19 February 2010

Bad patient

I've been a bad patient lately. I still haven't started physical therapy, a month after the neurosurgeon instructed me to. Work has been busy, and I never seem to remember to call during daylight hours. But I called today, and I'll be starting in about 10 days. I know that going back to work full-time in January set me back some -- I had no transition. I had been working 2 hours per day, then BLAM! I was working 8 hours. Given my current position, it has been hard to work a reduced schedule. Everyone wants something from me. And if they don't want it now, they want it tomorrow. It's nice to be popular, but there are limits.

But this isn't why I am a bad patient. I am about to willfully disregard the instructions from one of my doctors. If y'all remember, I had a deep vein thrombosis in my right leg, part of which migrated to my left lung (pulmonary embolus) as a bonus a week after the surgery. That blood clot bought me 6 months on rat poison ... er, I mean a blood thinner (Coumadin or warfarin). They want my level between 2.0 and 3.0. It's been 2.5 or 2.6 since early December, and I have forgotten my Coumadin dose only twice since I started taking the stuff. The hematologist put me on a crazy regimen -- 6 mg on Sun and Wed and 4 mg the rest of the days. But it clearly works, since my levels have been perfect. Today I had my blood checked, and the result was 2.8. I figured that he'd leave the dose alone. But I got a call from the nurse this afternoon instructing me to increase the dose to 6 mg alternating with 4 mg. I thought what the hell? but didn't say that out loud. I asked her if she was sure if that was correct, as my levels have been rock-solid on the other dose. She said that that is what she was instructed to tell me.

I have an appointment with the hematologist this upcoming Thursday, and I have decided to ignore his instruction. I am going to keep taking the Coumadin as I have been until I talk with him. I am not sure if I received instructions meant for a different patient, which would make sense. I have enough medical knowledge (duh) to make my own decisions, although I hate it when my own patients do that. We'll see what he says on Thursday.


Anne C. said...

I love that you are doing something that you dislike seeing in your patients. Nothing like turnabout being fair play to keep things in perspective! :D

Lorraine said...

Yeah, but the kind of knowledge isn't the same when it's your patients, unless you have doctors as neurology patients. Your level of expertise allows you to make an educated decision to wait. And it isn't like mistakes in *translation* of orders have never happened...

Glad you've signed on for the rehab.

neurondoc said...

The most annoying patient I ever had with respect to self-medication was a psychiatrist with Parkinson's disease. I literally never knew from appointment to appointment what dose of meds he'd be on, because he "adjusted" them so much. I eventually pawned him off on the movement disorders clinic at one of the local medical schools. I suspect that he is still adjusting his meds to his own satisfaction, regardless of dose toxicity.

And turn about is fair play. I am sure I'll get scolded on Thursday. :-)