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Same Shift, Different Day

Same Shift, Different Day

Pure EM Beats DIY Medicine Every Day

Harmon, Stacy MD

doi: 10.1097/01.EEM.0000827724.05932.5d
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    patient-doctor relationships, misinformation
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    Our dryer stopped drying clothes 13 months after we bought it, one month out of warranty. I'm not big on conspiracy theories, but, come on, that was perfect timing. A service call is $75 just to diagnose it. Then parts and an hourly fee are tacked on. I think we only paid around $300 for the thing in the first place, so I decided to do it myself. How hard could it be?

    I troubleshoot and problem-solve all the time. I got on YouTube and found a guy. Not to profile or anything, but he looked like an appliance guy. Besides he got right to the point. I didn't want some long-winded dissertation. Just show me the quickest way to git 'er done.

    I did have a little trouble and donated some blood to the job, but I finally got the heating element out. I had to order the part and wait for delivery. The laundromat experience in the meantime didn't really impress my wife. A new dryer instead of the repair looked better and better as time went on. Ultimately, I got the part and then had to review the video again because by that time I had forgotten how the thing went back together.

    I did get it working. It was satisfying but probably not really worth it. In fact, it went out again about a year later. I had a backup kit laying around and found my guy on YouTube again. This time I changed the thermostat, thermocouple, and heating element all at the same time. I'm done though: next time, a new dryer.

    Then it was the washer's turn. It started leaking just a little bit. The puddle got bigger and more frequent. How hard could it be? I'm a seasoned dryer repairman, after all. Back to YouTube. I soon found out that it could be a simple thing. A loose hose or even the pump seemed doable. But the main tub seal was a different ballgame.

    Trusted Expert

    I watched a couple of guys. There were some contortions to get to it, special tools, an extractor device, and a particular way to put the replacement seal in place. Challenge accepted. I went straight to Home Depot and bought a new washer. Had it delivered and set up as well. They even took the old one away. As Clint Eastwood would say, “A man's gotta know his limitations.”

    There's a lot of DIY these days. Medicine is no exception. It's certainly OK with me if someone wants to be proactive and try to take care of himself before coming to the ED. In fact, aside from real emergencies, I'm usually mystified if they haven't tried anything at all before coming in. I'm all for taking responsibility for your health and fixing the upstream problems like obesity and alcohol, tobacco, and drug use. Exercise and healthy eating are no-brainers.

    But the DIY can only go so far. It should be more like my Home Depot visit when you come to the ED. I exceeded my ability to handle this on my own, and now am deferring to a trusted expert.

    Increasingly, though, it seems like I am not a trusted expert. It's almost as if my patients found a guy. Not to profile again, but one who looks like a doctor. Better yet, one who sounds like a doctor or even is one. What Dr. YouTube and Dr. Google say is automatically vetted. My training and 27 years of experience are no match for them.

    Don't get me wrong, I love to explain what I'm thinking and include patients in the process of figuring out what's wrong and how to fix it. I don't expect them to bow down to my authority. I do expect cooperation and some decency, however. I am legitimately concerned about them, just like you. We are not trying to mow over their autonomy or be condescending. But there's a difference between DIY and just plain stupidity. You want to take charge and add some probiotics to help with your diarrhea? Go for it. You want to fine tune your LVAD? Not so fast. Maybe you need that in the hands of an expert.

    Doing What's Best

    There is a balance in there somewhere: shared decision-making meets leaving AMA. We can discuss all the options and try to explain everything, but we are ultimately the trustworthy experts. Eventually we have to say what they want is unreasonable, what they are refusing is dangerous. I am going to do what's best for you, not just fill your order and seek your satisfaction.

    I wonder if it's like that for others. Are folks telling their attorneys, “I was reading up on case law, and think you ought to refer to the precedent set in the 1914 case of Joe v. the state of Kansas”? Or to their mechanic, “I would check the flux capacitor; it seems to me that's definitely where the noise is coming from”? Are they going into the kitchen at a five-star restaurant and schooling the saucier?

    I'm not really that cynical. Most patients are grateful and helpful. We have great interactions, and things go well. The pandemic has certainly exacerbated things, though. DIY gone amuck. I have people telling me vaccines are gene therapy, and they don't even know what a gene is.

    Clearly, the DIY goes out the window with true emergencies. Codes and traumas don't elicit a lot of pushback. DIY gives way to DIH: deer in the headlights. That is where we shine, of course. Ultimate trust meets ultimate responsibility. It's exactly what we are there for: pure, unadulterated emergency medicine.

    If you're like me, that is what sustains you and makes the other stuff tolerable. I was told once in a completely different context by a mentor, “If you get humble, I'll get helpful.” We are helpful even when the patients aren't humble, but it sure is refreshing when they are.

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    Dr. Harmonis an emergency physician at Marian Region Medical Center in Santa Maria, CA. Read his past columns athttp://bit.ly/EMN-SameShift.

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