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.

Friday, May 11, 2007

Outcome of "Ethical Dilemma"

First of all, many thanks to all who commented. I was a little surprised by the unanimity of the response, though perhaps I shouldn't have been. Now, of course, either because of Jewish guilt (have to find something to beat up on myself about) or in the name of Continuing Education/Quality Improvement (same thing) I'm wondering why it was so hard for me to come up with that answer. Sometimes things aren't quite so clear on the spur of the moment, with a walk-in standing in front of me and other patients waiting. I'm not sorry about my answer (make an appointment to discuss it) and as it turns out, offering to teach her to self-inject was probably the only thing that made her agree to come back.

I weighed and measured her. Her BMI is 21.5. She doesn't feel she's fat; no depression; no eating disorder; marriage/life is fine; she's perfectly happy. She just wants to lose some of her "storage fat"/"cellulite" (she used both terms.) She gets palpitations when she tries to run, which she is convinced is because of "excess weight." She declined my offer of a cardiac workup, saying she'd already had one and everything was fine. When I tried to explain the status of the treatment as unproven and useless, she wasn't the least bit fazed: she'd done her research (a book written by a DOCTOR; 30 years ago, but still...) and read all about it. She believed it would work, and one way or another she was going to do it. Thanks for your time. No hard feelings.

Verdict: Altie. Allergic to reason and intolerant of science. Oh well.

I did what I could, and that's all I could do.

Once again, thanks to all for opinions.

[*waving @ bean*]


At Fri May 11, 08:00:00 PM, Anonymous Anonymous said...

"She gets palpitations when she tries to run,"

This happens to me as well. It's enormously frustrating, but I've never thought it was because I was fat, though. O_o

At Fri May 11, 10:45:00 PM, Anonymous Anonymous said...

Eh. I knew you would. (Had? Did?) Do the right thing, that is. Too bad about the OB/Gyn. Nice that the patient had no hard feelings.



At Sat May 12, 09:39:00 AM, Blogger Detail Muse said...

"Sometimes things aren't quite so clear on the spur of the moment, with a walk-in standing in front of me and other patients waiting."

Definitely. By the time you'd written your post, you'd marinated on it, giving us benefits you hadn't had in the moment.

I wonder if she got palpitations because she used OTC or altie sympathomimetics for weight loss?

And OMG I hope she doesn't end up with lumpy tissues from 40 daily injections ... that were intended to get rid of cellulite!

This was interesting, thanks for bringing it to the blog.

At Sun May 13, 12:30:00 AM, Blogger Bo... said...

I hadn't heard of anything like this before---no wonder it was a difficult decision. The fact that you gave it so much thought shows that you are very thorough and caring---and that you try to do your very best. Sometimes patients put us in those types of positions where we are danged if we do and danged if we don't....

At Sun May 13, 01:35:00 PM, Blogger XE said...

Hi Dinosaur,
I think you made the right decision. I love your blog, is it okay if I blogroll you?

At Sun May 13, 09:37:00 PM, Blogger #1 Dinosaur said...

Xavier: blogroll to your heart's content.

Many thanks for all the kind words, all.

At Mon May 14, 10:27:00 PM, Blogger Dreaming again said...

lower side of normal BMI ... used the language of many anorexics who are trying to fool their family's and doctors when they ask if they feel fat ...

I know she's not diagnosed with an eating disorder ..but this screams a long term eating disorder to me (as someone who's had one for over 30 years.) I'd be very interested what difficult patient thought. But, she's galavanting right now.

At Tue May 15, 09:52:00 PM, Anonymous Anonymous said...

Why is this any different than the altie's who used to come in demanding a prescription for Sporonox because their naturopath told them they were infested with Candida (pronounced "can-DEE-da)? Those people were told flat out NO WAY- end of discussion. Never lost a minute of sleep over those interchanges. Never got sued for the rare case of hepatic failure either. Never wasted any time trying to "educate" the illogical. Spent my time more productively and for the greater benefit of saner patients.

At Fri May 18, 05:37:00 PM, Blogger Margaret Polaneczky, MD (aka TBTAM) said...

Having stumbled back into the blogosphere a bit late to get in on yesterday's discussion, I just wanted to put in my two sense.

Agree completely with your approach to try to educate her, and to have no part in this quackery.

That gyn should be reported to his/her professional board.


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