Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Tuesday, February 09, 2010

Master of the Analogy

I have a patient in his 60s who is riddled with metastatic lung cancer. He isn't on hospice (oncology refuses to let him out of their clutches just yet; actually, the problem is that around here Hospice won't accept patients still on palliative chemo or radiation) but is aware of what they have to offer. He and his wife have assured me that they will let me know when they feel they need their help.

In the meantime, he comes to me for a visit because he is worried about his blood pressure.

Up until his cancer spread, I had been treating him (successfully) for high blood pressure. Pretty routine; good control; no big deal. The problem of course is that now he is extremely unlikely to live long enough to have a heart attack or stroke. I have already told him to stop his BP meds, and he has. At this point, his blood pressure isn't even all that bad, but he occasionally gets readings at home in the 150s over 90s. This has him concerned.

My gut reaction was a combination of, "Why?" and "It doesn't matter."

Although I have explained this to him and his wife several times before, either the chemo-brain or the whole brain radiation for metastatic disease has left him a little foggy. I need to find another way to explain this without coming right out and saying, "You're going to die of cancer before your blood pressure has any chance of hurting you."

So I said this instead:

Imagine there's a house with a leaky faucet. You know that it's important to fix leaky faucets, because they can cause big problems with the plumbing down the road.

He nodded his understanding.

Now imagine that the house is scheduled to be demolished next month.

"Ah," he said, smiling with comprehension. "It doesn't matter."

Exactly so.

One of the greatest pleasures I have in my job is watching things click. That "Got it!" moment when a vaguely abstract concept is presented in terms just different enough to trigger comprehension instead of confusion is exhilarating for both of us. Nothing beats the effectiveness of a great analogy.


At Tue Feb 09, 10:10:00 AM, Anonymous Anonymous said...

One of my friends has a chronic disease for which she is monitored closely because she is at extremely high risk of developing cancer in the affected organ system. She had a mammogram last year and at the appointment the nurse scolded her because her last mammogram was 5-6 years ago. She told the nurse not to worry because risk-wise, she'd almost certainly die of another, far more aggressive cancer long before she would develop a dangerous breast cancer (she's also younger than 50).

At Tue Feb 09, 05:15:00 PM, Anonymous Anonymous said...

I admire you, Dino,for being able to handle situations far beyond the ability of most mortals, be they doctors or not. Write all the books you want - as you say, writing is what you do, doctoring is what you are and one cannot change what one is.

At Tue Feb 09, 06:48:00 PM, Anonymous Anonymous said...

Alternatively, he feels that he can exert some control over controlling his BP appropriately in the face of the overwhelming cancer. I've seen patient's perseverate all the time over inconsequential health items just because it feels like they're doing something productive....

At Wed Feb 10, 05:28:00 AM, Anonymous Clinton said...

That is a wonderful analogy, Dr. Dino!

Someday I would like to collect a bunch of these sorts of things and have it published (or distributed somehow) since it can be the most valuable tool in a doctor's bag of tricks in illustrating disease in the context of every day life. :)

At Fri Feb 12, 10:19:00 PM, Anonymous Anonymous said...

As a nurse I find that I often try to find an analogy such as this one to 'translate' medical terms and 'doctorspeak' into something easier to understand. When I can use an analogy that relates to the client's work experiences, favorite sport, etc. I work with elders in the community, who often don't find "it's your age" to be a sufficient explanation for many of the usual changes of aging. That "ah ha" moment is great!

At Tue Feb 16, 09:17:00 AM, Anonymous Anonymous said...

A doc with common sense!!
Wish I could find one of those here in Oregon; I had to move away from Denver and my funny doc there. Have been here for 6 yrs now and feel more like cattle than anything. It would be funny except my doc decided 2 months ago that a chronic bladder infection is really flu (it's been TWO months!)
Yes, I'm looking for a new doc
ever think of moving to Oregon? :D

At Mon Mar 08, 11:25:00 PM, Anonymous Anonymous said...

My Dad had metastatic cancer Dx for nearly 4 years before he died, until the last month he took his HBP & chol meds every day. I perceived it to be the thinking that it's just what he did, so he kept doing it.

He also had a 3 fillings the month before he died, requiring 3 follow up visits ;) What can I say, if I get an untreatable cancer Dx, I am not even having my teeth cleaned let alone fillings!


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