Random musings ...

[kinetic]

Who are these people who, when you go to examine lung fields and ask them if they can roll over, say "no" and then proceed to be dead weight as you struggle to roll, brace, and auscultate? I'm not saying they do that on purpose (well, maybe I am ... ), but how feeble do you have to be in order to be unable to roll (this obviously excludes people who have just had surgery or are paralyzed, etc.)? I dunno ...it's irritating (especially when you're in a hurry), but I also feel so badly for them - that's gotta be a sucky sucky quality of life. I mean, I don't ever picture myself as being glued to my bed in one position being unable to move (not counting post-call, during which time I just lay in bed urinating on my prone body ).

---

Members don't see this ad.

 

[musiclink213]

Just think, if you were a patient, struggling through an illness, finally go to the ER where you are poked and prodded and everyone wants to examine you. Then you get admitted and have to explain the entire history again, maybe twice more if the attending comes by, go through the exam again. Then the night float comes by and does it. Then they call consults and the student on the consult service comes by, then the attending and fellow on the consult service come by. And of course, another history and exam. Then another consult. Plus all this time the nurses are reassessing you. I'd go nuts, I don't know about you. No one lets you sleep.

you hit it right on the head i htink. last june, i was admitted to the hospital first, in the ER, there's all these people coming in and they ask the same questions and do essentially the same physical exams. Then, once i got on teh floor, the nurse had to retake my history, then these 2 interns came and did another history and exam. At 2 am and 4 am, i got woken up because they wanted to see how i functioned in the middle of hte night.

Then, in the morning, the 3 yr resident came in and did another exam. This was followed by the attending and hte med student. Then later in the day, my regular neurologist came in and did another exam. I mean, i understand why it had to be done, but it just got really annoying after a while. Especially being woken up at 4 am and being asked to walk in a straight line and stuff like that. Then they wonder why I fell asleep in the MRI machine.

 

[DOtobe]

Rotations have made me realize that I never want to be a patient in a teaching hospital. I'm sure it gets annoying when ten different people come and ask you the same questions.

But the thing is, the patients are made aware that they are in a teaching hospital, so they should know that there will be medical students, residents, nursing students, etc. coming to see them. Most patients have been okay with me seeing them, but I remember one who as soon as I introduced myself said, "Why do I keep getting all these damn students?" Because you're in a teaching hospital...

So, yeah, it is really annoying. It's annoying with patients who can get up so you can listen to their lungs, can give a good history, but are just to stubborn and don't want to do it. But it's completely understandable in post-op patients, old demented patients, and other patients who just can't accommodate you.

 

[Homunculus]

Rotations have made me realize that I never want to be a patient in a teaching hospital. I'm sure it gets annoying when ten different people come and ask you the same questions.

some patients equate all this attention with better care. i've had just as many patients say how "wonderful it is to have so many people trying to make me better" or "people take such good care of me here" as the ones that complain about being woke up at all hours and being asked the same questions repeatedly. personally, it'd drive me nuts to have that many people coming in and out, lol.

 

[docB]

Who are these people who, when you go to examine lung fields and ask them if they can roll over, say "no" and then proceed to be dead weight as you struggle to roll, brace, and auscultate?

Why can't people ever understand that I can't hear them while I'm wearing my stethoscope? I've even told people that I can't hear them and then they continue talking. And why is it that when ever I say to take a deep breath if the person is over 50 they breath in and hold it? Even after I tell them to just breathe in and out they still hold it. Were people force to hold their breath for lung exams under penalty of death back in the 20s and 30s?

 

[Skrubz]

some patients equate all this attention with better care.

one of my friends feels that way and swears by teaching hospitals (in his case, UW). he likes how there's the chain of command with people essentially checking and verifying the data gathered by those lower on the ladder. then again, he is a rather unique personality.

 

[kinetic]

Is he, by any chance, your avatar?

 

[(nicedream)]

Is he, by any chance, your avatar?

 

[Skrubz]

Is he, by any chance, your avatar?

hahahahaha

 

[The White Coat Investor]

Why can't people ever understand that I can't hear them while I'm wearing my stethoscope? I've even told people that I can't hear them and then they continue talking. And why is it that when ever I say to take a deep breath if the person is over 50 they breath in and hold it? Even after I tell them to just breathe in and out they still hold it. Were people force to hold their breath for lung exams under penalty of death back in the 20s and 30s?

