Wednesday, December 14, 2016

What Internship Looks Like XXIII: Caring For the Patient

"For the secret of the care of the patient is in caring for the patient.”
~ Francis W. Peabody to Harvard medical students on October 21, 1925
If the secret is caring for the patient, the practicality is doing little things as a physician to minimize the big and small harms that patients suffer in our hospitals that have little to do with whatever chief complaint brought them to our attention. This was one of my favorite afternoon lessons while on wards, drawn by a physician-administrator who sees the iatrogenic morbidity statistics in our institution. The drawing reminds me of a "wound man," the early modern-era medical illustration technique in military medicine manuals that used one picture of a man with many different wounds to minimize the costs associated with creating and reproducing multiple illustrations. This one depicts delirium and falls that can come from a patient being sick in an unfamiliar environment; we should minimize overnight interruptions and tethers such as pulse oximeters, and make sure patients have their glasses, hearing aids, and dentures. Wearing a nasal cannula for supplemental oxygen can dry out their mucosa and cause nose bleeds. They can develop thrush or Clostridium difficile from antibiotics and mouth ulcers from chemotherapy. Being bedridden makes them susceptible to weakness, myopathy, deep vein thrombosis, and/or pulmonary embolism. The drugs we give them can have side effects like dry eyes/mouth, gastroparesis, and urinary retention. My attending was encouraging us to treat--to care for--the whole patient, not just their chief complaint.


1 comment:

Your comments let me know that I am not just releasing these thoughts into the Ether...