Doctor House was right. Everybody lies. Well, almost everybody.
She was a poorly controlled asthmatic. Perfectly controlled asthmatics can often make do with one inhaler a year. She consistently used 200 puffs a month. She was not doing well.
I had quizzed her on her need for inhalers at multiple previous visits. Over and over that she was doing everything I had asked her to do. She had gotten rid of her cat and avoided triggers. She was taking her medications exactly as prescribed. Her recurrent asthma attacks were a mystery it took me months to solve out. In the end the answer was simple- She was lying to me.
Her secret was revealed to me as I drove the mile from my office to visit my grandmother in her assisted living facility. As I waited at a light I saw my patient standing on the corner waiting to cross the street. In her right hand was the smoking gun, a smoking cigarette.
I drove through the intersection and pulled over, waiting for her to cross the intersection to where I was. As she approached I got out of my car. She did not look happy to see me. “You are so busted!” was my less than tactful greeting.
She was visibly embarrassed. She lowered the cigarette, trying to hide it from my view behind her leg. “This is my first cigarette,” she proclaimed, “I have been under a lot of stress lately!”
“So throw it away then,” I replied. She did, apologizing profusely and telling me that she was not going to smoke anymore.
She was lying again.
I found out two days later when my nurse saw her at another intersection, again with a cigarette again in her hand. At her next visit I was finally able to address the real reason for her asthma problems. Sine then, her need for inhalers has decreased dramatically.
Her story reminds me of a basic truth in medicine. Doctors are only as good as the information we get from our patients. Patients who lie get poor care.
Bart
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