Have you noticed in your practice that other people (never yourself) treat patients with medication that will probably work very well, but is very very unnecessary? Sure you have. It is the kind of medication you probably wouldn’t take yourself.
I remember the old days where we had branded adrenaline as very effective for allergy, actually quite safe, but you know….. usually not necessary. As of today, some of our more intelligent doctors rebranded adrenaline as the only drug possible to treat allergy and they point at the disturbingly negative numbers and charts concerning antihistaminics and steroids. I have been called out at staff meetings for being an idiot that I do not give all my allergy patients adrenaline, because the data is out there isn’t it….
Now of course they are right.. They always are. But that is not the point.
Allergy patients, (besides the acutely crashing ones) given some time and some over the counter medications usually heal fairly well without too much of our interference. And that should be the norm always. Stuff returns to normal. And as much as I like to act, start a drip, do a chest X-ray, the reality is that these patients do not really need us in the first place. Can we fix them fast? Yes we can, can we prevent one or two more severe cases? Sure we can. Will we save a lot of lives… naaaa.
But doctors cannot help but to act, and if the doctor has a lazy day, then certainly the nurses will act on our behalf. The fulfilment of years of training, the endurance of hardship in our faulty training programs, The suffering of many months of learning stuff by heart we are sure to forget after a day. Finally it all seems to have a purpose. We close the loop by doing stuff and making it all worthwhile. So we medicate…. a lot….
And somehow that seems appropriate – certainly more so then saying “hello” to a patient and leave it at that. That would take a bizarre form of nihilism that we are not capable of imagining. Or can we?
So hereby i propose to do the following from now on
DO give adrenaline in severe cases of anaphylaxis….. but
DON’T give everybody who shows up with a rash and a tummy ache adrenaline
DON’T give people that live in urban area’s and had some mild throat discomfort after ingesting an avoidable spice, the life-long discomfort of being scared all the time and carrying multiple adrenaline pens, while we all know that when the shit hits the fan they will not use it anyway.
Dr. Gerard Rover MD 