Most parents believe in modern medicine, and trust physicians. They may not do everything that their doctor suggests, but generally speaking, they will abide by our recommendations. However, parents are increasingly questioning their physicians and evidence-based medicine in general. This is particularly true for some religious groups, whether they be small cult-like sects or more mainstream groups like Jehova’s Witnesses or Scientologists. Lately it seems I am frequently negotiating with patients to do what is medically appropriate while not violating their faith.
I tend to be respectful of different faiths and opinions and try not to bully people into doing what I want. However, when the patient is a child, and the parents want to avoid necessary medical treatment, we’ve got a problem.  So far, I have never had to get a judge to force parents to treat their child, but I think it’s coming.
There have been some sensational cases of neglected children dying of preventable causes such as diabetes, urinary tract infections, etc. Even more common is the unvaccinated child, who becomes much more likely to get ill, or die as a result of preventable infections.
I certainly don’t think that modern (evidence-based) medicine has a monopoly on health, but I think many people forget its primary foundation. Evidence based simply means that doctors offer treatments that have been tested using the scientific method, and have been found to be safe and effective. Once you eliminate that simple requirement, you are dealing with treatments that may or may not have any merit, and potentially could be dangerous.
If you need kindling, don’t hold onto a stick with one hand, while chopping down on it with an axe. You would think this goes without saying. By the way, a colleague of mine did this with disastrous results. Knucklehead!
One thing that I learned as a resident in emergency medicine is that when a patient has cardiac arrest after a car crash, motorcycle crash or some other major trauma, those people are not going to do well.
In fact, it is rare for them to survive.
Of course, there are exceptions. One such patient was the victim of a high speed motorcycle crash into a large tree. When paramedics got to him, he was essentially dead. No pulse, no breathing. They got him intubated, started CPR, and headed toward the ER. Surprisingly, on arrival, he had regained a strong pulse and blood pressure. It was speculated that when he crashed, he was knocked unconscious, and because of how his body was positioned, he could not breath, perhaps because his face was against the ground, or something was pushing on his airway. Instead of developing cardiac arrest because of severe bleeding, head injury, etc, he had suffered a respiratory arrest, which was correctable. He ended up recovering, and proving there is always an exception to the rule.
Some people have a compulsion to steal items from the ER that have absolutely no utility to them. Perhaps the most commonly stolen item is the head of the otoscope. The otoscope is a device we use to look in people’s ears. It has a detachable head that has a light inside of it and when you look through it into the ear, you can check for ear infections, foreign bodies, and other things. When the head is removed from the holder (which is bolted to the wall), it doesn’t work. It is completely useless. Unfortunately, when the head has been stolen, the handle also is completely useless. I can’t tell you how many times I’ve wanted to examine a patient’s ears and looked up to realize that there was no head on the otoscope. I actually have considered faking the exam–just holding up the useless handle near their ear and saying “Yeah, looks pretty good all right!” Instead, I go to the nearest empty room (if there is one), cannabilize another otoscope head and bring it back, cursing the vile thief who is wasting our time and money.
Other favorite items to steal include: surgical lubrication, bandaids, tongue depressors, and sterile gloves. Once I walked into a hallway near the exit and found a woman “helping herself” to hospital towels, and about to head out to the parking lot. These are towels that are imprinted with the name of the hospital all over them. They would not look good in your bathroom. I stopped and asked the woman, who was about 70 years old, “Are you stealing those towels?” and she looked down at the floor and said, “Yeah, I guess I am.”
I said to her, “You know I’ve got an idea. Why don’t you leave them there for now. Who knows? We might need them.” She said okay, and hurried off. I think she needed to get home to dust her otoscope head collection.
I’m starting to think narcissistic disorder is a relatively common affliction among the powerful. See my recent post on Rod Blagojevich. Perhaps there is a functional business or political advantage gained by this particular personality disorder.
CEO of Merrill Lynch John Thain recently had to resign after it was discovered he had spent 1.2 million dollars redecorating his office. Doing that in the best of times seems insane to me, especially since the toilet alone cost $35,000. But to spend so frivolously when Merrill Lynch was completely imploding, and needing to be bought out by Bank of America is pathologic. Normal people would not ask the federal government for billions of dollars while their company was completely falling apart, and then spend that much on decorating. Oh, and he also bonused out several billion dollars to Merrill Lynch executives prior to their take over by B of A.
Wow.
As a doctor, I am pathologically motivated to explain this insane behavior by making a diagnosis, so we’ll go with narcissistic personality disorder. But why are these narcissistic people (Thain, Blagojevich, Bernie Madoff, etc) so successful? I mean they’re running companies, getting elected governor, and people are handing over their life savings to them. What gives?
Well, this can’t be coincidence. I put forth that their success is in fact due to their narcissism. Situations that would make the normal person nervous, and cautious, have no effect on these individuals. They simply charge forward to face whatever challenges life throws at them, and in so doing, appear heroic. At least initially. Then at some point, their heroism is recognized for what it really is–Hubris, foolishness, and narcissistic personality disorder.
