Saturday, September 02, 2006

Aggravated DocSurg Public Service Announcement #2

Jus' fer example....

I took my car to the mechanic the other day, and he said I needed a new head gasket. So, after forking over a few hundred bucks, I got my car back with the warning to avoid speeds over 40 mph for the first 100 miles. Then I got on the interstate; I had missed driving my car and decided to let it rip at 95! What a gas! Out of the blue, dammit, the stupid car started smoking more than Bill Clinton with a box of Cohibas at a stripper convention. What gives? I just got the damn thing fixed!

Finally got home later that day and DogSurg is throwing up his toenails all over the house. When I asked SWIMBO what was going on, she said she had no idea. The only new thing that had happened that day was that the lawn guys had put fertilizer all over the yard, along with some yellow signs that say keep the dog and kids off the grass for 24 hours. Sure enough, the surglings start kneeling to the porcelain god soon thereafter. What gives? Some doggie virus? If it's that damn lawn chemical I'm gonna sue!

Next morning I get up to make a big breakfast; rooting around in the fridge I find some sausage that's only a week past it's prime. Few hours later, it's me that is chumming for land sharks. What gives? I cooked it! The stuff ought to be good long past its due date!

The appliance repair guy came a while later to fix my dishwasher; he told me to wait until tomorrow before running it. But hey, I got a sink full of dirty dishes..... I can't believe it -- he didn't fix it, there's water running everywhere!


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Why is it that the above facetious examples of asinine behavior are universally recognized for what they are --- pure unadulterated stupidity --- while similar actions in relation to one's healh care are not? Why do physicians and nurses stuggle with patients who would never think about not following directions to care for their hot tub, but who routinely disregard often important instructions in regards to treatment? It comes down to the idea of compliance:
com·pli·ance (kəm-plī'əns)
Function: noun
1 a : the act or process of complying to a desire, demand, proposal, or regimen or to coercion b : conformity in fulfilling official requirements
2 : a disposition to yield to others
3 : the ability of an object to yield elastically when a force is applied : FLEXIBILITY
I guess most of us Americans have a bit of an independent streak, and don't really cotton to the idea that someone else should be giving us instructions to follow. But, let's be honest here --- when I give, for example, pre- or post-operative instructions, I'm not giving them for my own good! When patients are non-compliant, it causes me heartburn, raises my blood pressure, and frustrates me to no end, not to mention increases the patients' risk for complications. It makes the idea of designing a 25 page informed consent almost palatable. Here are a few examples of how to be non-compliant:
  1. Crawl around your dirty attic two days after undergoing hernia surgery
  2. Stop taking your blood pressure medication for a week or so before surgery --- and make sure not to tell your doctor!
  3. Don't take your bowel prep before colon surgery because you don't like how it tastes
  4. Eat breakfast on your way to the hospital on the morning of surgery --- remember, "N.P.O." is only for those with really weak stomachs anyway
  5. Keep taking your Plavix or Coumadin until the night before surgery, despite instructions
  6. Smoke --- and smoke heavily --- after a complicated vascular operation
  7. Antibiotics, shmantibiotics!
Have I seen this? Oh, yes. Where does it lead? In order: severe wound infection requiring further surgery and weeks of open wound care; oh-my-God, possibly stroke-inducing perioperative hypertenstion; wound infection and risk for anastomotic leak (yeah! with a second operation and colostomy!); aspiration pneumonia, postoperative ARDS, etc.; bleeding -- a lot of it; failure of the vascular graft, more surgery, and potential loss of limb; infection and further surgery.

On and on it goes, where it stops, nobody knows!

When I ask these folks just what were they thinking, I never get a straight answer --- but I get a lot of groans and eye rolling from their spouses, who are apparently well aware of their tendency to ignore advice and instructions. Why are otherwise normal, intelligent people so willing to do things that put them at risk for significant problems? I dunno. I blame Rumsfeld!

Maybe I need to write a book about this phenomenon and get really famous.....