Some myths really ought to be true. We doctors might react with surprise and pesky feeling when we encounter patients who told us something new and "mysterious". Erosion of patients’ trust follows, if we are ill-equipped to face these "myths".
Insofar as the myths themselves reflect the patients’ interpretation of the illness, their words give us a glimpse of the medicine that we never understand well. The emphasis on learning from doctors and senior, although salutary in numerous ways, has a very dark side to it. We must not forget that we sometimes learn more from our patients than from our professors.
I met a patient who came out from intensive care unit this morning. He smokes, has alcoholism, has been taking methadone for heroin abuse, and is now suffering from tuberculosis causing torrential bleeding from his lungs.
"How is everything going and is the methadone adequate?" I asked.
"Doc, the wound pain is okay," my patient told me nonchalantly. "But the current dose methadone isn’t good enough."
A hint of uncertainty passed over my face. "Are you serious? We don’t cut the methadone dose at all. You have been taking 40 mg every day from the methadone clinic, and we are now giving you 20 mg twice daily."
Before the conversation went out, I then remembered the words from the book "How to Win Friends and Influence People" that I was reading on my way to work this morning.
Show respect for the other person’s opinions. Never say, "You’re wrong".
I promised him that we will look into that and get the right dose for him. I turned to my junior and confessed openly that I am not pretty sure if the drug that we started him for tuberculosis would influence the methadone metabolism.
I went back to my office. The return from my PubMed search after a few mouse clicks goes like this, "Rifampicin (the drug that we used to treat tuberculosis) alterations of methadone effects, leading to withdrawal, are well documented and were linked previously to altered methadone metabolism subsequent to enzyme induction by rifampicin…"
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2 comments:
Dear KM,
I'm glad that you have shared this story! It reminds me of what I read in "How Doctors Think". We tend to stereotype our patients, and in the process neglect vague but important complaints. It is so easy to constantly fall into the trap of fulfilling our stereotypes, and this incident is a valuable warning. I hope that, like you, I will always be able to practice with an open mind (and also not be lazy to look it up)!
Sure, the perspective and preconceived opinion that we doctors carry around in our head are fundamental in shaping what we see and what we do not see.
That brings me to one of my favorite quotes, "Our heads are round so that our thinking can change directions."
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