Weapons and Medicine: What's the Correlation

Weapons and Medicine: What’s the Correlation?

Robert M. Blumm, PA, DFAAPA, PA-C Emeritus

I can vividly remember a story my father passed on to me about a night when there was a suspected burglar in our home. Dad instructed Mom to stay in the bedroom and he went to the kitchen where, under low illumination, he loaded his shotgun. At just that moment, my mother tapped him on the shoulder and he spun around ready to fire. Thankfully, he had been in combat situations and knew enough to confirm a target. My mother could have been lost to a shotgun and a flawed decision. Shotguns seem to be the weapon of choice for home defense and it may have this status because one need not be adept at aiming. The homeowner merely points in the direction of the perpetrator and fires. The goal is that the load in the shotgun shell will hit the intruder and scare them off immediately. The problem with this approach is that a clear vision of the intruder is not always 100%; it could be your teenage child returning home late in a discreet manner after climbing out of the bedroom window (I was guilty of that infraction). It could be a covert liaison of one of your kid’s friends or it could be an intoxicated person trying to enter the wrong house. The outcome of a hasty demonstration of force could be a dead or severely injured child, friend, or stranger.

There are some clinicians who are guilty of a similar type of practice, especially when being overworked. They typically want to provide the patient with a positive experience so that they will return in the future. Sometimes their concern about practicing medicine with advanced scientific technologies and applying a differential diagnosis is a secondary consideration.

An example of this might be a sixty-four-year-old senior citizen with insomnia. This is common in aging patients: there are multiple strategies that can help, but it is so much easier to just give every insomniac a sleeping pill. There are three different outcomes of this practice. The patient may get a night of restful sleep; they may have a drug/drug interaction; they may create a crisis situation or they may be so groggy from the medication that when they wake at night to use the bathroom, they may fall down a flight of stairs because they have become disoriented. This could happen for the next twenty-four to forty-eight hours, even impairing their abilities behind the wheel of a motor vehicle.

Dr. Christine K. Kasssel, president and chief executive of ABIM, made a statement about the Choosing Wisely Company: “The right care for the right patient at the right time.” This excludes the use of many expensive, unnecessary tests, whether they be labs, X-rays, CT scans, or MRIs. The idea is to consider the diagnosis and pinpoint the correct care.

Too many clinicians are treating sore throats and viruses with antibiotics perhaps because of their previous training or because of convenience. One must consider the side effects of an antibiotic and realize that with no strep test, there will be no help and the possibility of an allergic reaction, development of resistant bacteria, and side effects such as abdominal discomfort and diarrhea. Why is this happening? Employers of convenient care clinics, urgent care clinics, and hospital Fast Tracks expect it. Another reason is that the patient expects a prescription and feels that if there is none, that they have left the facility without treatment and at a personal cost. Wanting to satisfy a patient and forgetting that this practice could be an affront to the oath of “first do no harm”, remains a dilemma.

Rick Voakes, M.D., wrote an article in Health Bytes:

“If medications are prescribed without an adequate explanation as to the purpose of those medicines, ……YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE

If antibiotics are prescribed for illnesses that are caused by viruses, such as colds, bronchitis, sore throat not caused by strep, RSV infections, chickenpox, stomach virus, sinusitis (less than 2 weeks duration), or any disease with the word "virus" in it, …… YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE.

If the doctor prescribes medications without ever examining your child, ……. YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE.

If the doctor prescribes oral antibiotics over the phone (without seeing your child), ……. YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE.

If you notice a pattern of getting hundreds of dollars of lab tests on every visit, then being treated with the same antibiotic every time, ……. YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE.                             

If the doctor orders many lab tests, but you don’t understand the purpose of most of the tests, ……. YOU JUST MIGHT BE GETTING SHOTGUN MEDICINE.”