Trust No One

There is a montra that a staff physician taught me on one of my first inpatient hospital rotations as a resident: Trust No One.  (Her other big soap box was: always do a rectal exam, but I wasn't too found of that rule.)  At first "trusting no one" seemed rude and inefficient.  Afterall, we are a team of nurses, doctors, pharmacists, and even patients.  If I can't trust the patient's story, the nurse's evaluation, the ER doctor's opinion, or the pharmacist's recommendation, how can I be a team player?  More importantly, how can I get anything done?

Well, long, long ago, I learned that patient's are not always trustworthy.  "I quit smoking," from the guy who you could smell before you saw.  "I've never had sex," from the pregnant teenage girl.  "No, No.  I would never do drugs," from the patient with pupils the size of dinner plates.  "I've been sober for a long time," from the guy who goes into alcohol withdrawal seizures two nights later.  While, yes, most diagnoses can be made from the patient's history alone, there are still some times you have to take their history with a grain of salt.  So, I guess the montra holds true.

However, when it comes to my own medical community, I am a very trusting person.  It is true that if you treat the nurses well they will make your life easy (and, although I haven't experienced it, they also can make your life miserable if you don't).  There have been so many things I've learned from nurses along the way.  The amount of time they spend with the patients, their personal experience, and their thoroughness are huge helps.  However, there have also been times it has led me astray.  There were a few examples even just this week that I wish I would have asked more questions, gotten more details, and trusted my instincts and training more when the nurses were anxious, stressed, and frantic for the doctor's orders they wanted.  Instead of taking a step back and reigning in the situation, I caved and ordered more tests, started more medications, and skipped steps I should have taken.  Thankfully, the patient's didn't suffer, and it ended up just being a waste of precious healthcare dollars and a blow to my ego.  But, now the montra is a little louder when my pager goes off.

Now, to be fair, the same holds true for people with "Dr." in front of their name.  The number of times is growing where the story from the other doctor is not the same story that I come up with when I go to see the patient myself.  I've gotten a patient with an "anxiety attack" from the emergency room that ended up being a heart attack.  I've gotten someone who "just needs to be watched until a spot in a nurshing home opens up" in rhabdomyolysis.  It wasn't me, but I heard a story about an intern who asked the pharmacist with help changing someone's IV steroids to oral and ended up giving 3x the amount they wanted.  Can you say - 'roid rage.  Montra true once again.

I realize that this might be unintentionally sounding arrogant or elitist.  In all honesty, as much as I try, I haven't always been worthy of that level of trust either.  We all are doing our best, but eventually when I'm the one solely responsible for someone's health, and ultimately someone's life, I don't want to have anyone else to blame.  So, with all due respect, don't mind me if I verify the patient's story, question the nurse's evaluation, reexamine another doctor's patient, or look up a medication dose one more time.  It's just my montra: I trust no one.