"My doctor told me..."

[angeloublue22]

I've have a weird week this week with some weird information that patients have said their doctors told them. It cracks me up because they either have the worst doctors I've ever known or they completely misunderstood what their doctor told them.

Example: Pt with a large abscess that's open and swelling. Abscesses don't usually swell more once open, so I was curious.

ME: How have you been treating it?

Pt: My doctor told me to clean with dawn dish soap and bleach. (He cut it open with a bleached knife and washed it with more bleach and dish soap)

What the doctor probably said: Clean with soap and water.

(Hey, bleach cleans stuff, right?)

another patient: Brought in five antibiotics from various dates some different kinds.

Me: Do you take all of these?

Pt: no, I just take them when I need them.

Me: Tell me what that means because that's actually dangerous.

Pt: Since I get lots of infections (from IV drugs) my doctor told me to take them whenever I feel an abscess coming on and stop as soon it goes away. (Queue my almost having an aneurysm.)

Me: Educated pt on the dangers and pointed out that each bottle says to make to take all medications and they would have received the same teaching from the pharmacy.

Pt: I don't think you're right. How do they even know how long to take an antibiotic? They're just guessing (I'm seeing stars in front of my eyes).

Me: tried to explain how they know how long to take antibiotics.

Pt: I think my doctor knows more than you since he's a DOCTOR and you're not, so I'll do what he says.

What the doctor probably: Do I even need to say it?

Please chime in with interesting "my doctor told me (input misinformation here)" I need a laugh before I go insane.

[JKL33]

Your OP implied that you thought the bleach part itself was crazy, not just the way he was using it. But yes, it sounds like he may not have entirely followed instructions. :)

[morte, LPN, LVN]

That's actually not a particularly unusual MD instruction, when used for wounds it's more commonly called "Dakin's solution", but it's still just diluted sodium hypochlorite, or what is commonly called "bleach".

Surfactants are also not unusual for MD's to recommend for wounds, preferably a highly biocompatible surfactant, a common one being dawn dish soap.

I figured we could depend on you...

[hppygr8ful, ASN, RN, EMT-I]

[ATTACH=CONFIG]27720[/ATTACH]

Also I might add that with my recent wound experience I was having my weekly treatment and suddenly I smelled vinegar. I asked and the wound care nurse told me she was cleaning with Acetic Acid or as she put it household vinegar. Told me I could do the same if I purchased a small bottle for that purpose only.

Hppy

[DowntheRiver]

I have a several patients tell me that their doctor told them that their port can only be used for chemo. By this they mean we can't take labs from it (even though we verify a return for chemo, etc.), use it to give blood, fluids, or even scans (contrast).

[DextersDisciple, BSN, RN]

That's actually not a particularly unusual MD instruction, when used for wounds it's more commonly called "Dakin's solution", but it's still just diluted sodium hypochlorite, or what is commonly called "bleach".

Surfactants are also not unusual for MD's to recommend for wounds, preferably a highly biocompatible surfactant, a common one being dawn dish soap.

I was pretty bewildered about the bleach and dish soap too but now I have learned something new today. Fascinating! Thank you for this.

[KatieMI, BSN, MSN, RN]

That's actually not a particularly unusual MD instruction, when used for wounds it's more commonly called "Dakin's solution", but it's still just diluted sodium hypochlorite, or what is commonly called "bleach".

Some patients who need MRSA skin decontamination cannot afford chlorhexidine wipes and shampoo. One common solution is 3/4 cup of household bleach/every 5 gallons of water for bathing.

Also, our all-familiar Peridex is 0.12% chlorhexidine. There is also OTC mouth wash made of 0.1% chlorhexidine for people who cannot use Listerine for whatever reason.

Re. the subject - I had enough of it to write a book. From glucose 800, sodium 110/comatose one who "drank a lot of fluids, just as doctor told!" (8 x 64 oz. of Coke within couple hours in a hot humid day). To a guy who was apparently told by two physicians, one of them was naturopath, that garlic and salty water were somehow good for healing infected wounds. After that, he was treating himself for a good few weeks by pasting his gangrenous leg with mix of garlic and salt twice a day. The following surgery was a grisly one, but, as surgeon put it, the meat was already pickled and brined.

I wonder what could be legal implications of correct and appropriate teaching "understood" wrongly. Like another smart one I once cared for who "figured out" that if he was told he could have "something I could see through" (meaning clear liquids) included doughnuts. That one was caught just in time before making it to operation table, but what if that was missed and the guy aspirated and suffered consequences?

Ironically, I had a patient I saw Thursday morning with a chronic diabetic foot ulcer that I sent home with instructions to make and use Dakins solution at home. The VNA called me on Friday morning to tell me that the patient was "putting bleach on his wounds". Upon more clarification that patient had told her he was using "bleach water" (correctly made into Dakins) and she had misinterpreted and panicked. So it does happen!

[canoehead, BSN, RN]

The example of the baby with platelets of 32... the doctor may have meant the child didn't need to be hospitalized, or need transfusions, which is technically correct. The mom didn't have the education to differentiate between not needing emergent treatment, and not being sick.

When I worked OB I heard so often from women that were tired of being pregnant saying "my friend had her baby at 36 weeks and she was fine." Fine to them was the child was discharged without needing special care. They have no idea of the issues that were probably dealt with in the nursery, or what could happen, and most of them didn't care to be educated.

[HeySis, BSN, RN]

I have a several patients tell me that their doctor told them that their port can only be used for chemo. By this they mean we can't take labs from it (even though we verify a return for chemo, etc.), use it to give blood, fluids, or even scans (contrast).

I have seen that a lot, and I've heard doctors tell patient not to let anyone use their ports except the infusion/chemo team. It usually happens because someone has not properly cared for a port after accessing it and had it clot off and it had to be surgically removed and replaced.

[tiffanyB12]

To the earlier post making a comment whether patient education is provided in Urgent Care Centers or Outpatient centers, the answer is yes. I work as a nurse in Urgent Care and we do patient education upon discharge with every patient. MD and I both do, and we also provide an After Visit Summary with specific instructions. Pt education and patient response are charted. Taking care of any questions patient while at the clinic results translates to higher patient satisfactions scores, and eliminated many potential phone calls/my chart messages after patients leave the clinic.

[applewhitern, BSN, RN]

My son had a port, and you can bet we used it only for chemo. The first two got infected and had to be removed. They aren't cheap, even with insurance. I try to avoid using anyone's chemo port for simple blood draws and such, for this reason. Even at the cancer center, the staff used a peripheral site for blood draws, instead of the port.

[By-a-thred, RN, ADN]

He was using pure household bleach. I have heard little bit about using a diluted bleach and soap although I'm not terribly familiar with the method, and thank you for going more in-depth for me. The dawn dish soap was not the problem because at least it's soap. I think the look of the wound proved he was not doing it right. It was swollen to the size of a soft ball.

Sounds like a classic case of "If a little is good, a lot is better".