How to address anti-vax families requesting certain medications?

[BITB11]

I am sure that everyone here has encountered similar situations. Patient doesn't get vaxxed. Patient ends up intubated in ICU or on HFNC/bipap etc. Family is crazy and scrutinizing/criticizing medical management. I think its easy to explain why we aren't using Ivermectin.. you can just explain that the data isn't there and theres potential adverse effects and potential of doing harm. But I find it a struggle sometimes when families request IV vitamin C. I can explain that there is no data behind it, but then families will counter that with "but whats the harm? Why not just give them it?" Logistically, giving medications that cost a lost of money and have no data for benefit is the true reason why we don't just give everyone Vitamin C etc. But you can't really explain that to families whose loved ones life is on the line... that its a money thing. Because that just fuels their fire of doctors being money hungry and feeding into big Pharma etc.

Anyone have a good approach to these conversations?

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[aafisahar]

no

second time ->no

third time -> no and call security

 

[Katheudontas parateroumen]

It’s definitely a big time struggle. They will come back and be like “well if you say he’s dying why can’t we just try everything”. Shrug and just say no and explain what you’ve already said. Usually my go to is there is no specific cure/treatment for severe Covid; we only do treatments that have proven benefit and anything outside of that is harmful and would be off label, experimental and would be scrutinized. It’s kinda white-lie since we do a lot of things off label and marginally beneficial but that usually puts it into perspective of we are doing the most right for their loved one. And to be honest, a lot of our Covid patients are already on PO vitc from previous anyways so I just tell them oh they were already tried on vitamin c. Whatever

 

[DrMetal]

Explain to them that covid is just part of the evolutionary process, and that some portion of the population (namely, the the obese diabetic and less intelligent type) will have to die.

 

[SurfingDoctor]

I am sure that everyone here has encountered similar situations. Patient doesn't get vaxxed. Patient ends up intubated in ICU or on HFNC/bipap etc. Family is crazy and scrutinizing/criticizing medical management. I think its easy to explain why we aren't using Ivermectin.. you can just explain that the data isn't there and theres potential adverse effects and potential of doing harm. But I find it a struggle sometimes when families request IV vitamin C. I can explain that there is no data behind it, but then families will counter that with "but whats the harm? Why not just give them it?" Logistically, giving medications that cost a lost of money and have no data for benefit is the true reason why we don't just give everyone Vitamin C etc. But you can't really explain that to families whose loved ones life is on the line... that its a money thing. Because that just fuels their fire of doctors being money hungry and feeding into big Pharma etc.

Anyone have a good approach to these conversations?

I mean, the reality is that cost is kinda not a good argument and vitamin C isn't going to make or break the medical expense. Just lying in the bed costs $10K/day. No overpriced orange juice is really going to impact that. They really should be given the option to give useless treatments to their family member if they pay for it out of pocket... fee for service. ie they can have all the high-dose vitamin C they want. They just need to go to the pharmacy, pay for it and then after the monetary exchange, hand it to the healthcare staff. But that's just my opinion and also not practical.

Instead, you could turn it around on them...

Doctor: "We don't use treatment X because it has been shown not to be beneficial."

Nutty family: "Why aren't you using X. It ain't gonna hurt?"

Doctor: "Oh, okay. Well, what dose and route should I use to provide efficacy?"

Nutty family: "Sh-t, I don't know, you're the doctor!"

Doctor:

 

[Siggy]

if there’s no harm, then I don’t really care and order it. There’s already plenty of voodoo is regular practice.

After all, how many alcoholics end up on a banana/rally bag?

Edit: …and before anyone goes all smooth brain and says, “Durrrr thiamine, Wernicke's,” the dosing for that is 300-500 IV TID, not 100 daily over 10 hours. The multivitamin and the rest in it can be giving with good enough oral bioavailability and isn’t, in general, needed.

 

[chessknt]

if there’s no harm, then I don’t really care and order it. There’s already plenty of voodoo is regular practice.

After all, how many alcoholics end up on a banana/rally bag?

Edit: …and before anyone goes all smooth brain and says, “Durrrr thiamine, Wernicke's,” the dosing for that is 300-500 IV TID, not 100 daily over 10 hours. The multivitamin and the rest in it can be giving with good enough oral bioavailability and isn’t, in general, needed.

There is at least a logical and reasonable extrapolation to make that b12 and folic acid are deficient though because these people don’t eat food… Vitamin c in COVID is based on absolutely nothing.

I usually try to explain that people have been trying crazy **** for this virus for a year and a half and we need to accept that a higher power is in charge and I’m just there to support them. Since almost 100% of these people are some variant of devout Christianity this usually gets them to agree with me on premise and disarms their hostility because they think I also hold similar beliefs tk them. If they try to push it beyond that I just start talking about something else and ignore them and don’t engage when they ask.

