Sunday, August 28, 2011

A Helping Hand

A couple days ago in the resident's lounge, one of the physicians came in to round with his team (of residents and med students). Because the lounge is rather small, I overheard most of what they said.

They discussed this one patient in his 30s who didn't finish high school, has uncontrolled diabetes, has peripheral neuropathy (numbness & tingling in fingers and toes) as a result, has chronic pain, and is taking narcotic pain meds in order to bear it all. According to the med student and intern taking care of him while in the hospital, they report that he is unpleasant/uncooperative to work with, appears to be "throwing away his life," and just want his pain meds. The physician took this as a moment to ask, "Why?"

This segued into a discussion from the physician about here is a guy who's slipped through the cracks of health care. He takes narcotics for the pain, but narcotics likely make him sleepy and also feel not great, throwing him into an endless loop. His PCP (primary care physician) likely tried to truly help him once, but since he's uneducated and doesn't know how to manage his diabetes, thus his health deteriorated. In his frustration, his PCP likely labeled the patient as "non-compliant," which is technically true - but again, why? It became easier for the PCP to just refill his narcotics and send him on his way. His PCP is also an older physician who's likely jaded from seeing so many of his own patients fall despite his care.

Here, said the physician, was an opportunity for us - med student or intern - to turn the guy's life around. Here, in the hospital, where we have "control" we can say to him, "You need to get your act together and turn your life around." Here we can extend a helping hand and spend the time to give him the education necessary to manage his diabetes. He's a young guy and has a shot of doing well years down the line, why should we also abandon him just because he has a label of "non-compliance?"

I have friends who call their patients "idiots" for smoking and having a BMI of well over 40, and then gets admitted for pneumonia. Or for being alcoholics and developing acute pancreatitis as a result. Sometimes I look at one of my friends, who's overweight and gets winded after going up 2 flights of stairs (how sad . . .), and say "Dude, you get winded after 2 flights of stairs. When was the last time you exercised?" To which his response is, "I've been busy and I just don't feel like it." How dare he call his patients idiots for ballooning up to a BMI of 40+ (FYI, that's more than morbidly obese), for telling them to exercise and eat healthy, when he doesn't do the same and could be in their shoes 10-20 years down the line.

Anyway, righteous indignant rant over. We all, medical and non-medical alike, have an opportunity to turn someone's life around. We all fail from time to time, but that doesn't mean we no longer deserve help. Even so, I'm beginning to feel myself become jaded with adult medicine after just 2 months . . .


Biki said...

Sometimes I wonder about the reason people aren't compliant with their doctors orders, and I think it's a very involved subject.

I do believe that at least a few of these noncompliance patients do so out of sheer stubbornness. Some due to the bad rap that doctors have gotten in the last few years in the media. If you believe most doctors are money hungry quacks, why ever would you listen to them.

But I think some of the noncompliant patients are confused.
I sat in a doctors office and received two different views of my tests, and what it means. One from the doctor and the differing view from a patient educator. I went with what the doctor said, and at the next visit brought the confusion up to him. Needless to say, he was not a happy camper.

And for a tricky diease like diabetes, the education should be an on going thing. And it needs to be grounded in reality. I mean really, how many people eat fast food each week? Teach people to make better choices that fits into their actual lives, not some pie in the sky life. Just because we're sick doesn't mean it will be easy to change our ingrained bad habits.

Keep up the good fight!

R said...

good post.

sometimes i tell my pt's to exercise 30mins/day minimum and i dont even get that myself :( how rude of me lol.

and gosh, bmi 40+. jesus muffer of gosh.