Same shift, different day: Pure EM beats do-it-yourself medicine every… : Emergency Medicine News


patient-doctor relationships, misinformation


Our dryer stopped drying clothes 13 months after I bought it, one month out of warranty. I’m not a fan of conspiracy theories, but hey, it was the perfect timing. A service call costs $75 just to diagnose it. Then the parts and an hourly rate are added. I think we only paid about $300 for the thing in the first place, so I decided to do it myself. How hard could that be?

I troubleshoot and fix problems all the time. I went to YouTube and found a guy. Not for profiling or anything, but he looked like an appliance guy. In addition he went straight to the point. I didn’t want a long dissertation. Just show me the fastest way to do this.

I struggled a bit and gave blood for the job, but finally got the heating element out. I had to order the part and wait for delivery. The laundromat experience didn’t really impress my wife. A new dryer instead of the repair looked better and better over time. In the end, I got the part and then had to watch the video again because by then I had forgotten how the thing came together.

I made it work. It was satisfying but probably not really worth it. In fact, he left about a year later. I had a backup kit lying around and found my guy on YouTube. This time I changed the thermostat, thermocouple and heating element 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. The puddle got bigger and more frequent. How hard could that be? I’m a seasoned dryer repairman, after all. Back to youtube. I soon discovered that it could be a simple thing. A loose hose or even the pump seemed doable. But the master tub seal was a different ball game.

Trusted Expert

I watched a few guys. There were a few twists and turns to get to it, special tools, a puller, and a particular way of fitting the replacement seal. Challenge accepted. I went straight to Home Depot and bought a new washer. I had it delivered and installed as well. They even removed the old one. As Clint Eastwood would say, “A man must know his limits.”

There’s a lot of DIY these days. Medicine is no exception. I’m definitely okay if someone wants to be proactive and try to take care of themselves before coming to the ER. In fact, other than real emergencies, I’m usually puzzled if they haven’t tried anything at all before entering. I’m all for taking responsibility for your health and solving upstream issues like obesity and alcohol, tobacco and drugs. use. Exercise and a healthy diet are a no-brainer.

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

More and more, however, it seems that I am not a trusted expert. It’s almost like my patients have found a guy. Not profiling again, but one that looks like a doctor. Better yet, one that sounds like a doctor or even is one. What Dr YouTube and Dr Google say is automatically verified. My training and my 27 years of experience are not up to them.

Don’t get me wrong, I like to explain my thoughts 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. However, I expect cooperation and a little decency. I am legitimately concerned about them, just like you. We’re not trying to take away their autonomy or be condescending. But there’s a difference between tinkering and outright stupidity. Want to take charge and add probiotics to help with your diarrhea? Dark. Do you want to refine your LVAD? Not so fast. Maybe you need this in the hands of an expert.

Do what’s best

There’s a balance in there somewhere: shared decision-making meets leaving AMA. We can discuss all the options and try to explain everything, but ultimately we are the trusted experts. Finally, we must say that what they want is unreasonable, what they refuse is dangerous. I will do what is best for you, not just fill your order and seek your satisfaction.

I wonder if it’s like that for others. Do people say to their lawyers, “I was reading the case law and I think you should refer to the precedent set in Joe v. State of Kansas in 1914”? Or to their mechanic, “I’ll check the flux capacitor; I think that’s where the noise is coming from”? Will they walk into the kitchen of a five-star restaurant and educate the saucier?

I’m not really cynical. Most patients are grateful and helpful. We have great interactions and things are going well. However, the pandemic has certainly exacerbated things. The tinkering went wrong. I have people telling me that vaccines are gene therapy, and they don’t even know what a gene is.

Clearly, DIY goes out the window with real emergencies. Codes and traumas don’t elicit much repression. Do-it-yourself gives way to IHL: deer in headlights. That’s where we shine, of course. Ultimate trust meets ultimate responsibility. That’s exactly what we’re here for: pure, unadulterated emergency medicine.

If you’re like me, that’s what sustains you and makes the other stuff tolerable. A mentor once said to me in a completely different context: “If you become humble, I will be useful. We’re helpful even when patients aren’t humble, but it’s certainly refreshing when they are.

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Dr. Harmonis an emergency physician at Marian Region Medical Center in Santa Maria, California. Read his past columns on

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