Example:
Do you have any questions?
Can we please start inhaled budesonide I heard blah blah
Ok so I’ll call you tomorrow with another update if that’s it then.

 

[Dred Pirate]

I mean, the reality is that cost is kinda not a good argument and vitamin C isn't going to make or break the medical expense. Just lying in the bed costs $10K/day. No overpriced orange juice is really going to impact that. They really should be given the option to give useless treatments to their family member if they pay for it out of pocket... fee for service. ie they can have all the high-dose vitamin C they want. They just need to go to the pharmacy, pay for it and then after the monetary exchange, hand it to the healthcare staff. But that's just my opinion and also not practical.

I did a medical mission trip to south america and one our people got a GI and had to be hospitalized - we had to do exactlly this. Go to the pharmacy, purchase the protonix - and bring it to the bedside for the RN to administer,

 

[SurfingDoctor]

I did a medical mission trip to south america and one our people got a GI and had to be hospitalized - we had to do exactlly this. Go to the pharmacy, purchase the protonix - and bring it to the bedside for the RN to administer,

 

[lymphocyte]

I did a medical mission trip to south america and one our people got a GI and had to be hospitalized - we had to do exactlly this. Go to the pharmacy, purchase the protonix - and bring it to the bedside for the RN to administer,

I worked with a great cardiac interventionalist from Sri Lanka. Apparently the folks selling stents would wait outside the cath lab, and the family would try to negotiate a price then and there; If they couldn't afford a stent, it was a diagnostic angiogram until they saved up enough.

 

[aafisahar]

I worked with a great cardiac interventionalist from Sri Lanka. Apparently the folks selling stents would wait outside the cath lab, and the family would try to negotiate a price then and there; If they couldn't afford a stent, it was a diagnostic angiogram until they saved up enough.

Yep, if you talk to docs from India/Pakistan, they'll share stories about wheeling folks out of the icu sick AF because families ran out of money.

Our system sucks, but theirs is a whole nother level of ****.

 

[Hamhock]

I find it a struggle sometimes when families request IV vitamin C.

Anyone have a good approach to these conversations?

Family: "Why won't you use vitamin C?"

Me: "For the same reason that I don't use ascorbic acid unnecessarily"

Honestly, I haven't tried this technique -- but I might soon. It's probably pretty easy to close the conversation based upon the family's response to the refusal of ascorbic acid.

HH

 

[lunaire]

I would tell the family that I would try anything that we have evidence of working. I will not try anything that has been shown to make no difference. All medication and intervention carries the risk of ADRs. All drugs carry a small risk of allergy and uncommon drug-drug interactions. Exposing patients to a drug that doesn't work is kind of a negative expectation intervention... Even vitamin C at antioxidant dose carries risk of oxalic acid kidney stone formation.

 

[Doctor Bob]

When families ask for vit C, I shrug and give it.

When families ask for other unproven/unstudied/harmful/whatever meds and say something like "well they're dying anyways so why not try it", I tell them that I don't experiment on patients regardless of their condition.

 

[Onefellswoop87]

Family: "Why won't you use vitamin C?"

Me: "For the same reason that I don't use ascorbic acid unnecessarily"

Honestly, I haven't tried this technique -- but I might soon. It's probably pretty easy to close the conversation based upon the family's response to the refusal of ascorbic acid.

HH

Had an attending in anesthesiology residency who did something similar. Patients after the Michael Jackson propofol news would be weary of anyone using propofol but he’d assure them that “Oh, we don’t use just generic propofol, only Diprivan here”

 

[Hamhock]

When families ask for other unproven/unstudied/harmful/whatever meds and say something like "well they're dying anyways so why not try it", I tell them that I don't experiment on patients regardless of their condition.

why do you experiment with vit C on patients, then?

HH

 

[chocomorsel]

Yep, if you talk to docs from India/Pakistan, they'll share stories about wheeling folks out of the icu sick AF because families ran out of money.

Our system sucks, but theirs is a whole nother level of ****.

Except you are comparing Apples to Oranges. Comparing US to India and Pakistan. Come on.
BTW, I am an African woman and know about how hospitals back home work if you have no insurance. Which most people don’t. Buy your own supplies, sleep at bedside and help the nurses with your families care, pay up before discharge or held hostage.
But you cannot compare a developing country to the “Greatest superpower” in the world and say “it could be worse!” Of course it is!!!

 

[Doctor Bob]

why do you experiment with vit C on patients, then?

HH

Well... Marik wouldn't consider it experimentation

 

[thehundredthone]

Well... Marik wouldn't consider it experimentation

Nor ivermectin...

 

[BicepsTriceps]

I tell them I can only give oral vitamin C tablets and do that.
Same with any other supplement or vitamin. As long as it's PO and has no contraindication I'll order it.
I will never prescribe anything IV unless it's indicated.