The Triumphant Return of Nurse K!

Yes, it is 3 a.m. and Doctor D should be sleeping since he is still getting over his viral infection, but some news just can't wait:

The world's greatest medblogger has returned! Nurse K is blogging again and as brilliant as ever. Who knows how long the cynical goodness will last? So head on over there and laugh till you wet your undergarments!

By the way, this is by no means lessens my endorsement of Tex and Nurse Lee yesterday, but heck, Doctor D would recommend Nurse K over even his own blog.

ER Nursing Blogs (Friday Linkages)

Doctor D actually works in an Emergency Room, but he only rarely tells fun ER stories. He prefers leaving the wild and crayzee emergency stories to the professionals. Nurses always have the best emergency room stories.

With Nurse K still on blogging hiatus the world is a little less fun, but fortunately Doctor D as a little ER joy to share. He has found two ER nurse blogs that never cease to make him smile:

• Nurse Lee is a newcomer to medblogging who blogs at Life in the ER. Doctor D found her when he came across this post and has been enjoying her ever since. She can be a bit silly, and Doctor D has no idea whats up with the glamor shot with a gasmask profile picture. Perhaps her way of preventing airborne illnesses? You should go check Nurse Lee out.

• Another great ER nurseblogger is Tex over at Weird Nursing Tales. He has been serving up wildness from the ER since 2007.
  

Of course, neither Tex or Lee could ever replace good old Nurse K, but reading them will definitely help scratch that ER story itch until K makes her triumphant return.

You can also hang around here with Doctor D (who isn't nearly as funny) to hear more next week about how silly the 1 to 10 painscale is, and to get your doctoring questions answered.

Never Say 10! (How Doctors Interpret the Painscale)

A question from a reader:

My doctors all use that 1 to 10 pain scale. Could you explain why? It seems so crude. Is a doctor equating my "6" to someone else's "6"? I always figure that "10" should be left for when a wolverine is gnawing off my face while my lower extremities are on fire, but other people may use "10" more casually.

The painscale is one of Doctor D's biggest pet peeves! The “powers that be” in medicine prefer looking at data rather than real people. And by data I mean numbers. Academics, researchers, and bureaucrats love numbers! They add them up to make treatment or policy recommendations. I often appreciate these bean counters that help clinical doctors, but it gets problematic when we try to pull hard numbers out of subjective human experience.

Medical people are now all commanded to record a numerical pain level on each patient. 0 means no pain at all and 10 means the greatest pain humanly possible (such as fiery wolverines.) They tell us to record this number like a vital sign, but while a fever of 102° F is the same temperature in every person, 8/10 pain may be a very different experience for different people. And lots of hospitals are making policies like "No one can be sent home from the ER until their pain is less than a 5."

Doctor D sees lots of people every day who claim they feel level 10 pain—the most excruciating agony a human being can experience. 10 is by far the most commonly chosen number on the scale. Doctor D suspects that some people might be exaggerating a bit when they answer “Ten” while texting and complaining about the lack of pretzels in the waiting room vending machine. I've seen a few people I was certain had 10 of 10 pain and it seems like disrespect to those people to classify bruises and upset stomachs in the same category. But pain is subjective, so who is to say a mildly sprained ankle isn't more horrific to this individual than the fires of Hell?

Obviously there are some addicts who lie about pain to get drugs, but I think more commonly people say 10 because they lack the imagination to conceptualize greater pains or they hope that a 10 will cause doctors and nurses to take their discomfort more seriously.

While the painscale is supposed to empower patients to define their own pain, it ends up tricking people into an answer that gets them nowhere. Anyone who says 10, who doctors don't think looks like a 10, is immediately assumed to be full of shit. And anyone who answers 11 or greater must a histrionic drama queen who is both lying and saying something impossible. If pain is a vital sign, then saying your pain is an 11 is like saying your temperature was 200° F.

If you want your pain to be taken seriously never say 10! (Unless you're pushing out a baby without an epidural or you have several broken bones sticking out of you.) If you want a doctor to respect your pain say. “It hurts like hell, but I would give it a 7 or 8.” Your doctor will recognize that if you understand how bad 10 is then your 7 is really horrible, so your doctor will work hard to alleviate your misery.

But trust me, never say 10! Even if it you had to set your self on fire to get the wolverines to stop eating you say 9. Ten on the painscale is a Catch-22; answer “10” and the doctor immediately thinks you are about a level 4.

What is the worst pain you every felt? Doctor D's worst pain of his life was about a 6. Did a doctor believe you went you complained of the pain? Do you think the painscale was helpful for getting your pain treated?

