There was a guy who had some chest pain and ended up with two stents. He felt better after that, unfortunately, so he never took his plavix, or his toprol, or his pills for diabetes and cholesterol, or even a baby aspirin. He didn’t exercise or eat any better. The only thing he did was to keep smoking.
Fast forward one year. He gets chest pain again, textbook-freaking-classic unstable angina over a period of a week or so and once again ends up in my ER. I can tell from his EKG and blood tests that he’ll likely go on to have a heart attack, but I still have to talk him out of leaving the ER against medical advice.
The moral of this story: we reap what we sow. All I really have to offer is some damage control. I certainly can’t undo years of bad decisions.
March 5, 2008 at 1:54 pm
Check out the “shoes” on Dr Bruce Campbell’s recent post (Smoking Slippers)–
http://www.froedtert.com/HealthResources/ReadingRoom/HealthBlogs/Reflections/Smokin+Slippers.htm
March 5, 2008 at 2:23 pm
Those are some healthy looking legs attached to those slippers. Pretty brazen.
March 5, 2008 at 9:48 pm
I guess I’ve become too hardened and cynical.
Today my attending wanted me to call a pt with severe 3 v disease who no-showed for his pre-CABG appointment and had given the CTS nurse a rash of excuses why he couldn’t come to clinic. He had to be scheduled for cath about 3 times before he complied. Poorly controlled DM, HTN, lipids etc…
I responded that if the pt no-showed and had a fatal MI that we might be better off…
but in the end we did call him and cajole him to show up for his CTS appointment.
Sometimes I wonder why we try.
March 6, 2008 at 12:18 am
Because you guys are doctors. You became doctors to help people and save them…the only problem is some people don’t really want to be saved. I wouldn’t be surprised if some of them take twisted pleasure in seeing others try to save them. Maybe they’re attention whores and like the attention they get from the doctors who have to deal with them.
I’m cynical to this matter in a different perspective. As cruel as it is to say…if the man dies, at least it’s less stupidity to deal with in the world today.
Even though I say it, I don’t necessarily believe it every time. I wouldn’t do things any differently than you would if I was in your position. I’d still help the guy.
It’s just one of those things where you think one thing, but do something that contradicts the thought.
Really, I don’t understand people who don’t do anything to make their situation better. There are those who can’t because they can’t see how to make it better or they don’t even know they had a problem…then there are those who knows there’s a problem but does nothing to solve it. Thinking about people who behave like that really boggles my mind. What were they thinking? What are they thinking? Maybe they’re in denial.
Anyway, love your blog, 10/10. The first time I found it I stayed up late just to read it start to finish. I can’t say I remember most of the names for the drugs and medication mentioned…but these are fun reads anyway!
March 6, 2008 at 9:51 am
I like your blog …
Thanks very very much ..
^_^
March 6, 2008 at 4:38 pm
mifuyane, you are one cynical dude/dudette…
Anyway, I think a lot of what we see in these people is just plain old ignorance, avoidance and indifference. So what if my blood pressure is a little high? So what if my sugar is 200 points above what it should be? So what if my LAD coronary artery is 90% occluded and makes my chest hurt when I walk down to the packie for some smokes? What’s the problem with washing down this KFC family meal with a tub of carbonated sugar water in front of some crappy VH1 reality show?
People just don’t realize, or don’t care, what they’re doing to themselves. And by the time there is a consequence to their actions, they think it’s too late to do anything about it so they just don’t. It’s the sad reality of being in medicine…you can care all you want about every patient that you meet, but you can’t make someone take care of themselves properly.
March 6, 2008 at 9:39 pm
Admitted a patient for his 29th episode of DKA today…
When did it become a doctor’s job to make people care about themselves? I can give information, medicine, sometimes even a procedure to help improve a patient’s quality of life.
It’s up to the patient to decide to take my advice or decide that my plan is just not worth it.
But once the patient makes a decision, should we keep forcing physicians to treat the same event over and over? If someone would rather smoke coccaine than take his insulin (beta blocker / plavix / antibiotic / whatever) who am I to force him to do otherwise?
Cynical doc in Texas
March 7, 2008 at 10:44 am
Alright, everyone just take a step back for a second. Is it really that hard to imagine that someone doesn’t see the need to take their medicine if they are feeling fine? Sure, we know the rationale behind preventive care and keeping chronic problems in check to avoid complications, but we have all spent years of our lives learning the reasons for that and the implication of not taking care of those problems. It may sound irresponsible to hear a person say that they don’t see the point in taking anything to control their blood pressure if they don’t feel bad.
It’s not a doctor’s responsibility to make people care about themselves, but there is unquestionably a responsibility to educate your patient. And I don’t mean the 20-second “you’re going to die or have a stroke if you don’t start taking care of yourself.”
How many pills are you taking, 10/10?
Idealistic doc in Texas
March 7, 2008 at 11:24 am
I couldn’t agree more, “it’s not a doctor’s responsibility to make people care about themselves.” You really think this guy doesn’t know any better? Especially after the first MI?
I don’t take any pills. I also don’t smoke, eat right, and throw in some exercise. But that’s probably just a coincidence.
March 7, 2008 at 11:46 am
Don’t get too proud of yourself, Ten. I’ve seen you “exercise.” You get chest pain from patting yourself on the back.
March 7, 2008 at 3:14 pm
Do you have met my Dad, eh.