I sat in an audience of about 500 other nephrologists learning the latest about diseases affecting the filtering parts of the kidney, the glomeruli, and their treatments. It was the second day of the American Society of Nephrology Kidney Week and the end of a very long day of lectures that would be capped off with a discussion of case studies, led by experts in diseases of the glomeruli, the answers unknown to them and us.
i hear you
help me help you
Over the years, I find myself becoming increasingly irritated by patients who don’t know their medications nor bother to bring them with them to their doctor appointment. I get that remembering ridiculous drug names like Carvedilol and Sevelamer and Furosemide, not to mention the trade names like Coreg or Renagel or Lasix that we doctors often use interchangeably (courtesans to the pharmaceutical industry we sometimes are) is challenging for anyone not in the medical profession, especially if the number of medications is approaching ten or more as it is for many of my patients. But to not bring an updated list or the bottles? Or even worse, to spout off some nonsense like, “I take a green one for blood pressure and a white one for something else, I don’t know what.” For real? How could one not know what they are putting in their mouth every day? How could one so blindly trust us doctors, then get angry at us when shit goes wrong? To date, I’ve been quite patient, just letting the offender know that I am unable to my best job for them if I don’t know what they are doing. But some, irritated with my seemingly endless questions I presume, direct me to their “record”—“It’s all in my record,” in a huff, as if my asking questions to get to know them and what they are doing is somehow a waste of their breath and time and energy required to move all those facial muscles.
I try to educate.
“Do you have any idea how often the ‘record’ has errors in it? How often what the doctors think patients are taking has very little in common with what they are actually taking?” I’ll say. “And let’s not forget all the crap not prescribed that people are swallowing but don’t tell us about, thinking it can only be a positive thing because it says ‘natural’ on the label.”
Jerry-Maguire
OK, I don’t say that last sentence, but I wish I was that badass. Instead I feel like I’m in some kind of unfunny remake of Jerry Maguire—“Help me to help you! Help ME help YOU!”
Years ago, someone told me about a true badass—an older respected white male doctor in a public healthcare clinic (so lots of reasons why he could get away with it) who would sit down with a new patient, asked why they came in to see him and their medical history. Early on in the interview he asked if they smoked and, if so, how many cigarettes each day. If the answer was yes and even 1 cigarette he would throw his hands up in disgust and storm out of the room yelling, “How am I supposed to help you if you aren’t willing to take care of yourself by smoking!” And that was it. The patient could return only if they quit smoking. Supposedly he had a high success rate of returning patients who had quit smoking.
Maybe I’ll try out my own version: “Oh you don’t know your medications or have your pill bottles?” Inhale slowly with my eyes closed, then add, “This is a waste of my time and yours. Come back when you are willing to participate in your care.” Then stand and walk out, wishing I had a microphone so I could drop it. Dr. Grubbs out.
Because this continuing to allow folks to think I, as the provider, should be the only one working to restore or maintain their health only reinforces bad behavior. Like faking orgasms.