Follow-up post: The Purpose Of Pain: Why the painscale doesn't work

Work Excuse

Doctor D's blogging excuse note:

Sorry to readers for the lack of posts this week. Between weening myself off of coffee and catching a virus from my son, Little D, my free-time productivity has drastically dropped. I'll get a post up answering one of your questions soon. Right now I'm taking another Tylenol.

Are Modern Patients to Blame? (Friday Link)

Doctor D has made his triumphal return from his vacation and is back to working himself to death and blogging.

Today is Friday which means D delivers some exciting links for your weekend reading. Doctor D has an interesting radio piece for you:

National Public Radio did a piece about how educated patients who read about medical care on the internet are costing too much. Doctor D is so relieved! He had been told all along it was doctors who are bankrupting the country. Turns out it's you patients, who all have "medical student syndrome" and think you have every disease you read about. You even made that nice overworked doctor in Virginia cry!

It actually is an interesting use of 8 minutes:

So medical pages like this one are ruining the healthcare system! Too much information and you start demanding tests and treatments you don't need.

Doctor D's theory is that doctor blogs might actually be helpful with this problem. Instead of just giving info on diseases and treatments, medblogs actually give the perspective of healthcare providers. Hopefully patients who read heathcare provider blogs learn not just about diseases and treatments but the mindset of physicians, which includes understanding why over-testing and over-treating is not a wise choice.

Doctor Blogs could save the healthcare system billions! Hopefully the AskAnMD will get a generous government grant to underwrite Doctor D's important work!

So what do you think? Does being an educated, web-savvy patient make you cost the system more? Do you think reading Medblogs make your healthcare cost more or less?

How To Speak Doctor

Question from a reader:

My heart sinks when I realize the vast difference between a detailed medical appreciation of my disease and the incredibly simplified version my doctors tell me. Do doctors feel like they are speaking baby talk to patients? Do patients ever really understand our illnesses, tests, and treatments?

First of all, any doctor who implies they have a full understanding of your body is bullshitting you! Some specialists may know a little more about a particular organ or disease, but in the end your body is a mystery and doctors are all just making educated guesses. Doctors know some useful things, but things we don't understand far outnumber the things we do.

Patients are nervous about doctors working with limited knowledge, so MDs learn to sound more knowledgeable than we really are. One of the easiest ways to sound really knowledgeable is to use a lot of technical jargon. We can really impress non-medical people by throwing out some dense multi-syllabic pseudo-Latin with a lot of acronyms mixed in. It just sounds so darn smart!

Doctors are also used to talking with each other in medical jargon and sometimes forget that patients have no idea what the heck these words mean. It's not that "MI" or "Raynaud's phenomenon" are too difficult to for you comprehend; it's just that they sound really complicated if you don't speak Physician.

If a doctor says something that makes no sense the best strategy is to frankly ask, "What does that mean?" When it comes to understanding your prognosis or making a decision it is important that you understand what is being discussed.

A wise teacher once told Doctor D, "If you think you understand something, but you can't explain it in a simple way you probably don't really understand it." This is true for medical knowledge. Your doctor should be able to explain these things in plain English when you ask for it.

Listening to a simple explanation in plain words it may become obvious that your physician doesn't fully understand everything either. Don't panic! We don't have to understand everything about a body or a disease to treat it well. We may not be good talkers, but we are great guessers!

Have you ever had a doctor that just couldn't speak simple English to explain your condition? Doctor D would love to hear your stories in the comments.

The Instinct To Link (Friday Links)

Since he is on vacation this week, Doctor D hasn't been keeping up with the world of Medblogging, but he does have some links for you:

You can still get your Doctor D fix because he did a Psyche Consult, so you can read his guest-posts over at the Reality of Anxiety Blog!

The first post Stress and The Survival Instinct explains the nature of stress instincts, and the second post on Anxiety Management explains how to take control of the stress instinct.

"For your hunter-gather ancestors violence and danger may have been around every corner, but you do your hunting and gathering at the local grocery with laws in place and police nearby to stop most violence. So why are the safest human beings in history always so stressed?"

Readers of this blog know D loves discussing how instincts that worked well in in the past cause a lot of poof health today from obesity to avoiding exercise. Doctor D hopes that understanding our instincts will lead to healthier living.

What do you think? Do you live better when you understand your body better? Or does understanding that certain instincts like stress instinct and eating instincts are hard wired make them harder to resist?

Doctor D will be returning home late next week after his stress-free vacation and he'll be posting some answers to your questions again soon after.