Rolling on the floor laughing.....so true, so true

 

[DOtobe]

about the people taking a deep breath and holding it. I don't understand why I have to tell some people "you can breathe out now." Even the little ones I see on my peds rotation now know just to breathe in and out (and not hold it)...

 

[kinetic]

What about the people who breathe in and out but in an ungodly noisy fashion? They inhale ("HHHHHUUUUUUUHHHHHHH!!!!!") and exhale ("AHHHHHHHHHHHH!!!!"). Or how about the people (this may be hard to explain) who think "breathing in and out" consists of extending and flexing their spines?

What about people who you go to test their patellar reflexes and they kick before you even hit them? (At least they have the decency to look embarrassed.)

How about my favorite? The patient in 10/10 pain who is lying on the bed with their ankles crossed and whistling quietly while watching TV? Or you specifically say, "OK, 10/10 is like getting hit by a bus," and before you're even done they interrupt with, "yeah, that's how I feel right now!" And you just look at them for a long time.

 

[johnthestreak]

i like the "looking at them for a long time" bit. i plan to do it with absolutely no expression on my face.

 

[kinetic]

i like the "looking at them for a long time" bit. i plan to do it with absolutely no expression on my face.

Well, duh. I don't stare at them with my tongue hanging out and my eyes crossed or anything. Although maybe ...

 

[docB]

Do you have any medical conditions? No.
Have you ever had surgery? No.
(yaah notices huge scar on belly)
Where does this scar come from? Oh I had surgery. I had pancreatic cancer.

Silly patient.

I love the patients that pull this number:
Me: "Do you have any medical problems?"
Pt: "No."
Me: "Well do you take insulin? (or atenolol, or Dilantin, or Amiodarone)"
Pt: "Yeah."
Me: "Then you have a medical problem. Don't you."
Pt: "No. As long as I take that I don't have a problem."

Oh and the long, silent, uncomfortable stare is great. I find it to be better than saying "Are you ------- kidding me?"

 

[kinetic]

Or what about the people who take medications, but can only tell you "it's a pink one ...you know what that is, right? I mean, you're a doctor!" And I even - God knows why - ask them, "well, can you tell me why you take it?" "No, doc, but it's pink!" "OK, I know you know your colors, now can you recite your ABCs, dolt?"

And it's fine to self-d/c everything from insulin to metoprolol, but these ******s throw down the Viagra like they're Pez. Apparently, your hard-on is more important to you than your life.

I'm a big advocate of long, uncomfortable pauses with hard looks thrown around, but never underestimate the power of an unexpected mooning. Take that, loser patients!

 

[DoctorDoom]

Your hard-on is more important to you than your life.

True.

Oh, this isn't an exam. Sorry.

 

[Apollyon]

And it's fine to self-d/c everything from insulin to metoprolol, but these ******s throw down the Viagra like they're Pez. Apparently, your hard-on is more important to you than your life.

I was talking about just that last week - tell these guys there's a 1 in 3 chance that it will kill them, and they'll take those odds to get laid.

 

[docB]

I'm a big advocate of long, uncomfortable pauses with hard looks thrown around, but never underestimate the power of an unexpected mooning. Take that, loser patients!

Too funny! That's the first time anyone has suggested something that would truly convey my feelings to my patients! I'll try it. Keep your eye on the newspapers to see how it goes for me.

BTW I have actually said to a patient "So you don't know any of your drug names but you can describe them? Well, here you go. Let me know when you're done." while dropping a copy of the dictionary sized PDR picture reference on their lap.

I also hate the people who don't know any of their history but refer me to a family member. "I don't know any of that. Why don't you go get my wife from the waiting room and ask her." "Why don't I? Oh, because I'm too busy to go try to track down your wife who could be anywhere between the parking lot, the waiting room and the cafeteria. Once your wife shows up why don't you ask her about your history and I'll cruise by sometime after you grow a brain.

I firmly believe that society would be well served by a "Don't know meds, Don't know history, Don't get no ER care." policy. Darwinism at it's best.

 

[Vincristine]

Or what about the people who take medications, but can only tell you "it's a pink one ...you know what that is, right? I mean, you're a doctor!" And I even - God knows why - ask them, "well, can you tell me why you take it?" "No, doc, but it's pink!" "OK, I know you know your colors, now can you recite your ABCs, dolt?"

