On prescribing coumadin

I was rounding with the cardiologists, and there was a patient with atrial fibrillation, new in onset, but the patient was 90 something years old, with severe dementia, bed bound, and cared for in a nursing home, where the patient needed help with all ADL's (activities of daily living: from dressing yourself and brushing your teeth to simple stuff like wiping your ass and chewing).

And the medical student couldn't understand why I was against starting coumadin (a blood thinner that would prevent strokes) in this patient. It works. It's effective. In this patient, where fall risk is nonexistent, it's even pretty safe. So we went to the cardiology fellow, and he was for coumadin as well. The student even felt a little vindicated.

Of course, the primary medicine service asked for Hospice to see the patient, and no coumadin was started. And that's why I went into medicine. Because the art of medicine is all about the simplest lesson in life: just because you can, doesn't mean you should.

3 comments:

Vicodin said...
This comment has been removed by a blog administrator.
incidental findings said...

Dear Vicodin:

Because of you and your obviously advertising waste of space comment, I have been forced to enable comment moderation, which I personally think is quite shitty, but now is requisite. It is people like you that detract from the spirit of the internet and make this whole internet community a lesser place. I hope that you get herpes and your penis falls off.

Ben said...

I just discovered your blog this week. I hate to drag up an old post, but this comment has shown me a new pinnacle of intelligent rebuttal.

Ben