Tonight I got guilted into working clinic. My buddy was involved in a car accident last week and has been behind in studying ever since. Doing the good-guy thing, I agreed to cover his shift despite my own looming test and scarcity of time to study.

The clinic we work at serves the uninsured.  In other words, we often get difficult cases that have a multitude of comorbidities that may be the cause or effect of the patient’s low socioeconomic status.  On top of that, their lack of insurance means that these conditions are often unmanaged.  As an example, my first patient had a history of heart attack, hypertension, diabetes and several other conditions.  Her glucose on admission?  450.  Yowza.  And that was with three diabetes meds…

My last patient was the highlight of my night though.  He was an older gentleman presenting with foot pain.  What started as a normal history quickly turned into a torrid story of drugs, underground fights and jail time. I liked John, and I felt he was being truthful.  There was no reason to lie, and I had no indication that he was pulling my leg.  I finished my exam and presented to the attending.  As I said the words I realized how they must sound to a third party who was not involved in the interview.

“Patient with foot pain…. history of narcotics…. abuse of morphine and prescription pills…past hospitalization for OD…. pain not radicular or easily reproducible …”  Before he could respond I knew he thought John was seeking drugs.  But somehow I knew differently, and I said so.

“I know this looks bad, but I think he is being honest,” I stated.

“This doesn’t sound much like physiologic pain…” he responded.

“Let’s go look at him.  I don’t even think he wants pills.”  We went into the room and the doctor quickly interviewed and examined the patient.  His years of experience showed; he was much more efficient than I had been only moment earlier when I fumbled through the same exam.

The conclusion?  John did indeed have a neuropathy that could be explained physiologically (I don’t plan to divulge details).  I was proud, and vindicated, when John asked about exercises and stretches to do since he didn’t want any more pills (and he didn’t take any, for those that might think that was a ploy).

John left feeling better, with a follow-up and some strategies to reduce his pain in the meantime.  I honestly left clinic smiling because I felt like we had really improved some lives.

As I walked out into the cool evening air I was struck by a bible verse.  I am not a christian, however I did grow up catholic and I believe Jesus, and the bible, had some good things to say.  

“Whatsoever you do to the least of my people, you do unto me.”  

The patients we serve at the clinic are those who are down on their luck.  Some of them are criminals.  Some of them are liars.  And surely some of them are drug seekers.  But how can we know who is who?  And shouldn’t we treat the least of all people with the utmost dignity?

Was the attending wrong to have preassumptions?  I don’t know.  But I think it is easy to get jaded in medicine.  That is exactly what we have to fight against.  I have seen blogs posting about the annoying drug seekers and resource suckers.  But what happens when you misclassify someone who truly needs your help?

The best ER doctor I have ever met told me: “I would rather 10 junkies get their fix than 1 person who truly needs medicine to do without.”  

I think John would have gotten proper care had I been there or not.  But preconceptions are a dangerous thing in medicine.  No matter how many times you see a disease or symptom, never forget you are dealing with a unique individual.

I don’t know if there is a God who judges how you treat the least of His (or Her) people.  However I do know that if you fail to give each patient, the least or the best, the dignity and respect they deserve as humans you will never fulfill your potential as a doctor.  Perhaps whatsoever you do to the least of all people is the best you will ever be.

Per usual, TNQD killing it with this very thoughtful post.

Quality

A great post in light of our recent narcotics lecture…

(via mrspediatrician)