And it's fine to self-d/c everything from insulin to metoprolol, but these ******s throw down the Viagra like they're Pez. Apparently, your hard-on is more important to you than your life.

I'm a big advocate of long, uncomfortable pauses with hard looks thrown around, but never underestimate the power of an unexpected mooning. Take that, loser patients!

This reminds me of the guy I saw yesterday who was amuzing enough with his slicked back grey hair, black jogging suit with a shiny silk shirt, complete with too much bling-bling. BUT when we tried to figure out how often he took his clonidine, he kept saying, "I don't know, is that the little pink one"? Without missing a beat he called his wife and handed his cell phone to the doctor. He then said, "Ask my wife. When she dies, I'm going to have to get remarried so someone can find my clothes for the funeral."

I about fell over.

 

[edinOH]

Me: So what kind of medical problems do you have?
Them: I don't have any.
Me: None?
Them: No, nothing.
Me: What medications do you take?
Them: I brought a list...

Atenolol
Accupril
Lasix
Lipitor
Glucophage
Metformin
70/30 am/pm
synthroid
plavix
asprin

Me: I gather from this list you must have high blood pressure, diabetes, CHF, low thyroid, and possibly a hx of a stroke or heart attack?

Them: Well, yeah.
Me: But you don't have any medical problems?
Them: (dumb empty look)

 

[docB]

Me: So what kind of medical problems do you have?
Them: I don't have any.
Me: None?
Them: No, nothing.
Me: What medications do you take?
Them: I brought a list...

Atenolol
Accupril
Lasix
Lipitor
Glucophage
Metformin
70/30 am/pm
synthroid
plavix
asprin

Me: I gather from this list you must have high blood pressure, diabetes, CHF, low thyroid, and possibly a hx of a stroke or heart attack?

Them: Well, yeah.
Me: But you don't have any medical problems?
Them: (dumb empty look)

Continuation in a perfect world.
Me: Well I'm sorry but you have demonstrated that you have no right to medical care. In fact society has decreed that you be euthanized and ground into a nutritious protein slurry to be used as cattle feed. Please step into the metal box.

 

[radiojimi]

you have to admit the question "do you have any problem?" (medical or otherwise) is ambiguous and is fair game for being interpreted as a search for any unaddressed issues.

Strangely enough, I'll bet you most patients who provide such frustrating replies are really trying to be as helful as possible by being stoic and macho and only talking about the problems that REALLY bother them. Either that or they're simply in denial.

Either way, crazy answers like that are a cue to try a differently worded question. No worries.

... and as for the patients who are terribly underinformed about their own health, well, try and forgive them for their ignorance. Most have no idea what fund of knowledge you must have to distinguish one drug from another or why any of the details of their history that you're asking them matter. They simply have no friggin' clue. All they know is that you're the guy in white who's supposed to fix 'em, or at least make them feel better.

You also have to admit, providers rarely ever sit down with the patient and correlate the physical appearance of the medications they prescribe (e.g. using pictures from the PDR) with the indications for their use, the dosing, and expected side-effects. There's simply no time. They say a picture's worth a thousand words, but what do providers give them with the script? Yep, you guessed it, a thousand words.

The system's broken people. Until we get to a point where patients know their providers well enough to establish a rapport and within that context discuss and understand in detail their plan of care, scenarios like the "They told me to take this pink pill" cluelessness will not go away soon.

I'm just trying to mollify the grief you guys feel for having to wade across the chasm of knowledge in order to reach your patients.

 

[Harrie]

aaarrgg...I HATE it when patients say that they take "that little white pill, you know doc, it's that small white pill for the heart or something"

Personally, my favorite mispronounced word is prostRate. "Yeah, my dad had prostrate cancer."

 

[kinetic]

you have to admit the question "do you have any problem?" (medical or otherwise) is ambiguous and is fair game for being interpreted as a search for any unaddressed issues.

Well, you may have a point except for the fact that they get asked this question every time they see a health care provider. And every time they say "no", they go through the same litany of, "don't you have HTN, CHF, DM, hypothyroidism ...". And they respond, "duh, yeah". That's not ambiguous - that's brick-wall blockheaded ******edness. Flipper learns faster than some of these *****s.

Strangely enough, I'll bet you most patients who provide such frustrating replies are really trying to be as helful as possible by being stoic and macho and only talking about the problems that REALLY bother them. Either that or they're simply in denial.

