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I pity the fool…

July 19, 2010

Loggers, farmers, and people who live on the street are just some of the inherently stoic people that I’ve treated. Right now I work in an area that services lots of hard-working, blue-collar folk. I respect that their time is valuable and understand when they don’t want to undertake the hassle of coming to clinic for something small. Most people don’t want feel like a burden. I’m guilty of the same (self-treating) – but that’s for another post.

The Globe and Mail recently highlighted the trend of DIY Medicine. In the words of my brother: “Yikes.”

When I do see any patient in the office, giving careful instructions is essential for avoiding unnecessary visits and encouraging necessary ones. “You have such and such condition. I expect that 1, 2, and 3 are likely to happen and are not to be worried about. If they develop, deal with them like this. If it lasts longer than so many days/weeks then return. If X, Y, or Z happens or if you are worried, come back to the clinic. Also, if  A, B, or C happens go to the ER. Okay? So, what will you watch for?”

We can’t always anticipate outcomes and there are many occasions that people just do not come in to clinic in the first place. They try and figure it out at home. Half the time, leaving something alone makes it better. Oh, the tincture of time! I wish I could bottle it. However, people usually do want a quick fix for their ailments, so that they can return to work and fun A.S.A.P., and they often administer an attempt themself. This can go really well – “oh, an ibuprofen helped my achey shoulder” – or really poorly – “oh, maybe I shouldn’t have stuck a needle in that.” I am frightened for the person that cuts into what they think is a cyst, and realizes, as they gush blood on their bathroom floor, that it was in fact a vascular lump. There are reasons health care professionals exist.

People often ask “why can’t I take out the staples and stitches myself?” Well, anyone can take out staples and sutures. There is a technique to removing sutures in order to reduce the chance of infecting the deep tissue with the process, but it’s not hard to learn. However, not everyone knows what an infected wound or one liable to dehiss (come undone) looks like. When I have a patient (or caregiver) who is pretty bright, and a very small wound, I do sometimes take the time to teach them how to know when it is safe to undo things, but I do this rarely. Taking out sutures or staples isn’t rocket surgery. The worst that can happen is that your bowels wind up on the outside of your body. I actually saw this on a surgery rotation; it is very distressing to the patient and staff. Although it can happen even when professionals are giving the best of care, it’s scary enough that I think it ought to deter most average Joes and Jills from trying to do major medicine in their basements.

Bad things are far more likely to happen in an amateur’s hands, and said amateur probably won’t be able to find the How to Sew an Ear Back on For Dummies book on Amazon in a timely-enough fashion. Leave the gore to us. It keeps us employed and we kinda like it. A lot.

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