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The physician and the self-educated patient

October 18, 2010

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.

2 Comments leave one →
  1. October 28, 2010 2:43 pm

    Huh, interesting.

    I work in an upper GI surgery unit in the UK, and NGs are standard practice in our unit too: I had no idea there was such an unequivocal Cochrane review! I shall certainly be feeding this back to the team, thanks for bringing it up!



  2. November 9, 2010 11:04 pm

    I agree that so many individuals are looking up their own medical information. However, there is a fine line between knowledge and conflict. Particularly when it comes to information on medication. I have dealt with patients that carry their own medication reference book. And believe me, they will tell you every side effect of that medicine and every reason their NOT GOING TO TAKE IT! The same applies to looking up medical procedures. Some patients will absolutely refuse a colonoscopy once they read the procedure. I’ve had to do some pretty good talking to finally get them to understand the procedure’s positive vs negative. Although I think that a patient should be well informed, there is certainly a line that can be crossed that can put them at a great risk for a catostrophic event! I speak primarily of the older patients, however, many younger ones become great investigators! I must say that I myself have to keep up even though I am no longer actively working. Medicine is an ever evolving science with new technology. It is hard to stay on top of all the new technology, as well as the new illnesses, or rather those that are rearing their ugly heads again.

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