If you had asked me what cats can teach me about healthcare a year ago, I would have answered, probably nothing. Well, live and learn. My daughter's cat has just taught me a couple major lessons about healthcare. Who would have thought cat-sitting could lead to valuable knowledge about how doctors prescribe drugs?
Here's Jack:
Jack is a good cat. He knows how to relax, and is definitely not anxious about things:
Jack is a rescue cat. Something bad involving men wearing boots must have happened to him in his early days, because he gets really scared and is desperate to get away from any man wearing boots.
Jack sets up the learning environment
A few weeks ago we were cat-sitting him. He had been outside for too long; workers came onto our property to work on an extended project. It was getting dark. Jack wasn't responding to the usual "come home" inducements. I spotted him hunched down in a hiding spot intensely watching the workers. I went to him. He was too scared to follow me home, since that would bring him out of his hiding place and closer to the scary men. So I picked him up. He got really scared. He scratched and bit my hand pretty well. I managed to hold onto him and get him into the house. Now that he was safe, he was OK, and I just had to treat my badly hurt and bleeding hand, which I did with a thorough wash and bandaging.
First Lesson: Doctors, prescribing and protocols
By the next day my hand had swollen up pretty badly. I got an appointment with my primary care doctor. I provided all the details. She put in an order for antibiotics in case the swelling and redness continued. It did, and I filled the order. I took it as directed, and after 5 days there was still lots of pain and swelling. So she gave me a different kind of antibiotic, which was supposed to cover the kinds of things the first one doesn't.
After a couple days, things weren't improving by much. Here's my hand at that point -- notice the lack of knuckles showing how swollen it still was:
My daughter, who's an MD, had been following the events and asked to see my medications. She then sent me information that made it clear that my doctor had given me the wrong antibiotic! Just as bad, the doctor had advised a wait and see approach, while the literature clearly shows that the right approach is to give the drug right away. I gave this information to my doctor; the only appropriate reaction would have been embarrassment and apology, and that is not what happened.
Finally, I wondered what if you didn't have an amazing daughter who happened to be an MD with access to the literature? This makes it even worse for my doctor: Dr. Google came up with the right answer -- the answer to the question MY doctor got wrong. And wouldn't admit it.
I've had an incurable form of cancer. As my cancer doctor said, I've won the lottery, and I'm OK for now. That was hard. The cat bite was easy. There's no excuse for failing to learn the right approach if you don't already know it and following the approved protocol. My trust in doctors other than my daughter for doing simple things is now below zero.
Details of the first lesson
The points been made. If you are skeptical or want details, here we go:
First prescription:
Second prescription:
The article on UptoDate (a resource used by doctors to make sure they're up to date) recommending Augmentum (commercial name of a combination of amoxicillin and calvulanate):
The part of the article on prophylaxis:
I gave the information to my doctor. Here is the key part of her response:
In other words, she decided to violate the authoritative protocol because of "anecdotes." Not because there's an emerging body of evidence-based thought. Anecdotes.
Here's what I should have done before accepting her treatment. I should have asked Dr. Google. Here's the question:
The first result is Google's attempt at giving the answer:
Prophylactic Augmentin. How about that? But the article's 10 years old. Let's check the first "regular" result:
Same thing. Respectable source. But undated. Check the next result:
Just two years old, in a real medical journal, same advice. We're done here.
Conclusion
Too many doctors just do the wrong thing. Even when they know it's the wrong thing, they do it anyway! Doctors increasingly complain about having everyone second-guess them and look over their shoulders. Well, guess what: when you screw up, you deserve that and more.
I've long since preferred to get my cash from an ATM rather than a teller. I'm now at the point where, for anything that's at all routine, I will strong prefer an automated medical knowledge agent to a doctor who can't be bothered to do the right thing. Until that's available, I will just have to endure doctors not liking me because I check each and every thing they do to make sure it's the right thing.
The best thing is -- Jack the cat wasn't done! I'll tell the next important thing he taught me in a post soon to come.