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

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

  • Why medicine must stop worshipping burnout and start valuing humanity

    Sarah White, APRN
  • Why perinatal mental health is the top cause of maternal death in the U.S.

    Sheila Noon
  • A world without vaccines: What history teaches us about public health

    Drew Remignanti, MD, MPH
  • Unraveling the mystery behind one of the most dangerous pregnancy complications: preeclampsia

    Thomas McElrath, MD, PhD and Kara Rood, MD
  • How community paramedicine impacts Indigenous elders

    Noah Weinberg
  • Pain is more than physical: the story your body is trying to tell

    Katie Hatt, DO
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

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

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

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...