Thursday, June 26, 2008

Frustrations with giving medical care

I'm sure there are a many frustrating things during intern year, and I'm sure I will blog about quite a few of them. Here's one.

There are so many patients in the hospital who fight with you about their care. You're trying to do something for them which will make them better, and they don't want to go through with it. And I'm not talking about interventions that are risky, or have lots of side effects, or ones that we're not sure about or ones that don't matter that much. Sometimes they're life-saving interventions! Here's my example from intern year:

I had a patient who had a horrible infection - she needed IV antibiotics. She wasn't about to die just yet, but if she didn't get the IV antibiotics soon, she would get horribly sick. And we know this because we see it happen all the time. Sometimes we don't even know people have infections in the hospital yet until they're horribly sick - we got lucky and managed to catch this patient before they got to this point. She tried to refuse the IV antibiotics! She said vitamins or herbs might do just as well. Ridiculous. She also had made some really bad medical decisions that had got her in this situation in the first place. I spent close to an hour talking her into, first, letting us put an IV in her arm, and then second, getting the IV antibiotics. What if I had said, fine, don't get the IV then. She would have gotten seriously sick! But of course, I spend more than an hour arguing for her, and she got the IV and the IV antibiotics, which probably saved her life.

The problem is that it's very difficult for doctors to say something like oh well, it's your call, go ahead and die to a patient. First of all, they genuinely believe in the therapy and believe that they're right. Secondly, if they didn't try their absolute hardest to argue with the patient for their own good, doctors would be held liable. It's very frustrating, but I think we're stuck with it.

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