Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How medicine can be like a scene in Jerry Maguire

Gregory Bratton, MD
Physician
June 17, 2011
Share
Tweet
Share

Although the famous clip from Jerry Maguire is about a sports agent trying to negotiate a new contract for an entitled egotistical football player, every time I see it, it reminds me of work. Put a white coat on Tom Cruise, and transplant them from a shower room to an exam room, and it becomes a pretty accurate portrait of my daily conversations with patients.

In fact, when I was on medicine call the other night, I had this exact conversation with two patients. The first was a 33-year-old male who overdosed on Rohypnol, went into cardiac arrest, and was resuscitated, intubated, and taken to the ICU for monitoring; the other was a 65-year-old end-stage renal disease patient on chronic dialysis with a fever and a 10 cm x 10 cm abscess overlying his AV shunt.

Briefly, my conversations went something like this …

The overdose patient awoke in the ICU, was extubated, and said, “I am leaving. Give me the papers.” When I explained to him that we would like to monitor him for a little longer (especially since his heart had stopped less than 12 hrs ago!!!) and get him the social help that he needed, he refused, and began pulling out all his IVs to leave.

“Help me help you,” I said. “You died last night. Next time it might be for good.”

He replied, “I don’t want your help.” Then he signed his Against Medical Advice (AMA) papers and walked out of the room and down the hallway in nothing but his boxers and no-slide hospital socks — to go and get his next high, I’m sure.

The older gentleman with the abscess was even more disappointing. After claiming to be very “in tune” with his health and aware of his infection, he refused admission to the hospital because, “I don’t like the dialysis machines, and the food is bad.” When I told him that it was my medical opinion that he be admitted and treated with IV antibiotics and a probable surgical I&D, he said, “I know medicine. I read the internet, and this is no big deal. Just give me some pain meds, and I’ll be fine.”

“Sir, you have an abscess at a very dangerous location. It can ruin your graft, but more importantly, you’re febrile and may be on your way to bacterial sepsis,” I emphasized.

After gaining no ground with my reasoning, I gave him the AMA paperwork. “I’m not signing that unless you treat my pain,” he said. “I need hydrocodone 7.5/500. That is the ONLY thing that works.”

To which I replied, “This is not a trade-off. Help me help you. You could get very sick from your infection. Let me treat you.”

Needless to say, he left without treatment or pain meds.

Patient autonomy is one of the cornerstones of medical ethics. It is defined as giving patients the right to make decisions about their own care without the influence of a physician. The twist is that it is the physician’s responsibility to provide all the information to that patient about their condition so that they can make an informed choice, but not to decide for them.

However, as I experienced the other night, sometimes you want to throw ethics out the window, lock the patient down, and do what you know is “right” for them. Other times you want to beg and plead, “Help me help you” as Jerry Maguire did in the clip. But, alas, we do not. We hold true to the ethics of medicine and allow patients to make, in some instances, very poor decisions.

ADVERTISEMENT

The Hippocratic Oath states, “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone … But I will preserve the purity of my life and my arts.”

There are two parts of this oath that strike me in these particular situations. The first is primum non nocere. I have to remind myself that what might be beneficial to me, might be harmful to others. Meaning, no matter how much schooling or studying or experience I have in medicine, it holds no weight to what my patients are experiencing in life. To some, my helping prolong their life or heal their wounds might be, in one way or another, harmful to them. Often, the choices that patients make that seem absurd to me, are calculated and well thought out to them.

The other is “preserving the purity of my arts.” No matter how I feel personally or professionally about a patient or their condition, as soon as I impart my frustrations and biases on that patient, my “art” becomes tarnished. I respect medicine and the forefathers of the profession too much to bring shame on it. So I stick to the facts and hope that my patients make the right medical choice for them.

As long as we practice medicine, we will be faced with difficult patients — those who feel entitled, those who don’t take their medications, those that skip appointments, and those that refuse treatment. However, our responsibility is to continue to do our jobs well by providing our patients with all the resources and information that they need to make informed choices, good or bad, even if they express no appreciation or interest. And when they make poor choices, our job is to be there for them, without bias, when they return.

We took an oath on it.

“If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.”

Gregory Bratton is currently serving as Chief Resident at John Peter Smith Hospital in Fort Worth and is planning to pursue a fellowship in Sports Medicine. His blog Insights on Residency is one of several blogs that can be found at Journal Watch.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Pro-actively improve quality, rather than reacting to liability concerns

June 16, 2011 Kevin 2
…
Next

What big hospitals can learn from smaller ones

June 17, 2011 Kevin 3
…

Tagged as: Hospital-Based Medicine, Patients

Post navigation

< Previous Post
Pro-actively improve quality, rather than reacting to liability concerns
Next Post >
What big hospitals can learn from smaller ones

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Gregory Bratton, MD

  • a desk with keyboard and ipad with the kevinmd logo

    A reminder of why doctors do what they do

    Gregory Bratton, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Discussing smoking habits with patients

    Gregory Bratton, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Playing hurt and when to return to football after a concussion

    Gregory Bratton, MD

More in Physician

  • When a doctor becomes the narrator of a patient’s final chapter

    Ryan McCarthy, MD
  • Gaslighting and professional licensing: a call for reform

    Donald J. Murphy, MD
  • When service doesn’t mean another certification

    Maureen Gibbons, MD
  • Why so many physicians struggle to feel proud—even when they should

    Jessie Mahoney, MD
  • If I had to choose: Choosing the patient over the protocol

    Patrick Hudson, MD
  • How a TV drama exposed the hidden grief of doctors

    Lauren Weintraub, MD
  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why physician voices matter in the fight against anti-LGBTQ+ laws

      BJ Ferguson | Policy
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why physician voices matter in the fight against anti-LGBTQ+ laws

      BJ Ferguson | Policy
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How medicine can be like a scene in Jerry Maguire
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...