Treat the patient, not the numbers

In Oriental Medicine and in Homeopathy, we would not run any laboratory tests before treating a patient.  Information was solely gathered by physical observation and the interview process.  So detailed and careful were those exams that they put Allopathic Medicine (“Modern Medicine”) to shame.  So, by the time I studied Allopathic Medicine in PA school (22 years ago), I was ready to learn that observing the patient in front of you is often more important than a measurement or lab test.

Below are a few classic examples:

High Blood Pressure

At my first job out of PA school in an ER, providers will still treating high blood pressure reflexively.  If a patient’s blood pressure was high, they popped a few pills into the patient to bring it down to “normal” quickly.  I had learned that such a practice was dangerous but it took me three months to get the ER staff to change their old habits.  If someone has had high blood pressure for a long time, they probably need that pressure to keep both their heart and brain perfused with blood.  We now know that lowering chronic hypertension abruptly can lead to ischemic disasters.

Low Oxygen Levels

Pulse Oximetry is a gentle finger clamp that uses a laser to measure how much oxygen is in your blood.  When these first came out, if someone had low oxygen levels, they reflexively supplemented their oxygen with an oxygen mask.   But ironically, if a pt has acute exacerbation of  Chronic Obstruction Pulmonary Disease (COPD) high levels of uncontrolled oxygen can result in respiratory failure!  For unlike healthy patients whose respiratory reflex is triggered by high CO2 levels, in these patients it is low O2 levels that trigger the response which you can blunt by supplying uncontrolled oxygen – thus ironically killing someone using oxygen.  This problem was later solved with special delivery systems.

High Temperature

The old school ideology was that body temperature needs to be brought down to normal range.  In Japan and China, a person with a fever is made to sweat more — their high temperature is raise further.  The body produces a fever to kill bacteria.  It is true that only some organism are killed or slowed down by high body temperatures and that the response is non-specific, but you should usually give fever a chance to work.  But in the ERs where I first worked, nurses would not give blankets to patients with fevers even if they had the chills in fear of raising their temperature.  And they would always give Tylenol or Motrin for any temperature over 100 deg C.  It took me 1 year to get that practice changed.  I had to print out article after research article and finally present them to the medical group.

Well, those are only a few examples to a principle which I will quote in an up-coming post.

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12 Comments

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12 responses to “Treat the patient, not the numbers

  1. Ed

    Sabio… I like this new direction. So-called “traditional medicine” is anything but traditional. It might be modern, but so what? It is much more like a cultish religion than otherwise. An example of this is when one tries to challenge the orthodox point of view on a health issue. You are treated like a Christian who just said something like, “Oh, Satan, abortion and homosexuality are not so bad”. The “medical believers want to help and re-educate you immediately. Otherwise you are ostracized. Look out!
    I had a large number of medical practitioners of all ranks and stripes as patients at my holistic clinic in Minneapolis. We did, chiropractic, Oriental Medicine including herbs and acupuncture, nutrition (not pills) and massage therapy. Among the many things that I worked hard to teach them or demonstrate to them were the following: Food can both cause diseases and it can also cure them… food matters; Fevers are good for you… they create an environment that is to hot for many bacteria and viruses which are temperature sensitive; antibiotics often create stronger bacteria and NEVER can kill a virus. (Viruses live inside the cell wall and are immune to antibiotics which kill bacteria that live in the interstitial space); antibiotics do not cure ear infections in infants and children (according to a large study done in the 1990’s and published by the American Academy of Pediatrics); women should and are made, to give birth in an upright position… putting them on their backs is for the convenience of the MD, as are various drugs to speed up or slow down the delivery… these drugs also have a money making side affect in that learning disabilities appear to be associated with (read “can be caused by”) changing the natural time of delivery; further, what do all you medical geniuses think causes “back labor”? Could it be laying the mother on her back so the baby, the abdominal contents and the placenta can press on the lumbo-sacral plexus of nerves??? … and my last of endless examples, medications suppress the symptoms creating both a false sense of improvement and new problems for which there will be money making drugs and money making surgical procedures.
    Now before some folks get too riled up, let me say, that my life has been saved twice by modern medicine’s emergency procedures. That is what they do well and are largely dangerous at most everything that is not critical. One of the reasons I retired early was my deep fatigue and discouragement at always having to fight the rigid orthodoxy of medicine. And their haughty arrogance just about gave me a reason to seek out a stomach pump… oh wait… I could just vomit naturally. Of course there is no money in that.

  2. Temaskian

    Interesting to know, since I have HBP.

