Just a snapshot

One of the truly frustrating things about being a doctor is that it's hard to really understand someone's life. We only get to see little glimpses into a patient's life, like looking at a single frame of a movie and trying to tell its plot.

I had this experience recently with a patient. He is smart, pleasant, has a good job, and attractive (I'm not gay, but in my humble assessment). And he is single. I feel like if he is single, what are my chances? He has every advantage over me in the dating world, and he's striking out. Is he a jerk at home? Is there something else there?

I had another patient who is having marital issues because of his medical problems, and I don't get it. I found him to be really pleasant and engaging. I can't believe someone like him would have relationship issues over medical things.

It's tough to understand these situations, and I am picking relationship stuff because it's relevant to me, but I have no doubts that there are answers. It's just that I don't have them, and it's not my place to ask. But it's unsatisfying to go home and know that there is a whole side of a patient's life that I don't know and probably never will.

Cruel summer

This has been a hot summer, and as a result, we've seen sickle cell patients running into all kinds of trouble. Sickle cell is an annoying disease in that everything can set off a crisis. If it's too hot or too cold, too much exercise or not enough, dehydrated or drinking the wrong liquids... there are so many triggers and they're all common sorts of things.

Because sickle cell patients have been running into so much trouble, the nurses and physicians are complaining about them and their unbelievable consumption of opioids. I've seen some patients take in enough dilaudid to put down a horse. People accuse them all the time of drug seeking and inappropriate use.

The thing about having sickle cell disease though is that it is rife with chronic ischemic pain. That hurts. It also lowers life expectancy by decades with median age at time of death in the 40's. That sucks.

I hate giving out huge doses of opioids as much as the next guy, but pain is pain, and if I had sickle cell, then I'd want a little more dilaudid too.

Human lie detector

The show 'Lie to Me' is based on the idea of microexpressions, and if you can accurately see and interpret these findings, then you can be a human lie detector.

I seem to have a knack for this, as I am usually pretty good at spotting the liars, the folks who are outright dishonest about their history of medications usually. But they usually make it pretty easy when they tell me they need 6 xanax a day and oxycontin is the only medication that relieves their chronic back pain.

Knowing when someone lies to you is a remarkably depressing experience. It is one thing to be ignorant of what someone is doing, but to see the lies, that hurts. Still, one thing that people really have a hard time with is the manipulative patient who is actually in pain. I know that he's mean and demanding and wants dilaudid 4mg IV q2 hr, but he is s/p fasciotomy for necrotizing fasciitis. I think he deserves some pain medication, even if he is a jerk.

New design

I changed the site design in order to make use of a variety of features that Blogger offers. I am sorry if you liked the previous look better. I will be tweaking this from time to time until I like it. Hopefully, the sharing options and fixed width columns will make up for it.

Are you listening?

One of my patients was raving about me today to the staff. 'Oh Dr ifinding is the best doctor I've met! He really listens and treats me like a person!'

I think it has to be the saddest commentary on the profession of medicine that I was exceptional because I treated her like a human being. It's ridiculous, but we as a profession have really hurt ourselves. If we could just listen for a few seconds to what people tell us, then that would make all the difference. What earned me all this praise from this patient? She didn't want to take insulin more than once a day. That's it.

But there is a trick: she never said anything about concerns with insulin. That part I had to deduce. But is that really so hard to figure out?