Tuesday, December 6, 2011

The noncompliant patient (that was me)


I alluded to an incident in my prior post that I'd like to share more about.

For you non-docs, "curbsiding" is stopping a doc (usually of a different specialty than you) that you run into to ask their opinion about a patient case.  They don't get paid for that, of course, but it's usually a common courtesy among physician colleagues.

So, in this scene I tried to curbside one of my pulmonologist teachers and colleagues about "my patient's" (really mine) frustratingly worsening coughing fits.

The scene: busy hospital hallway.
The players: Dr. Jen (of course) and Dr. K, prominent pulmonologist well-known to myself and the rest of our community hospital.

Dr. Jen:  "Dr. K, can I run a patient by you?"
Dr. K:     "Sure."
Dr. Jen:   "Well, see, I have this 30-year-patient who's been having recurrent bronchitis symptoms - mostly bronchospastic coughing - with some persistently decreased peak flows.  I've got her on albuterol and actually bumped her from Flovent to Advair to control her constant coughing.*  I hate to label her as asthma for the first time so late in life, especially without any wheezing, but..."
Dr. K:    (narrowing his eyes) "Is this you?"
Dr. Jen:   *gulp*  "Um, well, ah....yes."
Dr. K:     "Jen, you have asthma."
Dr. Jen:   "No, you're supposed to say, 'Jen, stop being such a typical resident hypochondriac.'"
Dr. K:     "Make an appointment with me, okay?"

I did.

I was not a compliant patient in the beginning; I hated the idea of having a chronic disease, of being "sick."  I evolved from "healthy" to juggling a twice daily inhaler for my lungs, two inhalers for my nose (uncontrolled allergy symptoms worsen asthma, and I've got allergic rhinitis like crazy), a pill for my allergies, and a pill for my asthma.  When Dr. K picked up on my frequent heartburn, he added a twice daily pill for that.*  "Hate" is too gentle of a word for the emotion I felt when I looked at all of those pill bottles and inhalers.

Dr. K was the rare physician's physician.  Through 5 years of treating me, he saw straight through my unimaginative excuses and attempts at self-deprecation.  He picked up on subtle clues in my history and exam - clues that I hadn't even put together myself - that necessitated further evaluation and action.  He gently prodded me to realize that, despite my feeble attempt to convince myself otherwise, I really did need all of that stuff.

I started taking all of my meds as prescribed, and, lo and behold, started to feel like myself again.  I could exercise without getting faint, and I wasn't coughing all over my patients and colleagues.  Do I still hate carrying my albuterol inhaler and spacer with me everywhere I go?  You betcha.  But I have come to accept that I have a chronic disease, and it's not going away.  Dr. K helped me to see that I'd rather kick its butt by taking good care of myself than live in denial and feel miserable.

I tried to thank him before I moved, but he deflected my attempt with kind words about enjoying our time working together.  I like to think that he knew how much he had helped me but was being humble; sometimes, though, I worry that he just was so effortlessly skilled that he didn't recognize just how powerfully he impacted me.

I can only aspire to be as much.

I know; the asthma-reflux connection is controversial.  But try telling that to a pulmonologist.  (And, at least I'm not having heartburn all day any more.)
** In those days, we had lots of samples in our office cabinet.  Since then, most academic institutions refuse samples from Big Pharma, given the evidence that they affect our prescribing habits even when we're aware that they can: (http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1497.2000.08014.x/fullhttp://www.sciencedirect.com/science/article/pii/S000293430500197Xhttp://chestjournal.chestpubs.org/content/102/1/270.short).  Looking back, I have to wonder if having those samples available postponed my treatment seeking.

1 comment:

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