  3. scote

    “The old school ideology was that body temperature needs to be brought down to normal range. In Japan and China, a person with a fever is made to sweat more — their high temperature is raise further. The body produces a fever to kill bacteria. It is true that only some organism are killed or slowed down by high body temperatures and that the response is non-specific, but you should usually give fever a chance to work. But in the ERs where I first worked, nurses would not give blankets to patients with fevers even if they had the chills in fear of raising their temperature. And they would always give Tylenol or Motrin for any temperature over 100 deg C. It took me 1 year to get that practice changed. I had to print out article after research article and finally present them to the medical group.”

    Hmm…you had to show article after article…showing the data on **populations**. Sounds to me like you **are** using the numbers. And that is a good thing, though I can’t speak to the anti-pyretics–not an issue I’ve brushed up on. Anecdotes aren’t good evidence. Good, peer reviewed studies are. But the converse is also true. You need to apply the studies to populations and not ignore them on an anecdotal basis. Fact is that while you can interface with patients on a 1:1, individual basis, you should be treating them by the numbers when it comes to implementing proven therapies.

  4. @ scote
    I hope you understood the point of my article. Well before there were “articles”, it was clear that lowering a temperature reflexively was not abnormal. The title of this post is a commonly used phrase in medicine — it is an aphorism to wake people up. You seem to be reacting and quibbling over the words, not the message.

  5. @ Ed :

    You may not like the way my posts on this issue will go. I will criticize much of alternative medicine. But we agree on much of our critiques of “orthodox” medicine and especially as people use it. In my world, nothing is sacred. Stay tuned, and please keep me honest.

  6. Ed

    Will do. There is as much BS in the so-called natural or holistic fields as anywhere… and I might add especially in chiropractic. Quite possibly the only consistently honest place to turn is a bowl of chicken soup. As Tom Robbins said in one of his books: “I believe in everything, nothing is sacred. I believe in nothing, everything is sacred.”

  7. Temaskian

    Good point about the fever. I’m not at all involved professionally in any medical work, but I always told my wife to let my children’s fever do it’s work. Let it kill all the viruses, I would tell her.

    I operate according to logic, not according to common practice. I’m quite a fundamentalist that way. My children seldom get sick these days.

  8. geoih

    Here’s a link about the history of homeopathy and allopathy (and other things) that you might find interesting: http://mises.org/daily/4276

  9. @ geoih
    Indeed, an excellent article — much of which I have long been aware. Love Mises ! Thanks.

  10. Love the Tom Robbins quote !! (I look forward to your feedback on the Alt Med articles.)

  11. “But in the ERs where I first worked, nurses would not give blankets to patients with fevers even if they had the chills in fear of raising their temperature.”

    Don’t even get me started!
    I’m an ER nurse and unless I see a fever greater than 101.5-102.0 F, I usually don’t get paranoid about it [unless of course clinical situation warrants it, pt. is in distress etc.] I’ve had SO many of my colleagues tell me that ‘it’s bad nursing practice’ to give a pt. with fever/chills a “blanket” (warm or otherwise!)

    My usual response is – what do you do when you feel sick/feverish at home? Tylenol/Motrin and bundled up in bed, yes?
    So how the hell is this any different?! Not to mention that rather than clothes at home, your typical patient is dressed in a flimsy, thin, open gown!

    Also, from my favorite nursing site:
    [QUOTE]I’ve been an emergency physician for 10 years and have never (including my work in peds ED) seen a negative outcome as a result of giving a febrile patient even a warm blanket. I peruse this site because I care about my nurses. One of our nurses actually got “written up” for giving a poor, shivering, febrile patient a blanket. This disciplinary action was born out of pure ignorance. As in the above post, fever from normal physiologic, host defense response cannot harm a patient even if the temp goes up a little from a blanket. Pathologic hyperthermia is TOTALLY DIFFERENT. This includes Neuroleptic Malignant syndrome (toxic drug effect, usually Haldol), Familial Malignant Hyperthermia (rare genetic effect with general anesthesia), environmental hyperthermia (heat exhaustion/ heat stroke) and tumor lysis syndrome. These patients may require active and passive (and sometimes chemical) cooling. All of these are rare conditions. Some patients my have had neurologic abnormalities from a febrile disease like meningitis or rheumatic fever but this is a result of the invading organism’s effect on the brain NOT the elevated temp. So, please, give a shivering patient a warm blanket. What’s next? We withold milk from a febrile kid because it might “sour their stomach?”[END QUOTE]
    Link: http://allnurses.com/emergency-nursing/fever-vs-warm-410248-page2.html#post4709966

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