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

The importance of listening to the patient before we develop our plans

Robert Centor, MD
Conditions
July 13, 2016
Share
Tweet
Share

Around 30 years ago, LRZ taught me a most important lesson.  LRZ, one of my most fondly remembered patients, was a classic blue collar guy.  He had a wonderful, gregarious personality.  He had significant systolic dysfunction, yet still worked hard for the city.  Amongst other things he did, he shoveled the salt into trucks on snow and ice days.  He functioned well most days.

One day he came to see me.  In those days, prior to ACE inhibitors or the use of beta blockers, we focused on digoxin and diuretics.  As I picked up his chart I noted that he had gained 3 pounds.  From past experience, I knew that he would soon have progressive symptoms.

I examined him and noted bibasilar rales.  This occurred on a Monday, and I had more opportunities to see him that week.  He told me that his furosemide (Lasix) was not working as well as usual.  So I assumed diuretic resistance, and planned to give him a dose of metolazone (5 mg) in addition to the furosemide.  As we went over the plan, he paid attention.  I planned to bring him back in two days to check his weight, his lungs, and his potassium.  (For current trainees, in the absence of ACE inhibitors or ARBs, we saw much more hypokalemia, and the combination of a loop diuretic and thiazide both produced massive diuresis and significant hypokalemia: very dangerous given the doses of digoxin we used in those days.)

After laying out the plan, and making certain that LRZ understood, I got ready to leave the room.  As I reached for the door handle, LRZ stopped me.  “Doc, thanks for everything, but I came in because of my right shoulder pain.  I hurt it shoveling.”

I examined him, and made a clinical diagnosis of tendonitis.  Then I asked the most important question.  What are you taking for your shoulder pain.  LRZ responded, “Aleve.”

And then I understood. Diuretic Resistance and Strategies to Overcome Resistance in Patients With Congestive Heart Failure:

Drug-drug interactions have been associated with diuretic failure and, ultimately, resistance. Non-steroidal anti-inflammatory agents (NSAIDs) may alter renal hemodynamics by decreasing renal blood flow. In severe heart failure, prostaglandins play an important role in renal perfusion. Prostaglandins promote sodium and water excretion, and prostaglandin inhibition with aspirin or other NSAIDs has been shown to attenuate diuretic efficacy. Hall noted an impressive reduction in diuretic requirements when daily administration of as small a dose as 100 mg of aspirin was stopped.

So we stopped the Aleve and helped him return to his desired weight.

LRZ reinforced the importance of listening to the patient before we develop our plans.  How often do we learn more from listening to our patients than barreling forward with our agenda?  Listening takes a bit of time, but it really saves time.  As a physician, we work to help our patients. Therefore we must understand their concerns, their issues, and their plans.

LRZ taught me to listen to the patient before developing our plan and before pontificating.  LRZ helped me become more patient centered.  Rest in peace LRZ.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

Image credit: Shutterstock.com

Prev

The myth of when HIPAA gets waived

July 12, 2016 Kevin 6
…
Next

Limiting gay men donating blood: Discriminatory or rooted in science?

July 13, 2016 Kevin 5
…

ADVERTISEMENT

Tagged as: Nephrology

Post navigation

< Previous Post
The myth of when HIPAA gets waived
Next Post >
Limiting gay men donating blood: Discriminatory or rooted in science?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Robert Centor, MD

  • When the problem representation and the illness script do not match

    Robert Centor, MD
  • Think of diagnostic excellence as playing smooth jazz

    Robert Centor, MD
  • When constipation pain was worse than cancer pain

    Robert Centor, MD

Related Posts

  • How self-awareness helps with patient interaction

    Ton La, Jr., MD, JD
  • How to develop a mission-driven personal brand

    Paige Velasquez Budde
  • A patient’s family bridges two worlds

    Ton La, Jr., MD, JD
  • To anyone in medicine: This is why listening matters

    Sophia Zilber
  • A universal patient medical record

    Michael R. McGuire
  • A patient waits. And waits.

    Michele Luckenbaugh

More in Conditions

  • What one diagnosis can change: the movement to make dining safer

    Lianne Mandelbaum, PT
  • How kindness in disguise is holding women back in academic medicine

    Sylk Sotto, EdD, MPS, MBA
  • Measles is back: Why vaccination is more vital than ever

    American College of Physicians
  • Hope is the lifeline: a deeper look into transplant care

    Judith Eguzoikpe, MD, MPH
  • From hospital bed to harsh truths: a writer’s unexpected journey

    Raymond Abbott
  • Bird flu’s deadly return: Are we flying blind into the next pandemic?

    Tista S. Ghosh, MD, MPH
  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why physicians deserve more than an oxygen mask

      Jessie Mahoney, MD | Physician
    • Avarie’s story: Confronting the deadly gaps in food allergy education and emergency response [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

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

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

      Joshua Baker and James Jackson, PsyD | Conditions
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Avarie’s story: Confronting the deadly gaps in food allergy education and emergency response [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the physician shortage may be our last line of defense

      Yuri Aronov, MD | Physician
    • 5 years later: Doctors reveal the untold truths of COVID-19

      Arthur Lazarus, MD, MBA | Physician
    • The hidden cost of health care: burnout, disillusionment, and systemic betrayal

      Nivedita U. Jerath, MD | Physician
    • What one diagnosis can change: the movement to make dining safer

      Lianne Mandelbaum, PT | Conditions
    • Why this doctor hid her story for a decade

      Diane W. Shannon, MD, MPH | 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 1 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

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why physicians deserve more than an oxygen mask

      Jessie Mahoney, MD | Physician
    • Avarie’s story: Confronting the deadly gaps in food allergy education and emergency response [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

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

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

      Joshua Baker and James Jackson, PsyD | Conditions
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Avarie’s story: Confronting the deadly gaps in food allergy education and emergency response [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the physician shortage may be our last line of defense

      Yuri Aronov, MD | Physician
    • 5 years later: Doctors reveal the untold truths of COVID-19

      Arthur Lazarus, MD, MBA | Physician
    • The hidden cost of health care: burnout, disillusionment, and systemic betrayal

      Nivedita U. Jerath, MD | Physician
    • What one diagnosis can change: the movement to make dining safer

      Lianne Mandelbaum, PT | Conditions
    • Why this doctor hid her story for a decade

      Diane W. Shannon, MD, MPH | 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

The importance of listening to the patient before we develop our plans
1 comments

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

Loading Comments...