Caffeine Free in Med 3

Patient issues

As I rotate through Internal Medicine, there is a vast change of patient population between services. You don't really think about it, but it completely changes your mind set about your patients. I always worry about my patients, but I have totally different worries about each set.

Diabetes service: Many overweight patients who don't eat regular meals or take their blood sugars. Most people are chronic and will be in again when they don't do their follow up appointments. I know there are many accucheck using, insulin compliant patients out there, but those aren't the ones in the hospital. The more 'non compliant' you are, the more likely you are to end up here. You check every patient to see if they are going blind, losing their kidneys, or getting horribly deformed feet because diabetes destroyed their nerves. I worry that someday I will be saying that magic word - amputation.

Nephrology: Very few people are truly innocent here. A large number of my patients didn't take care of their diabetes, used drugs and destroyed their kidneys, or did not monitor their hypertension. The government covers the terribly expensive ESRD (end stage renal disease) so no patient worries about how to pay for this. Several of my patients had no desire to make life changes and seemed ready to sign out AMA because I could not fix their multiple health problems. I was more worried they would skip out, come back with sepsis from an infected dialysis line, get into the ICU (again for some of them), and end up back on my service to do it again.

Heme: Most of my patient historys sound a little like this - you've never drank, smoked, used drugs, and have been faithfully married for 40 years with 3 kids, 14 grandkids, and have lymphoma/leukemia. You are completely compliant with all medications and yet, medically, we have not been able to cure you. I worry that I'm going to give you some horribly immuno toxic drugs that will either destroy your immune system to the point that a cold kills you, or after feeding you these toxic substances, we will fail to cure your cancer and we tortured you for nothing.

It's night and day. One month I'm begging my patients and trying to convince them that being non compliant kills. Another month I'm facing the fact that being compliant may kill.

posted by Allie @ 5:18 PM