I wish they were just a little bit MORE stoic and macho and dealt with their one-day history of non-productive afebrile cough at home. And it's lame how we have to play mind games with patients. You always hear about the scenario where you see the patient, finish with everything, and then ask if there are any more questions ...and after twenty minutes, they blindside you with "oh, actually, I wanted to know why I have [fill in completely new sx or complaint]". And you're supposed to take your finger off the "eject patient from room" button, sit down, and start all over again with a cheerful grin and wonder what you could have done to facilitate a more easy discussion of this new, awkward, and usually-completely-unimportant-but-sometimes-just-as-irritatingly-lifethreatening problem.

... and as for the patients who are terribly underinformed about their own health, well, try and forgive them for their ignorance. Most have no idea what fund of knowledge you must have to distinguish one drug from another or why any of the details of their history that you're asking them matter. They simply have no friggin' clue. All they know is that you're the guy in white who's supposed to fix 'em, or at least make them feel better.

a) Yes, that lazy mentality is what bugs us. It's only their health, why should they care about it, right? b) Is it asking too much of a fund of knowledge to know what problems you've had and the names of the medications you're taking? Not the side-effects of said medications, not the interactions, not the clinical description of the diseases, etc.

When you're asked if you ever had a CT, say no, and are asked "did you ever get put through this machine with a round circle and had a picture taken of you", why is there this ambiguous and dense empty look? (And don't say, well, they're really asking themselves whether it was a CT or an MRI machine.)

You also have to admit, providers rarely ever sit down with the patient and correlate the physical appearance of the medications they prescribe (e.g. using pictures from the PDR) with the indications for their use, the dosing, and expected side-effects. There's simply no time. They say a picture's worth a thousand words, but what do providers give them with the script? Yep, you guessed it, a thousand words.

So we're damned if we do and damned if we don't. If we talk about side-effects, we're blabbermouths who are giving information overload and burdening our poor thimbleheaded patients. If we don't we're at fault for not sitting down with a 1,000+-page picturebook and having storytime and, if anything happens to the patient, we're also being paternalistic and withholding vital information. You were right when you said that most patients just think "ug ...man wearing white coat ...he make it all get better ...then I go home and drinky drinky to celebrate ...eat many magic pills ...".

I've had many patients who are dumb-ass ******s and fewer who are responsible people who follow-up when they should, know what their problem and medical history is, and even know what tests they've had (sometimes even the results, which I don't expect). Guess which group I am more than happy to help out? And guess which group calls your home number (which the page operator inexplicably gave out) at midnight to tell you their "sleepy pills" ran out and they want a renewal? This shouldn't be some stupid reinvent-the-wheel-each-time-I-see-your-dumb-ass goosehunt - if people don't know what's going on with their health (unless they're delerious, demented, or clinically ******ed), that should be grounds for a prolonged head beating with a heavy bat.

 

[DoctorDoom]

Continuation in a perfect world.
Me: Well I'm sorry but you have demonstrated that you have no right to medical care. In fact society has decreed that you be euthanized and ground into a nutritious protein slurry to be used as cattle feed. Please step into the metal box.

Easy mein Fuehrer, this is USA 2004, not Deutschland 1944. Stupid isn't a crime.

 

[kinetic]

Easy mein Fuehrer, this is USA 2004, not Deutschland 1944. Stupid isn't a crime.

Stupid isn't a crime, but we shouldn't devote so much of our resources to maintaining the dumbest people in our society. It's the opposite of 'survival of the fittest' - which I'm not advocating in it's strictest sense, but come on. We put all of our money into treating *****s who take little to no care of their bodies, who know nothing about their diseases, and who don't care to do anything to prevent deterioration of their condition. The pills you prescribe are a nuisance. The follow-ups you schedule are inconvenient. The tests you perform are a bother. The hospitalization that results is an irritation. Yet we continue to pour money into these slobs until their eventual demise.

It's a joy to take care of well-educated patients (and don't mistake these for the people who bring in carts of Internet articles for you) and patients who work their asses off to stay healthy or to prevent disease progression. And I don't mean well-educated as in "I'm going to give you an essay test on how to identify and treat a dissecting aortic aneurysm with bonus points for literature citations within the past 10 years". I mean, they actually KNOW they have HTN and actually take their medications for it. I would stay up all night for those people and not give a damn. I would field phone calls from those people at home without a care ...except those are the people who DON'T call you late at night for unimportant crap.

