A new patient, admitted with chest pain. Actively complaining of every heart attack symptom we've got-- left-sided chest pain, pressure, sweating, shortness of breath-- with a history of uncontrolled high blood pressure.
"While we're dealing with the acute problem, we're also going to start you on some medication. I don't know why your primary doctor hasn't been controlling your blood pressure."
"He thinks there are pros and cons."
"With your blood pressure, the standard of care is absolutely to medicate. There's not really a debate about this."
"Well, my doctor believes in alternative medicine."
"Did your doctor go to medical school?"
"I think so. I assume."
"Okay, well, I don't know what alternative medicine he has you on, but regardless of what you want to think about alternative medicine, in this circumstance it's just not working. Your blood pressure is way too high. You're experiencing a set of very alarming symptoms. You're in a hospital. What you've been doing has not been effective. We need to actually start treating you and address what's going on."
"I'm not taking anything without reading the literature."
"I'm happy to share whatever literature you want, but the nurses are telling me you're refusing any medication, and that's not what ought to be happening here. I'm trying to help you. I can't help you if you're refusing all medication."
"I want to read first."
"What do you read?"
"Every paper there is. Every argument, on both sides. Not the complicated medical jargon, but every study, simplified so I can understand it. I want to read all of it, I want to talk it over with my doctor, and then I want to pray on it, until I come to a decision about whether the medication is something I want to try."
"That seems like it will take longer than the time frame I think we're dealing with here. I want to know what we can do to help you feel comfortable taking the medicine now. Today. Tonight. Here."
"I want to give it a few months."
"That's not a reasonable plan. I don't feel comfortable going along with that plan."
"Then I want to be discharged."
"We're not going to discharge you in the condition you're in. I can't stop you from leaving against medical advice, but we're not going to discharge you. I'm trying to help you, but the medication isn't really a choice I want to give you. It's something you need. I can try calling your doctor, and seeing if he is actually a doctor, but I have eighteen other patients, and I can't spend the entire day trying to convince you to take medication that you need, and that isn't in any way controversial."
"I'll take half."
"Half of what?"
"Half of whatever you were going to give me."
"How about I give you all of what I was going to give you, because that's the dose that will actually help you, and if you want to pretend you're only taking half, I can pretend I was going to give you double?"
"Can I have one research paper?"
"I'll print out anything for you, that's fine."
"But can you have someone read it to me? I don't feel like reading. I feel, uh, I don't feel well."
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A nice example of "shared decision-making." You cannot make this stuff up. I would have stopped the conversation long before you did.
ReplyDeleteI would have let him die.
ReplyDeleteI basically want to become a doctor just so that I can compile the quotes that your patients say and make a blog out of them
ReplyDeleteIf you keep at it, soon I'll have a general procedure to every kind of question/fits a patient might throw at you. Love the stuff!
ReplyDeleteoh my dear God. I understand the desire for information but did he not comprehend the emergence of this situation?
ReplyDeleteThis is not quite the same but I had a patient I was giving meds to. He must have had 10 pills at 0900. I named and described what each pill was for as I opened them into the pill cup. He did not stop me to ask questions at any point. After all the pills were in the pill cup, and I had thrown the wrappers away, he THEN wanted to know, what was this red one for again? And this yellow one? and how about this green one? JESUSCHRIST.