[StealthNerd]

Of course I judge patients. I judge everyone. Either I feel bad for you because something unfortunate happened, or I don't feel bad because you never should have survived this long to do something this stupid. ... It doesn't mean I'm not going to give some of these worthless *****s more help then they deserve. It just means I'm going to be thinking to myself that we maybe ought to put something in the water to make everyone sterile.

Seriously though. Don't you guys sometimes feel bad that we're directly interfering with Darwin? I mean, my God, sex should absolutley not lead to children. Maybe we ought to come up with a policy to go with EMTALA that says if you almost die out of amazingly stupid, irresponsible, and dangerous behavior, then we'll save your life but tie off the tubes so you still kind of win that Darwin Award you were so desperately seeking. That tube tying would also come automatically with every DUI citation, felony conviction, and child abuse case.

O, what a wonderful world it would be if Stealth Nerd was in charge. ... *sigh*...

 

[StealthNerd]

O, and about all the smoking talk. ... If you're an adult, you ought to be allowed to do whatever the hell you want to yourself. I mean, whatever. Alcohol, drugs, sex, reckless behavior, smashing your face on the ground cause you're whacked out on PCP... whatever. It's just that you can't involve anyone innocent (so no doing the above while driving, for example), and YOU SHOULD NOT SUCK UP MY TAX DOLLARS TO FIX YOUR DUMB A$S.

For example: if you weigh 300 lbs and come into the ER for anything cardiovascular in nature, you should have to pay in cash. Up front. Same goes for smoking and lung cancer. Head trauma and helmet-less motorcyclists. Etc.

Sweet Jesus people. Come on. Of course we all judge patients.

 

[lilnoelle]

hmm...like I said, I'm not even close to being overweight, but I do have a family history of diabetes. And I drink juice at every meal, usually about 2-3 cups. I guess it's just hard to accept that fruit juice can be bad. What about the 'naked' stuff, the no sugar added, nothing added juice?

If your concerned, take an average day and count your calorie intake. If it seems like its higher than it should be compared to what you are burning that day (www.freedieting.com has calculators to figure out your calorie needs), then it might be a good idea to cut back. Most likely, if your not gaining weight, then you are not taking in more calories than you need to maintain your weight. If thats the case, then the juice is probably not much of a problem. When your metabolism slows some (age, less exercise, reduced muscle mass) you may find yourself gaining weight unless you reduce your calorie intake some.... in that situation, I would think juice would be the first thing to go.

 

[primadonna22274]

Along these lines though you can bet I DID lecture the obese type 2 DM mother of a 40# 22-month-old last night that this fat baby should NOT be given peach juice and white grape juice and any other kind of fruit juice, nor should this fat baby be drinking an 8-oz bottle of whole milk every 2 hr while awake. It's a wonder this baby's weight has been the same for the past 3 months.
This is also a formula-fed baby until she was weaned to whole milk (and way too much fruit juice). Come to think of it, I've NEVER seen an obese breastfed baby.
🙄

 

[lilnoelle]

Along these lines though you can bet I DID lecture the obese type 2 DM mother of a 40# 22-month-old last night that this fat baby should NOT be given peach juice and white grape juice and any other kind of fruit juice, nor should this fat baby be drinking an 8-oz bottle of whole milk every 2 hr while awake. It's a wonder this baby's weight has been the same for the past 3 months.
This is also a formula-fed baby until she was weaned to whole milk (and way too much fruit juice). Come to think of it, I've NEVER seen an obese breastfed baby.
🙄

40 pounds? Wow.... thats pretty big. My daughter (almost 5 years old) is 42 pounds and is up toward the top of the growth curve (both height and weight, so her adjusted BMI is fine).

 

[primadonna22274]

Exactly. 42# 5yo is normal. 42# not-quite-two...not normal.
Fattest child I ever saw was a 4 yo who weighed 111#. Not kidding. This was in my endocrine rotation several years ago. Come to think of it this kid would be, well, 13 now. Sad case. We did the thorough endo workup but all was normal. Turns out this child had witnessed her father strangle her mother a couple years back after plenty of other abuse. Dad was in prison (thank God). Mom was alive and trying her best to raise her kids. Kid was comforted by food...lots of it. But she was literally a Pillsbury doughboy(girl). Counseling hadn't helped (although was pretty sketchy counseling IMO). After all this the idiot insurance company DENIED nutrition counseling because the child didn't have diabetes etc.
Ugh.

40 pounds? Wow.... thats pretty big. My daughter (almost 5 years old) is 42 pounds and is up toward the top of the growth curve (both height and weight, so her adjusted BMI is fine).

 

[lilnoelle]

Exactly. 42# 5yo is normal. 42# not-quite-two...not normal.
Fattest child I ever saw was a 4 yo who weighed 111#. Not kidding. This was in my endocrine rotation several years ago. Come to think of it this kid would be, well, 13 now. Sad case. We did the thorough endo workup but all was normal. Turns out this child had witnessed her father strangle her mother a couple years back after plenty of other abuse. Dad was in prison (thank God). Mom was alive and trying her best to raise her kids. Kid was comforted by food...lots of it. But she was literally a Pillsbury doughboy(girl). Counseling hadn't helped (although was pretty sketchy counseling IMO). After all this the idiot insurance company DENIED nutrition counseling because the child didn't have diabetes etc.
Ugh.

wow. thats really sad.

I think sometimes its hard to convince people to change their lifestyle because they (at this point in time) aren't suffering any bad effects from it.
My sister is like that. She's obese (BMI around 38) and just keeps getting bigger and bigger. She has TRIED to lose weight various times, in fact, for a while we were on a diet together this last fall. Then she got pregnant with her fourth son and the diet obviously went out the window.
At this point in time, her lab numbers are fantastic, she's just as functional as I am, and other than for vanity reasons, has no real current impairment due to her weight.
She's an educated person and KNOWS the health risks with being overweight, but thats not always enough.