Conversely, I detest taking care of idiots. Every page you get about them is some ******ed thing. They're the ones who lay around in bed and expect you to "make them better" so they can return to laying around in bed at home. They're the ones who page you at night to refill their Claritin at 2 AM. They're the ones who are supposed to get mammograms and didn't because "I never got around to it". These people should be dropped off a very tall cliff in the middle of winter into a deep gorge with jagged rocks and ice-cold water.

 

[DoctorDoom]

I don't disagree that unmotivated patients are annoying. Nor do I believe in self-flagellation by doctors whenever a patient is non-compliant; it's not all my fault. But there's a difference between lazy, ignorant, and just not smart.

If a patient won't participate in their own care, of course there's only so much you can do. But advocating making people into Soylent Green just because they aren't razor sharp during your H&P is going overboard, wouldn't you say? Besides, prolonged sickness causes depression, increased meds cause confusion; poor compliance or engagement with their own care could just be a byproduct of the patient's illness, so I just don't judge them too harshly.

Resources? Come on. These people sought help at some point, and if they are ill we have an obligation to treat them. If they won't comply, it's on them, but they did seek care. Once you start talking about saving resources for the "deserving" and the "more fit" we start walking down the road to national "euthanasia" programs, not waters I would test.

Our care is truly advice. People either follow it or they don't. But we shouldn't deny people access to our advice or get bent out of shape because we don't like their attitude, or because they won't cooperate. Certainly you can refuse to see someone if you feel like they are actively rejecting your care, but we shouldn't deny them care on the basis of ignorance or stupidity alone, much less make them into a slurry.

 

[kinetic]

Dude, I would never advocate making patients into Soylent Green. Their bodies are way too fatty and usually purulent and infected. How about compost or mulch?

 

[kinetic]

By the way, I never said that we should assume that they don't care about their health and deny them care. That becomes quite apparent after a couple of hospitalizations and interviews, at which time I stop giving a crap about their dead weight.

And our help may only be "advice", but if they don't take the advice society pays, not just the dumb-ass. Which isn't fair. Therefore, mulch.

 

[radiojimi]

Kinetic, clearly you've been embittered by experiences at the front lines of (likely indigent) medical care. What can I say? Try and preserve your mental health throughout the process; it's not worth blowing a gasket over. Remember that all things shall pass, no matter how onerous (you gotta fall back on SOMETHING to keep your sanity!).

Dr. Doom raises several valid points to consider before relegating that slow patient to the garbage heap of humanity (in your mind anyway).

Again, I think the key really is re-establishing the real bond of long term doctor-patient relationships because then the patient has a better chance of caring about his/her doctor too, thus heeding their advice more carefully, and being considerate about mistimed requests for non-urgent care.
Will that happen in the age of managed care? Who knows? I suppose one can always hope...

 

[kinetic]

Why is asking people to know and care about their health considered embitterment? Just because I don't grin and bear it in silence?

And this has nothing to do with indigent people (although they ARE the worst offenders). Tons of middle class people are just as stupid. "Fix me quick ...I need to go see that movie!"

 

[Ligament]

If we eliminated health insurance and medicare/medicaid 95% of these problems would go away. It would cause patients to have some ownership of their health and health care costs.

ME: You ever had a CT?
them: YES, on 9/23/02 I had one and it cost me $1000. It showed X. Please, are you sure I need another?

They dont forget bills!

And screw this "provider" crap. If you ever call me a "provider" I'll stab you in the neck. You might as well castrate me and dress me in pink.

 

[edinOH]

I'm right there with you. Can't stand the term "provider". Bueurocratic b.s. is all that is. "Damit Jim, I'm a doctor not a provider!"

I would bet you money that most pts could tell you the brand of cigarettes, malt liquor, scotch, peanut butter, cookies, frozen pizza and t.v dinners they consumed/drank/ate on a daily basis. Why the f@ck is it so damned hard for them to remember which medicines they take, not to mention their actual doses and frequency?

I guess their tobacco/liquor/grocery "provider" took enough time to educate them about their choices. It couldn't be that these things are perceived as important in their lives and they just took the time on their own to remember them.

And another thing...

