family practice issues and general life events

Posts tagged ‘patient’

Judgement calls

Sometimes the correct answer is a judgement call.  Whether or not to take off a cast, whether or not to admit to a hospital.  There are more, but I am not going to name them all.  That is why practicing medicine is sometimes called the art of medicine.  Attempts to streamline or make it into a cookbook system of 1,2,3 will fail because human beings are well human.


People will point to statistics that having basic routine orders for pneumonia, COPD, acute MI have led to better outcomes overall, and while I do not disagree with that (makes it easy to not overlook the simple things) when was the last time you saw two patients with diabetes who were exactly the same.  Heck, it is common knowledge in medicine that different races react differently to the various blood pressure medications.  Is it racist to make your determinations of which medication to start with at least partially on one’s race?  No it is just good medicine.


There are quality control measures that do improve outcomes if you attempt to follow them, but there are also times that the variables should be allowed and are in fact required.  A patient who comes in for a cast check, and their x-ray shows healing, well then it is a judgement call as to whether the healing is enough to take it off.  A kid who is rough and tumble, you might decide leaving it on longer would be better, another patient who suffers from psoariasis who states that it is itching badly.  Well you might want to take off that cast and take a closer look.  Skin breakdown may require you to take off a cast earlier than you would have like.  All of these are judgement calls.  Which is correct, well both, but a different choice on the first might not result in significant consequences.


Judgements are made everyday in medicine.  People don’t even present for the same disease with the same symptoms.  As several of my mentors told me while in school, “They don’t read the textbook.”  And those that come in with all of the said symptoms like they did read the text book, well they are either a gift.  (Or sometimes not, sometimes they are just people who spent too much time on the internet)


The age of computers in medicine is great.  There are many ways they can help.  I find it most helpful in the case of drug interactions and drugs in certain disease states.  But as of yet, they don’t replace the actual human contact and the senses of the physician.  And I use four of my five senses routinely on a patient.  (Don’t remember ever using taste, glad we no longer live in an age where tasting the urine to check for sugar is necessary)  Touch, smell, hearing and sight.  People need that.  I refuse to diagnose over the telephone.  Rashes are rarely accurately described.  As cameras on computers get more definition, sight over distances may improve, but removing the other elements from the exam will not lead to better patient care.  It will remove the necessary human contact to understand what is going on.  A practice of medicine with less human contact and more automation?  Doubtful it will improve outcomes, and least in the near future


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