Tuesday, January 31, 2012

Just Don't Lie to Me

Florence + the Machine has an awesome CD out. I love it. One song on there has a line, "I'm not calling you a liar, just don't lie to me." I find this very apropos to a patient I'm dealing with.

He has an infection in his knee. As I've mentioned here before, working in infectious diseases, I have to ask people a lot of personal questions. Where do you live, what do you eat, what drugs do you do, who do you sleep with, etc. I try to be very open and use nonjudgmental language. During my physical exam, I look at his hands and arms, trying to find other signs of infection. He has track marks on the backs of his hands and in the crooks of his elbows. These are scars from injection drug use. I already asked him about drug use, and he denied any. We don't make eye contact during my discovery, but he must have noticed that I saw them. He mumbled something about donating a lot of blood products in the past.

I sat down at the end of the exam to tell him my plan - antibiotics and such. I said again, "You know, in this job, I have to ask a lot of personal questions, and I'm sorry for that. However it's not to judge anyone or notify any one else. It's simply to help me do my job the best that I can." He said that he understands and that I shouldn't worry about it, ask whatever I want. Again I asked about drug use and told him why this is important. Again he denies it. I tell him that I'd like to test him for HIV and Hepatitis B and C, and he said ok. He doesn't seem concerned. He's been very pleasant through this whole interview, even if I don't very well believe much that he's told me.

I'll wait to get his labs back and make a plan for his treatment. He'll probably need a few weeks of IV antibiotics at home. I'm more than a little concerned that he'll go home with the nice IV we put in place and shoot whatever he'd like into it. I explained to him the dangers of this, and he shook it off and said he'd never do that. I smiled and said ok, as Florence's words rolled through my mind.

"I'm not calling you a liar..."

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