Why is it that half of the time these same people act like they are doing me a favor by allowing me to admit them to the hospital? Just earlier tonight I had an 80y/o guy with a hx syncopal episode earlier today whom I correctly admitted for cardiac/carotid w/u etc. Man he was pissed when I told him I thought he should come in. His response, "Goddamnit, I've been in this ER for over 4 hours already, I just want to go home!" I would expect that out of a two year old, but not a rational adult (and he was rational as far as I could tell)!

I could go on but I think I will go ahead and let those who are smarter and more compassionate than me post how wrong I am for thinking these things and how I should just shut the hell up and be a better "provider".

 

[kinetic]

The reason I used the term "provider" was because sometimes these people also see nurse practitioners (and still don't know anything). It was an all-encompassing term. And, yes, the term "provider" is part of the reason people are starting to view doctors as their butlers. ("I hired you and I pay for your service, so I demand x, y, and z!" [Gunbattle follows for a brief period of time.] "Consider that my resignation, douchebag!")

 

[edinOH]

The reason I used the term "provider" was because sometimes these people also see nurse practitioners (and still don't know anything). It was an all-encompassing term. And, yes, the term "provider" is part of the reason people are starting to view doctors as their butlers. ("I hired you and I pay for your service, so I demand x, y, and z!" [Gunbattle follows for a brief period of time.] "Consider that my resignation, douchebag!")

I figured you learned it from radiojimi.

 

[radiojimi]

if any of my earlier comments have come across as being high-minded, I'm sorry. I don't claim to be smart, nor do I claim to be any more compassionate than the aveage joe.

Let's face it, taking care of people can be one of the most frustrating things in the world. So much to do, so much that can go wrong, and yet others you depend on frequently abdicate their responsibilities. Under such circumstances, who wouldn't be pissed ?

But the point of my posts was that your peace of mind stands a better chance of surviving the onslaught if you continually try and maintain some perspective.

I've seen drug addicts apologize on morning rounds for their belligerent behavior the night before after a member of the team came by at 3am (after several q30min calls) to patiently explain why they weren't getting the usual dose of pain meds they were expecting. You should have seen the transformation in attitude when that patient no longer felt she was being abandoned and instead saw herself as a critical partner in her health care.

In truth, most people want to be, or at least feel normal. They want to go about their daily business and enjoy life. The health care setting can be a subtle (and not-so-subtle) reminder that all is not right with them. The outburst you see from patients is but one of several (dare I say it?) normal reactions to stress. If you see it coming, it doesn't faze you, and the composure and empathy you show will not go unnoticed - especially if no one else seems to give a damn about them.

We once rounded on an MVA victim in the ICU. A few days into her hospitalization, she was conscious but couldn't move. The team came in, examined her, talked about her problems and the plan of care and left the room. No one seemed to notice that she could hear every word, and that she was still very much in the dark about her prognosis. She started weeping as the last of us left the room, and it was at that moment I realized how humiliating it must have been for her to be paralyzed and mute as a bunch of strangers violate her privacy and completely ignore her. I can only hope the few words of reassurance I came back to give her went some ways in alleviating her anxiety.

I agree patients need to assume greater ownership of their care. Getting them to pay for it will likely help, but that solution has obvious limitations. In the meantime, better communication between patient and (ok, just for you Ligament and edinOH ) their doctors can only help, and I don't just mean the words that are exchanged between the two, I mean the non-verbal cues that suggest you in fact DO care about them, that you expect more out of them, and that they in turn feel a sense of duty to you in being compliant with the plan of care. Yes, they are adults, but in a certain way, they are your children too.

 

[kinetic]

I don't disagree that empathizing with patients will create a better understanding. I've said before in other posts that I think that's a mature viewpoint to take. Unfortunately, I'm not mature (i.e., I can rationally THINK that is the correct course to take, but in practice that goes out the window).

The problem is I'm the complete opposite. I take care of my body, I exercise regularly, eat right, don't smoke or drink or use drugs, am not running around humping random people without any protection, and actually use a seatbelt when I drive without weaving in and out of traffic at high rates of speed. So it makes it tough to see the piles of human debris we have who don't do that.

WAIT, you say, first of all you have to be the most boring loser in the world and second of all you can't hold people to your standards. Yes, I am boring; but I'm a boring person who is healthy and doesn't cost taxpayers huge chunks of money. My past medical history is "nothing", my meds are "none", and my social history is "blank". And yes I can hold people to my standards because I'm footing their bill; if they paid their own way, I could care less if they lit Molotov cocktails in their butt while juggling chainsaws over Niagra Falls.

