Pointless Arguments

So today I was having a “discussion” with someone who had recently become a doctor, about a patient I saw in my GP clinic. This discussion quickly turned into an argument and that was not cool.

Basically, I saw a man who had metastatic melanoma and after undergoing chemotherapy he was declared to be palliative. He came into the clinic because he had felt some slight discomfort in his tummy last night and this morning he woke up and had a glass of water, felt the discomfort again, and vomited up everything from his dinner last night. He had some more water and vomited again. So he had 3 episodes of vomiting at 7 am. He then was no longer vomiting, his nausea had settled and he was able to have sips of water. He came into the clinic at 2:30pm. He hadn’t eaten since his vomiting episodes.

So anyway, I took a history and did an examination and my registrar and I decided that he had had a bout of food poisoning or was in the early stages of a viral illness. We sent him home with some anti-emetics.

I recounted this story to this person. Her immediate reaction was “did you give him some IV fluids?”. I was in a rural GP practice. There wasn’t really much opportunity to provide bags of IV fluid for someone like this patient.

But more importantly, when I examined him, I was looking for signs of dehydration. He had a blood pressure of 150/70 (which is high), he was passing urine, tissue turgor was good, his JVP was 3cm (which is normal), his capillary refill was less than 2 seconds. (Oh God sorry about this. I’ve just practiced writing all these examination findings up in notes that I’ve just spewed them on here)

Basically, He was not dehydrated. He had been having sips of water all day. I didn’t think he needed fluids.

This person I was talking to however, did. She said that I should have at the very least, given him dextrose. For “energy” apparently. I had never been taught that you could give someone dextrose for “energy” so I said I didn’t think it was indicated as he seemed quite well and was likely to go home and eat and drink normally. She started to get annoyed. She said that it didn’t matter whether it was indicated, and that if I thought about it “logically”, I would see that giving dextrose was the best choice. And that she was giving me advice to be a “better practitioner”. She went on to say that in other health systems they do give dextrose to these patients. I said that I have never been taught this and no one else suggested it at the time and he looked quite well. She said “Well you’re wrong. This is good advice”. And that I should follow it if I wanted to be a “good doctor”.

At this point I got quite annoyed.

I’m sure I’ve mentioned somewhere before that in medicine it is so hard to decide who is “right” and who is “wrong” regarding diagnosis and management of a patient. Everybody takes away something different from their learning and have been exposed to different things, and as such, they are all inclined to practice medicine differently. To say someone is “wrong” because they don’t do exactly what you would do in the same situation seems a bit silly. Of course, this is what always happens. There is no department in hospital you can go to without hearing the doctors there trashing other doctors and their care of patients. It’s just the way it works.

I’m just frustrated at the futility of it though. To get angry because you think yours is the Right way and someone else didn’t know that? When realistically, neither approach would have done much harm or benefit to the patient in that setting. As long as neither approach severely damages the patient in some way, there should be some grey area between this “right” and “wrong” thing. Shouldn’t there?

Why do people walk around thinking they’re way is the right way? Surely we’re all working to make people feel better.

Giving him IV dextrose would mean pricking him and making him sit around for an hour in a small GP practice when he was likely to go home and eat and drink something normally. This was my opinion. And my registrar, who had also seen this patient felt the same.

Her opinion was different. Which is fine. But for her to say that I was “wrong” and wasn’t a “good doctor” for not loading him with fluids, seemed a bit much to me. It seemed arrogant.

I guess this is how it’s going to be in this career. Everyone has their own “right” way. Even me I suppose. But I wouldn’t be calling someone else wrong or a bad practitioner unless they actually did something awful to a patient.

Well maybe I might. Someday.

But I hope not. Blech.

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