What have you learned from your patient today?

An online friend* said that MDs nearly always talk down to their patients**. That got me thinking, about my patients and how much I learn from them, every day. Because every one of my patients knows more about something than I do.

When I first came to my small town I had a new patient. Vague complaint. Once I was in the room, he explained: “I've used methamphetamines for 17 years and I want to stop.”

My thought: Panic. I don't know anything about methamphetamines. I can't help you.

He explained that he'd been thrown out of the drug treatment group and out of mental health.

Great. Hopeless. I thought, I can't do anything. Then I thought: yes, I can. I can do one thing.

I can listen. So I got the basic information, past medical history, allergies, surgeries, family history. Then I let him talk. Folks on meth talk fast. At 25 minutes I stopped him. “I need to listen to your heart and lungs. Then we will schedule you to come back every two weeks until I figure out how to help you.”

He was fine with that. He would come in and tell me about his life and the drug culture.

I started asking him about methamphetamines. “I don't know anything about it. How do I tell if someone is on it?”

“What do you know?” he said.

Teeth rot.”

He laughed. “That's late. Lots of people are on them. They talk fast. They are wired. They lose weight. But you can really tell when they are tweaking.”


Withdrawing. Coming down. They get jittery. Sleepy but wake. They scratch or pick. Hands shake. Irritable. Man, I can spot a tweaker across a room.”

So I picked his brain about methamphetamines in our area. He kept talking. He talked really fast about his life. Quite a big mess. He had a small son and wanted to be better for him. At last his speech slowed a bit.

“You know, I don't know how to be in the non-drug culture.”


“I've been in the drug culture for 17 years. I know what to do there. How do I find people who aren't doing drugs.”

My turn to laugh and I wrote a prescription. “Go to church. Hopefully they are not all on methamphetamines. In theory they should welcome you and if they don't, go to a different one. And it's only two hours a week and you do have an idea of how to behave.”

He did. We got him back in the drug program, we got him back to mental health, he was working and off meth. He slipped and came and told me and got clean again.

And he helped me tremendously. He told me there were lots of people on meth and it changed my practice. Some were on it for weight loss. Some were pregnant. I changed our prenatal intake. I would do the first visit, not the nurse. I would explain that our protocol (really my protocol) was to test for anything that could possibly hurt the baby. Then I would list the labs: hep b, hep C, HIV, a urine drug screen.

The patient would agree. One young woman listened to the list and said, “I'm glad you do a urine drug screen. My friend saw the other doctors and she used meth the whole pregnancy. They never figured it out. Her baby is kind of a mess.” She thanked me. THANKED ME for doing a urine drug screen as part of the routine pregnancy intake labs.

I have patients who fish for geoducks, a longshoreman, who build violin bows, who fish in Alaska, who run a factory in Brazil, who do amazing amazing things. I learn from my patients.

What have you learned from your patients lately? And if the visit is to be only 20 minutes or 10 minutes and about one thing only, forget it. You don't have time.

But I am going against the tide. I have my own practice for four years now, and I take forty five minutes for a new patient and an hour for a new medicare patient. Because that is the way I like to work. It works for me and for my patients. That way I have time to learn from my patients.....

Rejected by the Journal of the American Medical Association last week. Heh.
I can't remember his name, so not a HIPAA violation......I'm still grateful to him.

*etouffee -- blessings and thanks
**More than a Paycheck : Sweet Honey in the Rock

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