Tuesday 19 February 2013

Against Medical Advice

I have never told a single patient "I am smarter than you."  I freely admit to having thought it perhaps once or twice or five thousand times, but I've never said it aloud.  While I'm not the smartest guy in the world, I'm certainly well above average.  Additionally, physicians tend to be among the most educated people in the world.

Yeah yeah yeah, hey look at that, it's another Doc Pats Himself On The Back Event!

Oh, shut up!  I'm trying to make a point here and you're just being rude and interruptive.

Well then get to the damned point!

Fine!!  Where was I?  Oh, right.  The fact is, whether they like it or not, unless they happen to be doctors themselves (which they rarely are), my patients know less about medicine than I.  That may sound obvious, but hear me out.  I'm very thoughtful, conscientious, and careful, so when I give advice and make a plan of care, I fully expect my patients to abide by it.  And the vast majority of the time, they do.

Sometimes, however, people have other more pressing needs than some crackpot doctor trying to do something stupid like, oh I don't know, take care of you and your stupid, unappreciative, know-it-all ass!

Wow...sorry about that.  Anyway, a 50ish year old guy was brought to me after he had the shit beaten out of him, er, I mean after he was assaulted by multiple people.  Probably because he fucking deserved it!  

Ahem, let me take a second to gather myself here.  You can probably tell I'm still a bit miffed by this guy, and you'll see why in a minute.  This previously-healthy gentleman was brought to me having been beaten.  He had bruises all over his body, especially his face and torso, and he complained mostly of rib pain.  What was most obvious was the exquisite tenderness over his ribs and his bloody, crooked nose.  He was worked up fairly quickly with multiple X-rays and CT scans, and in addition to his 2 broken ribs and his broken nose, both his lungs were punctured, he had a broken bone in his back, and there was a small amount of bleeding in his brain.  One of these injuries is bad.  Two is worse.  Add them all up, and he's in REALLY bad shape.  Fortunately for him none of the injuries was bad enough to need surgery, but he at least needed very close observation in the intensive care unit for both the bleeding in the brain and the punctured lungs.  I admitted him and ordered repeat scans for the morning to make sure nothing was getting worse.

After I finished explaining this to him, he looked at me with frantic eyes and asked me how long he would be in the hospital.  At least three days or so, I told him.

"OH NO!  I got shit to do, Doc!  I can't stay that long!  I gotta get out of here!"

I resisted the urge to slap the stupid out of him, and I again explained the severity of his many injuries and how several of them could be potentially fatal if they get worse.  He seemed to understand, but he just kept telling me how he had "more important things" to attend to.

The next morning I headed straight to the ICU to make my rounds as I always do, but when I got to his room there was an old lady in his bed.  Thinking they had moved him elsewhere, I checked the computer census, but the computer had no record of him being in the hospital.  Suspicious of the answer, I asked the nurse where he was.  "Oh, he left last night against medical advice.  He said he had something he needed to take care of and refused to stay."



  1. Probably the exact thing that caused him to have the shit beaten out of him in the first place.

    1. I thought the same:

      We beat you up today. Pay up in 24 hours or tomorrow it's your daughters.

      I'd run too.

  2. Family? I don't know about you, but if I HAVE to be in the hospital but one of my kids is in danger, fuck my health I'll be there for my kids.

    1. But when you have several serious, life threatening problems at once, you have to take care of yourself before you can care for others. That's why on airplanes they always tell you to put your own oxygen mask on before you help others with theirs. If you die, you're no help to anyone.

  3. I would say, at least sometimes, people do know their own bodies better than the doctors. I've been dealing with the platelet blood disorder ITP since I was 12 or so. The first time I got checked I had a platelet count of 11K which caused a huge fuss. Well after awhile I learned how to take care of it and keep it up in the 100k area, but anytime I get sick it always drops dramatically. Recently I was admitted to the ER with hypothermia. I told the triage nurse I had this condition. A little while later the ER doc comes in nervous to tell me somethings. He says, "We found something... You have a blood disorder, etc etc". Oh really? I told the nurse that when I came in. After I warmed up, I was feeling right as rain to go home but the doctor refused to sign me out. She said there was no way she would send me home when my platelet count was at 15K. I told her it wasn't a big deal, and if I got a lot of sleep that night I would be fine in the morning. Still she refused. So I spent the night in the hospital and guess what- the next morning my platelet count jumped up to 65K and I was released. After 13 years of living with ITP, I would definitely say I know how it affects me personally better than a doctor would.

    1. Hm...this sounds vaguely familiar. If only someone could write a blog post about how doctors should listen to their patients. http://docbastard.blogspot.com/2012/09/listen-to-patient.html


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