I just finished my second work day here. My second work day here was 31 hours long. Believe it or not, I'm still upbeat. I realized a few things. One, MS-IV (medical student, fourth year) is almost as magic as MD when it comes to writing orders. Also, I still love internal medicine. My two patients are pretty typical of the range you see on the wards.
Mr. Wish has CHF, and as part of that disease, he is supposed to watch his salt intake, keeping it to an absolute minumum, I think off the top of my head, it's supposed to be less than 2 grams per day. A can of pop has about a fourth of that. So it takes some discipline.
Discipline he lacks.
Mr. Wish informed me that "yes, doc, I'm keeping a real low salt diet. I don't put salt on anything at all anymore."
I should state before going further than the reason he is in the hospital is because he gained about 15 pounds over the past three weeks, solely from the salt he "isn't eating."
So I asked him what he had for dinner, say, the night before he came to the hospital.
His answer was "we went out for Chinese." In case you were wondering, the average single dinner, without sides, at a Chinese resturant, has well over 2 grams of salt in it (not to mention upwards of 50 grams of fat)
He also firmly belives, despite taking diabetic medications including insulin, that he is only "pre-diabetic."
Some patient education is in order, I think.
The next patient...will have to wait for another post. It has been 31 hours since I've slept, and I'm going to enjoy this.
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3 comments:
Oh, the literal minded, who never got past the concrete thinking of early childhood. If it ain't white and crystal, it certainly can't be salt.
If he's not dead, it's only "Pre-diabetic." Don't hold out much hope, I worked with a surgeon, a brittle diabetic from way back, who never took care of himself. He died in bits (toe, forefoot, bka, aka...), ornery and sure of himself to the end.
Advice from a (nearly) old nurse, "50 MG Morphine" is not a complete order. Get the (nearly) old nurses on your side, and you will have much less scut work to do.
Patient education? I wonder if it isn't patient motivation that is really needed. A few people are motivated by reading facts in a book, or being taught by a teacher. But many others need a cheerleader. Doctors might not view that as "their job," but if the actual goal is improved health, then it might be something they should consider.
Well, glad to know you're still loving internal! It's always good when you do things that reinforce your possible specialty choice instead of making you go back to the drawing board.
I think that many patients have a misconception about medicine. Some patients will enjoy 10 grams of salt a day because they think that medicine can change everything - that eventhough you haven't told them about the magic pill or treatment for their disease, you're just holding out and you'll come through in the end when they continue to not follow "orders" to eat properly or exercise. It's like diabetics who think that taking care of their disease is taking insulin... More patients need to be educated on the limitations of modern medicine.
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