Thread by @WesElyMD

1/🧵 Giving & Receiving Advice:

My medical advice is not infallible. Maybe I’m wrong and maybe my patient knows it? Maybe that’s one reason she/he is non-compliant. Even if I am right, it might not be the time in that person‘s life to hear the message.

#selfcare #medtwitter

2/ A pt may seem to be listening & carefully taking it all in. But later that morning she/he may leave against medical advice (AMA). What are we to think when we give our best #advice and others don’t take it? Especially in the medical field?
 
#tipsfornewinterns #tipsfornewdocs

3/ First of all, of course, unsolicited advice is #criticism. Especially when I’m not with a patient, I try to resist all urges to give unsolicited advice.

4/ At the bedside things are quite different. We are there, all of us in medicine, to treat our patients’ immediate problems and help them steer toward success in the future.

5/ And whenever someone refuses our advice either through general noncompliance or through something more overt like leaving AMA, it may frustrate us. Should it?

6/ Have I erroneously judged a person for leaving AMA or subconsciously thought something negative about their character? 😔

7/ It is common to judge other people’s outsides using our insides. Meaning I don’t know how that person is suffering. I don’t know the power of a substance-use disorder in their lives controlling their thinking and preventing them from doing “the next right thing.”

8/ “Sir, all you have to do is the next right thing.” That's what I told my patient on rounds when he was lying there shaking from drug withdrawal, scared & unsure of how his life was going to go next.

#emotionalhealth #Recovery

9/ It might be better for him to hit rock bottom and so maybe leaving AMA is actually going to help him more in the long run. None of this is for me to understand, and it is certainly not for me to judge.

10/ Of course, I worry that his leaving will land him on the street in a more dangerous circumstance and that maybe he won’t live to be readmitted next time. I think he would have done better had he stayed and received our care. But I don’t know this.

11/ Most importantly, I must remain small and a person of service to the patient and never her or his judge. Never placing the patient as the butt of the joke or even a negative nod of my head as if everyone should listen to me. NOPE.

12/fin
In this example, addiction ruled the day. I can’t possibly understand what he’s going through, but I can focus on my ability to empathize with his pain and suffering. That’s what I’m left with. How about you?
 
#medtwitter #nursetwitter #tipsforolddocs

This paper by @RanaAwdish fits this 🧵perfectly…blurb…

“When patients believe they lack control, sense deficiency in self-confidence, or experience repeated authoritarianism, their helplessness can lead to passivity, neglect, loneliness & depression.

mayocl.in/3yGkLpj