I agree with you, radiojimi - my way causes a lot of frustration, tension, and hostility in my life. I applaud you for being able to approach things in a more understanding frame of mind (REALLY, not sarcastically). I just can't be non-judgemental (and I frankly never WANT to be non-judgemental) when I see some crackhead who was driving a car under the influence and killed a family of four and incidentally suffered some minor injuries which require treatment. And I can't be understanding when people bitch about health care today but sit around wondering how to get thin by eating more meat and heavy cream rather than eating a balanced diet and exercising more. Bastards just want a quick fix and no effort. And frickin' buckle your seatbelt, ******s! I know you want to be a thug, but when you get ejected from your car through the windshield, we should leave you on the ground with your bad self.

And look, would it kill you to write down your history and meds on a piece of paper? Is that REALLY asking too much? People do that and I'm fine with it ...I don't lecture them about needing to memorize their medication list. Just have it available! And stop calling me at random hours to refill your medications after you miss an appointment. And I don't want to give you a handicapped placard because you're fat - in fact, you should park FURTHER away from Popeye's.

And I'm tired of being "sensitive" (stop laughing, dammit!). Why do your knees ache? Cuz you're a fat ass! Why are you fat? Because you eat two-fisted and sit in the Barcalounger all day! Why are you pregnant (again)? Because your thighs are always situated in a ninety degree angle. What is this, rocket science?

And if you have COPD and are still smoking or have an MI and are still free-basing Crisco, I should be allowed to kick you in the head at least a few times a week. Instead, I have to sit and talk about, "you know, this may not be the best thing for you to do given your past history ...". More like, "yeah, smoke 'em while you got 'em because you're gonna be six feet under in about a month, grandma! Why don't you crank up the oxygen on that tank after I leave; maybe it'll explode and I can do some skin graft practice on your old shriveled body before the autopsy."

 

[DoctorDoom]

Dude, what was in your Soylent Green? I ate mine and all I did was take a nap...

 

[radiojimi]

Honestly, no one can fault you for feeling that way, least of all me.
And I respect your choice to respond the way you do - 'specially since I won't be paying for your evacuation when that aneurysm blows (will I? )

For the time you have the mixed blessing of being someone else's health care.. er - doctor, however, the goal (elusive as it may seem) is always to somehow make people's lives better. You can't win if they don't want your help, but the hope with the empathic approach is to have them feel accountable to you because you actually give a damn and they respect you.

As the mind is, so the body follows. Some people take to drink, some people take to food, others to sex or drugs, others to daytime television, ... and yet others to internet discussion forums.

Everyone's outlet is different. Those which are maladaptive show up in your ER to have their sequellae patched up. If you can get the patient thinking the right way about his/her life and health, the more motivated they will be to try and change. It's never easy, and that fatness of ass causing painful joints and high blood may be largely a sign of a tough living situation or a degree of demoralization that doctors are not privy to first hand.

Doctors (edinOH & ligament, what have you done to me??) won't always be successful in effecting positive change. I just think you'll win more with empathy than you will with cold efficiency - not just with the patients, but with your own inner peace as well - and THAT's where the real victory lies.

The defense rests, your honor.

 

[The White Coat Investor]

I'm a big advocate of long, uncomfortable pauses with hard looks thrown around, but never underestimate the power of an unexpected mooning. QUOTE]

I know a lot of patients I wouldn't turn my back on, especially with my pants down.

 

[kinetic]

Dude, what was in your Soylent Green? I ate mine and all I did was take a nap...

Musta gotten a bad batch. Hang on ...

(munch, munch, munch)

My love for patients abounds, as endless as the seas! Nothing brings me more joy than them and the sight of their faces lifts my heart and makes my cares fall from my shoulders! Lo, my heart is gladdened by their shadows upon my doorstep and my soul is refreshed by their presence! I look out the window and see only bluebirds flying about the honeysuckle and the morning dew glistening on the blades of green grass.

And now, I must go take a monster dump. Preferably on the head of a patient.

 

[docB]

Stupid is not against the law. Stupid and trying to do the right thing doesn't bother me. Stupid and couldn't care less I can't stand. And the attitude that they don't have to do anything and I'm the guy in the white coat who's there to make them better is clearly cause for liqufication.