Teachable Moments

Everyone who’s in medicine in one way or another has been involved with “teachable moments”.  For some, they’re teaching, others are learning.  One way or another, anyone can be on either side of the coin.

The other day, I got to do the teachable side – there were some medical students coming for a tour of our health region and some little stations were set up for them to learn/practice some common things – casting, a mock code, delivery of a baby through a mock up and suturing.  I had the privilege of doing the suturing station.  We all sat down with some instruments, sutures and pig trotters from the butcher and went about repairing minor wounds and using different techniques to close things well.  A couple of the youngsters were having some problems…of the kind where a general surgeon might look at them and not so gently tell them that they are destined to be a psychiatrist or a medical microbiologist because their mental and manual dexterity weren’t that good.

A wise movie karate sensei once said “No such thing as bad student, only bad teacher.  Teacher say, student do.”  In the short time I had, I felt there was a need to try and intervene with a few to keep levels of confidence up.  One clearly had an issue of knowing what they wanted to do and how, but were trying to do everything all at the same time.  Once we had that figured out and slowed things down a little, bang, no issues.  Another was overthinking things and wasn’t listening to advice, repeating the same problem over and over.  To solve that, I had to re-think how to re-teach this person this skill…I went back to basics and had them follow the steps as I did them to make sure they were doing what they needed to do the correct way.

The science of medicine is taught in the class room, but the important stuff – the art as well as the science – is learned on the job, in the ER, the OR, the wards and clinics.  It’s passed along from one practitioner to another – everyone at one point in their clinical lives will be teaching in one way or another…and if you’re in a patient centric specialty like family or internal medicine, your job is to teach your patients, so you’ll be doing a lot of it.  Remember how people taught you – were they crappy and doing it because they had to or were they good at what they did and enjoyed passing along their little tidbits?  Everyone is a teacher in medicine, be it to students, colleagues or your patients…so learn to be good at it, that way the art of medicine remains in the profession and continues to be passed along.

SIDE EFFECTS

Seems that I spent a lot of time discussing side effect issues with medications with patients this week.  I get that people are concerned about what’s going into them and what badness  might happen, but they forget to ask about the positive things that might happen as well.

There are risk/benefit ratios for everything we do in life, be it something we say to someone, something we eat or drink, some action or inaction, all can result in positive or negative effects.  Medications are no different.  Everything we do medically is calculated, based on evidence, training and experience.  We cross reference this with what is wrong with the patient, what they’re taking, what other problems the person has, and what other medication they are taking.  The more the person has going on and is taking, the harder the decision becomes.

Then there comes the other problem of mis/disinformation and plain old ignorance about what various medications do or don’t do and the frequency of said issues.  The internet is a great thing if used properly…however, many people have a habit of not reading good sites.  Another problem is Dr’s Mom and Friend Who Knows Everything (yet has no medical training) – I often hear people saying that their friend or mom says that they need this, that and everything else.  Rarely true.

Back to the problem at hand – person comes in with complaint X and is found to have diagnosis Y.  Treatment options include A,B,C and D…however patient is deathly allergic to A, and  C and/or D aren’t likely to be effective without B.  Since I can’t make someone do anything against their will (well, almost anything), my job now is to let the person know what I think is best for them and why.  I don’t hand hold – I’m blunt about options and what I think the best ones are for that person at that time.  I’m also blunt about concerns about minutiae that may or may not happen, especially side or adverse effects that happen one in a bazillion times – and for some reason, most people think that those will be the ones that happen to them.  You have to be blunt in the ER because you can’t hold onto folks that don’t need to be there.  Some folks will all of a sudden develop a decision making disorder about what’s really a minor issue and blow it all out of proportion, expecting family to convince them, as well as me, that this is in their interest.  Luckily for me in this case, I’d had a similar intervention and was able to speak from experience from both sides of the fence and we got down to business shortly thereafter.

Side effects or adverse effects occur sometimes, but not near as often as people think.  Ask your questions, sure, but also ask balanced ones, “Like what are the benefits as well as the risks?”.

Sean K