Abandon Logic 2


Reason drives us as physicians. Logic courses through our veins and supports the choices we make. However, some patients lack our tenacious grip on common sense. One young lady, wearing thick, bedazzled sunglasses (despite its being 4 a.m.) demanded immediate care.

Unfortunately for me, she lacked the ability to speak quieter than a jet taking off.  Also, she had the sphinx like ability to speak in riddles, though not all of her riddles had answers.

 

Me: “Hello, I’m Dr. Brandt. How can I help you?”

Her: “Like you don’t know.”

Me: “I don’t know?  I don’t know, that’s why I asked.”

Her: Sighing (very loudly), “I am pooping all the time, and my feet stink.”

Me: “Alrighty. So you’re having diarrhea?”

Her: “No. My poop is fine. I just poop a lot. Does your wife yell at you when you’re pooping all the time? My boyfriend does.”

Me: “So is that why you’re here?”

Her: “And my feet are stinkin?!”

Me: “…”

Her: “You’re actin’ like you don’t even care that my feet stink!”

Me: “Um, well, no, not really.”

Her: “You’re the doctor. Fix it!”

logic

 

I had a patient who tried to convince me that her brother was a Chupacabra, which I believe is Mexico’s version of Bigfoot. Her brother was in the room, and he looked more like a Yeti than a Chupacabra to me. Though, to her credit, at least she did not have crazy demands.

Have you ever had a patient demand testing? My patient believed that she had been poisoned. I have occasionally had patients who believe someone slipped something into their drink. Usually, the strange foreign substance is identified as “too much beer,” and they sleep for a while and magically become better.

Then I got a story like this.

This fine lady had a different agenda. She admitted that she had been injecting laced heroin (which was her norm). The problem arose when she felt different after using large amounts of her normal substance. So, logically, she concluded that her dealers put something abnormal in it.

Me: “So you have no pain, no shortness of breath, or any discomfort.”

Her: “No.”

Me: “You feel completely normal now?”

Her: “Yeah, now I do. But you gotta test my blood. I’m going to sue them!”

Me: “Sue who?”

Her: “My dealers!”

Me: “You plan to sue your dealers for giving you impure drugs?”

Her: “Exactly.”

I am not sure which part of the FDA regulates heroin and crack cocaine purity, but I wished her well in her pursuit.

Physicians have varying beliefs on patients researching treatments online. Some are in favor of having patients try to self-diagnose via Dr. Google. If all patients used logic and reason, this might seem like a valid approach. However, this approach creates unnecessary panic. A little bit of knowledge can be dangerous.

My partner took care of a wonderful elderly female patient with abdominal pain. Her husband, however, had researched her symptoms and wanted to be sure that we were doing the right thing.

Partner: “We evaluated you for several causes of your abdominal pain.”

Husband: “Have you ruled out ectopic?”

Partner: “Ectopic?”

Husband: “Yes.”

Partner: “She is 68 years old.”

Husband: “And?”

Partner: “And she had a complete hysterectomy.”

Husband: “And?”

Partner: “But she doesn’t have a uterus and … and yes, we ruled out ectopic pregnancy.”

Husband: “Good.”

At least he had an actual medical complaint he was concerned about.

I had a young gentleman who had globus hystericus. He received some Ativan and felt completely better. However, when he arrived at home, he went to the ultimate source for medical answers, Yahoo Answers.

This is a fine site where you can pose any question and the public as a whole will respond to your questions. After searching online for a few hours, he came back. I was still working and saw him again. He showed me on his phone (somewhat smugly) that I was supposed to give him Xanax because this is what someone received on Yahoo Answers. I asked if he currently had any symptoms, which he did not, and told him to have a wonderful day.

Logic.

Unfortunately, this may be one of the many times where we in health care have learned helplessness. Is acceptance of the illogical the best option for our own sanity? Maybe. Though the other option of embracing the crazy certainly seems fun as well. At least that’s what the Chupacabra told me.


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2 thoughts on “Abandon Logic

  • Bill Clifford

    Comment 1:

    “a little knowledge is a dangerous thing.” The rest of the quote is worth reading:

    A little learning is a dangerous thing;

    drink deep, or taste not the Pierian spring:

    there shallow draughts intoxicate the brain,

    and drinking largely sobers us again. (Alexander Pope, Essay on Criticism)

  • Bill Clifford

    Comment 2:

    We like think we are logical and by logical mean we thing apart from our emotions. The truth is, however, that our logic is actually based on our emotions and affections. If we have an affection for the truth for the sake of truth, then we can see the truth with some degree of objectivity. If we only want to see what confirms our own preconceived ideas, then that is what we will see. If we want (desire) to be sick (perhaps for the sake of attention) then we will see only that which indicates we are sick.

    Here is where truth (not genuine truth, but preconceived truth) can hurt. Preconceive ideas (and the emotional needs behind them) can lead patients to refused needed treatment or tests, or to insist on unneeded treatment or tests.