Lesson #1 from Internal Medicine

Keep it simple, stupid.

During my 2 straight months of wards on internal medicine, i somehow wound up having the same patient on 3 separate occasions.  While I thought it was strange that he kept coming back (for legitimate reasons), apparently that is not an uncommon occurance at our hospital ... frequent fliers we call them.

Anyway, this particular gentleman had a host of problems, all centered around his prosthetic heart valve.  He had his aortic valve replaced with a mechanical one a few years back.  This surgery helped him live a more normal life, however it carried with it the consequence of needing to be on blood thinners the rest of his life.  No one really explained the importance of these blood thinners to him and he eventually stopped taking them ... leading to a him having a stroke on two separate occasions.  Then when he finally got back on the blood thinners he wound up having hematuria (doctor speak for peeing blood ... yikes).  Needless to say, he had a healthy distrust for the medical profession, being that he kept seeing doctors and it seemed to keep getting him in trouble.

Well, over the time he was hospitalized we developed a pretty good relationship.  It's funny ... patients in a teaching hospital usually have about 4 doctors on average it seems.  It gets pretty confusing with all of them coming in and out of the room.  The medical student is actually the only stable one ... the one that comes in 2 or 3 times a day and talks to the patient the most.  About halfway through his stay he was calling me his "favorite doctor" .  I must say I didnt mind the new title and only corrected him sometimes  =)

At one point we decided we needed to do an ultrasound of his heart (echocardiogram) to check and see if anything was wrong with his mechanical valve.  During that study, the tech saw a "shadow" on part of his valve.  It didn't really look like a clot, but since he had these two strokes we were concerned it may be something causing a problem.  To find an answer we needed to do another test called a trans-esophageal echocardiogram.

I went to the patient's room and told him we needed to do this test.  I told him the name of the test and that we would have to sedate him and put an ultrasound probe down his esophagus to let us confirm if he had a clot on his mechanical valve.

He looked confused.

Then he said, "So you're telling me that you wanna stick a big tube down my throat ... where my food goes down ... to look at my heart?  How is that connected?"

Me:  Yes sir.  I know it sounds strange but your esophagus is right next to your heart.

Him:  So you can look at my heart through my esophagus, and you want to put me through all this because someone saw ... a shadow?

Me:  Um, yes sir.

Him:  Well, ok.  You're the doc!

So the patient consented to the test and it turns out the shadow was just ... a shadow.  But better safe than sorry.

I learned two lessons:

1. Sometimes things that make sense to me don't make sense to my patients.  And it takes patience to take time to explain it to them in a way that they understand.

2. Einstein was right ... if you can't explain something in a way that your grandmother would understand, you really don't understand it at all.