Wednesday, April 1, 2009

F*** up #1

While interviewing Mr. Z, a patient with a 10-year history of type-I diabetes, I couldn’t help but stare at the fresh, oozing lesion on his toe. A feeling of sadness overtook me as it became painfully obvious that his toe would have to be amputated. While curiously poking at the surrounding lesion, I asked “Do you feel this?” An emotionless “No” was his response.

After years of living with diabetes it becomes almost inevitable for microvascular damage to occur in the extremities. This disease insidiously damages the most vulnerable structures requiring capillary blood flow; in this case neuropathy had diminished the somatosensory fibers, and led to severe damage without him realizing it.

As the interview ensued my empathetic emotional state changed into frustration. Despite having medical insurance, an adequate level of primary care, it was painfully clear how non-compliant and careless Mr. Z was in regards to his personal care.

As I’m kneeling and inspecting the wound, “Mr. Z, have your average sugar levels stayed within normal range? Your HbA1c were high last time” He looks at me with a grin and a tinge of shame, “Nah, sometimes…I forget. I didn’t think I was doing such a bad job. Sometimes I pop some candy you know, I figure… I’m old, live a little you know.”

So I turn around, take off my gloves, throw them in the trash, and without thinking just blurted out, “you like candy, uh? So does my mother.” My tone was not so subtle or gentle.

He immediately responded “Say what? What you say son?”

Fu*k up #1- do not judge your patients. They don’t like it-- specially when you’re a young shmuck who thinks he knows what he’s doing. No matter how much you care about your patients, they are the ones responsible for following instructions. The technical term is compliance/adherence. I guess one should modestly strive for their personal best, remain professional (always), and learn to accept bad outcomes. It’s unsettling to think how many cases like these occur every day. How do you empower these folk without seeming like a judgmental tool? I apologized to Mr Z. to say the least.

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