White coats and little white lies

White coats and little white lies — having patience with your patients

I’ve always believed that the effective physician also needs to be part-detective. Part Joseph Lister, part Hercule Poirot. But even the most newly-qualified doctor may be able to spot when a patient is being economical with the truth, or even telling you big fat lies with bells hanging off them.

I admit to being what by today’s standards would qualify as something of a Luddite — your faithful Dorsal View doesn’t do Snapchat, Twitter, Facebook, Instagram… just all of that stuff generally. It makes for a simpler life.

However, a discussion thread on Reddit was brought to my attention recently and gave me a few grins, related as it is to doctors who have been lied to by their patients, sometimes hilariously so, under the title ‘Doctors of Reddit, what is the weirdest thing a patient wouldn’t admit?’ Here are a couple of examples:

“I admitted a guy for chest pain. As part of the work-up, I did a urine drug screen which came back positive for cocaine. After the rest of his cardiac work-up was negative, I said to him, ‘good news, you didn’t have a heart attack. It’s likely that your chest pain was caused by cocaine.’

“His answer: ‘I didn’t use cocaine. See, I was at a party and people had some lines of cocaine out on a table. As I was walking by, an oscillating fan blew the cocaine into my face, which is why my urine was positive’.”

And another: “In med school during my IM rotation at M&M conference, they reviewed a guy who presented in septic shock, with a poor response to initial antibiotics and no immediate growth on blood cultures. Turned out he had developed a diabetic foot ulcer that he’d been having his pet dog lick nightly because he believed dog saliva had curative properties. Eventually, it was figured out he had a rip-roaring C.canimorsus infection when the cultures turned positive about three or four days into the admission.”

And this from a nurse: “I can literally smell the smoke on your clothes and breath, see the nicotine stains on your fingers, and you’re trying to tell me you quit smoking 10 years ago?”

And finally: “I’m a doctor of dental medicine. You all f***ing lie to me about flossing. One guy who swore he didn’t know why he was losing his teeth because he was brushing twice a day caused me to get heated. I have him a mirror, scraped a chunk of plaque off his teeth from his gum line, and showed him a big heaping pile of plaque, proving that he was not brushing. I gave him the benefit of the doubt and told him I would show him how to brush and he turned it down because that ‘couldn’t possibly be it’. Some people just want dentures as fast as possible.”

Do you like your boss?

It’s an interesting question to ask yourself, as it’s a matter we treat as academic. Your boss is your boss — deal with it. But even if you don’t like your boss and it’s having a negative effect on your professional life, that doesn’t mean you can’t quietly poke fun at them. Consider it therapy.

I am always glad to receive any comments, opinions or contributions to info@mindo.ie. Here are a few unattributed boss-related one-liners to take away from this issue’s offering.

“A power struggle with your boss is when they have the power and you have the struggle.”

“Got a new boss this week and I’m using suck-up muscles I’d forgotten I had.”

“The fastest, most effective way to learn about servant leadership is to take a puppy for a walk.”

“If your boss is getting you down, look at him through the prongs of a fork and imagine him in jail.”

And my personal favourite to finish. If you are employed by a large institutional healthcare organisation (I can’t imagine which one that might be), you may even recognise some of the following:

According to Native American wisdom, when you learn the horse you’re riding has died, the best thing to do is get a new horse. Because of procedural considerations, however, the boss at my company has decided to try other strategies first. These include:

Purchasing expensive, high-tech whips.

Assigning a different rider.

Telling the horse it could be fired.

Organising a horse-study committee.

Surveying competitors to find out how they make their dead horses go.

Changing the dead horse’s classification to ‘living-impaired’.

Hiring consultants to study how to ride a dead  horse.

Creating a team of dead horses, harnessed together for increased efficiency.

Giving the dead horse to a non-profit, so its cost is fully deductible.

Initiating a study to find out if productivity is enhanced by lighter riders.

Adjusting the overhead costs of the dead horse to zero for accounting purposes.

Promoting the dead horse to management.