Medicine: Managing Disease
>> Thursday, December 29, 2011
medicine by ~bloodred on deviantART
Internal medicine, in my experience thus far, focuses on acute management of chronic diseases. This makes sense given the nature of inpatient hospital medicine - you're there to manage the patient acutely and get them better to the point where they can safely walk out the door and not keel over.
Almost every patient I saw while on inpatient medicine was admitted because, for whatever reason, their chronic diseases got the better of them and they suddenly get ill. An alcoholic patient came in with delirium tremens due to alcohol withdrawal. An alcoholic patient comes in with alcohol-induced pancreatitis. A patient with congested heart failure comes in with acute shortness of breath and chest pain. A diabetic patient comes in with a non-healing foot ulcer/injury. A patient in chronic renal failure comes in with shortness of breath. As you see, the majority of our medicine patients have long-term chronic diseases such as alcoholism, diabetes, congested heart failure, or chronic renal failure.
For one reason or another, their disease gets out of control and they experience symptoms that prompt them to seek immediate care. Much of the time it's because these patients don't keep their chronic diseases well-managed and under control, thus they let their health slide. The reasons behind why patients do this is complex and something I can't even begin to explain, so suffice it to say that many patients let their health slide to the point where they need to be admitted to the hospital. They sometimes come to us and almost literally say, "Save me."
We do our best to manage their underlying chronic disease as that usually does the trick in making them feel better. But do we "fix" anything? Not usually. Alcoholics continue to drink alcohol. Diabetics still have diabetes. Congested heart failure can't be fixed. Chronic renal failure is irreversible. The question now is: will these patients be able to take better care of themselves so they don't get re-admitted (at least, not for a while)? From what I've seen the answer is all too often a "no."
This creates an endless loop. Some patients have been pegged as "frequent flyers" because of how often they're re-admitted for the same problems over and over again. I've heard an entire department snicker upon hearing one particular patient's name because the patient kept getting re-admitted for the exact same issue. And every time they manage the patient's chronic disease, symptoms resolve, they reiterate to the patient how to manage the chronic disease, and send the patient out the door. Weeks to months later this is all repeated. I've sensed either a distinct jadedness or detachment from some of the attending physicians.
The longer I spent in internal medicine, the more of that jadedness I felt in myself. I began to feel almost a sense of futility in caring for some of these patients. Many of them I know are unable to adequately make the necessary changes to better manage their health, indeed it can be very difficult for any of us to do! A patient about my age but weighing almost 3 times as much got stuck in a CT scanner. How does that even happen?! Why do I even bother?
Even so, I've had some wonderful patients on medicine. These are people you work your butt off to help get better. These are the people you say goodbye and hope to never see them again, and in all likelihood you won't (not for a long time at least). Every few days there's always that one person to make it all worth it.
Almost every patient I saw while on inpatient medicine was admitted because, for whatever reason, their chronic diseases got the better of them and they suddenly get ill. An alcoholic patient came in with delirium tremens due to alcohol withdrawal. An alcoholic patient comes in with alcohol-induced pancreatitis. A patient with congested heart failure comes in with acute shortness of breath and chest pain. A diabetic patient comes in with a non-healing foot ulcer/injury. A patient in chronic renal failure comes in with shortness of breath. As you see, the majority of our medicine patients have long-term chronic diseases such as alcoholism, diabetes, congested heart failure, or chronic renal failure.
For one reason or another, their disease gets out of control and they experience symptoms that prompt them to seek immediate care. Much of the time it's because these patients don't keep their chronic diseases well-managed and under control, thus they let their health slide. The reasons behind why patients do this is complex and something I can't even begin to explain, so suffice it to say that many patients let their health slide to the point where they need to be admitted to the hospital. They sometimes come to us and almost literally say, "Save me."
We do our best to manage their underlying chronic disease as that usually does the trick in making them feel better. But do we "fix" anything? Not usually. Alcoholics continue to drink alcohol. Diabetics still have diabetes. Congested heart failure can't be fixed. Chronic renal failure is irreversible. The question now is: will these patients be able to take better care of themselves so they don't get re-admitted (at least, not for a while)? From what I've seen the answer is all too often a "no."
This creates an endless loop. Some patients have been pegged as "frequent flyers" because of how often they're re-admitted for the same problems over and over again. I've heard an entire department snicker upon hearing one particular patient's name because the patient kept getting re-admitted for the exact same issue. And every time they manage the patient's chronic disease, symptoms resolve, they reiterate to the patient how to manage the chronic disease, and send the patient out the door. Weeks to months later this is all repeated. I've sensed either a distinct jadedness or detachment from some of the attending physicians.
The longer I spent in internal medicine, the more of that jadedness I felt in myself. I began to feel almost a sense of futility in caring for some of these patients. Many of them I know are unable to adequately make the necessary changes to better manage their health, indeed it can be very difficult for any of us to do! A patient about my age but weighing almost 3 times as much got stuck in a CT scanner. How does that even happen?! Why do I even bother?
Even so, I've had some wonderful patients on medicine. These are people you work your butt off to help get better. These are the people you say goodbye and hope to never see them again, and in all likelihood you won't (not for a long time at least). Every few days there's always that one person to make it all worth it.
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