The physician and the self-educated patient

Physicians should realize their patients are now able to learn a great deal of information about their condition.

I was confronted one day in the clinic by a patient and her family who were upset that she’d been treated with a “nose-stomach tube” while in the hospital.  After some questioning, I understood that they meant her nasogastric tube, which is a routine device employed in patients following abdominal surgery to prevent intestinal distension.  It turns out, they had researched the device and found a web page stating that the tube works contrary to popular belief and actually slows recovery from surgery.  The web page actually cited a study from the esteemed Cochrane Library that evaluated 37 randomized controlled trials, involving 2,866 patients randomized to routine nasogatric tube use and 2,845 randomized to selective use or non-use of the tubes.  Not having the tube used routinely resulted in significantly earlier return of bowel function after surgery along with a decrease in pulmonary complications and other potential benefits.  The tubes did not appear to reduce the rate of leakage from intestinal repairs.

So how was I supposed to defend our actions?  I told the family that using nasogastric tubes is standard practice, and that often my residents would do these things because they had been taught to do them by others.  I also told them I was excited to learn about the study as it reflected my own biases.  And I made a commitment to them and to myself to continue to use them selectively or not at all, and that I would pass the information on to more and more of my colleagues.

However, the real message to my colleagues is to become much more informed,  understanding the vast amount of information that is available to our patients and their families.