I’m a Nurse, not a Saint


Priest (Photo credit: Wikipedia)

I am continually amazed and astounded by the things patients feel comfortable saying to me. It’s as if they think a nursing degree is equivalent to a counseling degree, a white set of scrub pants akin to a white collar, and a hospital or outpatient clinic room is the same as a confessional. It’s not.


Confessional (Photo credit: cliff1066™)

Don’t mistake my words for a renunciation of confidentiality. My lips are sealed when it comes to protected health information and you, but, as in real life, there are times when people provide too much information. I’ve provided some examples so you can judge whether you need to be a little more discreet on your next hospital or doctor’s visit.

When I ask you to undress down to your underwear and cover yourself with a sheet, you don’t need to tell me, “I don’t wear underwear.” That is a surprise best left for the doctor. I’m not coming back in to check that you disrobed appropriately.

If I ask you to take off your shoes to be weighed, don’t apologize for the holes in your socks. Our office is only responsible for checking sock holes on alternate Thursdays in months that end in -Z. Any other time, don’t worry. We won’t be putting it in your permanent record nor will I be calling your mother (or the Emergency Room) to rat you out.

If I come in with an shot for your child, don’t tell them it won’t hurt. Chances are it will. I’ll try to minimize the pain, but since I can’t tell them to “suck it up, buttercup,” I’m hoping you’ll have your big girl panties on and shush them rather them tell them you’re sorry the “mean nurse” hurt them.  The mean nurse can’t do shit unless you give me permission, but I’m not telling your toddler “your mean mom made me do it.”

If I do a cervical check on your pregnant girlfriend, don’t ask her if she’s enjoying it. She’s not. Neither am I. Creep.

Never ask me to rub “extra hard” down there if you’re unable to clean yourself off. There are non-medical devices and non-medical personnel who can meet your needs much better than I can. Once you ask, the only “happy ending” I’ll think of is your discharge or death.

Don’t ask if you can strip down to your underwear to ensure your weight is “accurate.” I personally don’t want to see you half naked and believe stripping down for non-medical reasons should happen in your home, not in the exam room.  You can buy your own scale for the cost of a co-pay.

Going Down?

Going Down? (Photo credit: billhd)

Don’t expect me to believe that you need an early refill on your methadone, oxycontin, oxycodone, percocet or vicodin because the bottle you just filled fell into the toilet with the cap off, ruining all of the pills. Unless a major study at a prestigious medical center proves that toilets have a preference for narcotic painkillers, I’m suspicious. This never happens to anyone’s heart, allergy, or diabetic medicine. If you have to lie, go big or stay home. Don’t let drugs kill your creativity.

Remember I’m a nurse, not a saint.

Screening Mammograms May Be Dangerous to Your Health

Breast cancer awareness

Breast cancer awareness (Photo credit: The Suss-Man (Mike))

Recently I had the  unsettling experience of being called back for additional views of my left breast after my screening mammogram.  I had questions for the radiologist prior to consenting to the additional views and he had one for me, where had I gotten last year’s mammogram?  I replied I hadn’t as I was following the U.S. Preventive Services Task Force (USPSTF) recommendation that average-risk women get mammograms every 2 years.  Many doctors, particularly radiologists, don’t buy into the recommendations and advocate for yearly mammograms. The radiologist implied if I’d had a mammogram last year, we’d know more about the suspicious finding on this year’s mammo. In other words, if something was wrong, it was my own damn fault. Call me cynical, but any group that makes a steady income on screening procedures isn’t likely to agree with a recommendation that will cost them business.

I choose to follow the guidelines because I’m a little suspicious of the entire screening mammography experience, particularly when the National Cancer Institute website points out “Potential harms of screening mammography include false-negative results, false-positive results, overdiagnosis, overtreatment, and radiation exposure.”

As medical science looks at cancer more closely, it turns out that some abnormalities labeled as cancer are not a threat to a women’s health and will not lead to death (A similar conclusion was reached after screening males for prostate cancer became widespread and led to overdiagnosis and overtreatment). The New England Journal of Medicine recently reported on breast cancer overdiagnosis, defined as cancer that doesn’t need treatment.  The study found that up to one third of breast cancer diagnoses, between 50,000 to 70,000 cases annually, don’t need treatment. Experts even debate whether one type of cancer, DCIS (ductal cancer in situ), should even be called cancer. In a 2006 study founded by the Susan G. Komen foundation, they estimated that 90,000 diagnoses of DCIS were actually misdiagnosed because of pathologist error, leading to incorrect treatment.  So medicine is really great at FINDING cancer, not so good at figuring out whether it needs to be treated.

Cancer treatment comes with it’s own set of risks. Errors involving chemotherapy and radiation treatment helped to define the patient safety movement. When 32 year old health columnist Betsy Lehman died after receiving a massive overdose of chemotherapy four days in a row in 1994 at Dana Farber, institutional policies changed to include double checking of medication calculations and closer supervision of physicians in fellowship training. Even so, a second patient subsequently suffered a chemotherapy overdose of the same medication. Radiation treatment holds the same risk of the cure being worse than the treatment. In 2007 a man with tongue cancer died of a radiation treatment overdose that left him deaf, partially blind, unable to swallow, and caused his teeth to fall out. Even after the cause of his radiation overdose was identified, other patients around the country suffered a similar fate.

When all was said and done, my repeat mammogram turned out to likely be a cyst and a six month view of the breast should bear that out.  If the diagnosis had been different, how would it have felt to challenge the doctors treating me? Asking for a second, independent pathology review, double checking all medication calculations, and, in the case of radiation, learning about the equipment and asking questions to ensure it was properly calibrated and set up all seems like a large burden for someone coping with cancer. Even more troubling is the thought that questioning the supposed experts could lead to an adversarial relationship with the medical team. It’s too easy in healthcare to label someone a bad patient or noncompliant when they question the doctor.

The problem is that many of the truths that medicine hold true aren’t true at all.  Receiving a cancer diagnosis must be hard enough. Having to question it’s validity and treatment is a burden no one should have to bear.