WILTIMS #310: Sometimes, just ask

I actually did something productive! I was joking on Tuesday that my only helpful attribute was being male so that I could check the bathrooms for the missing veteran (who has since been found BTW). Well today, I finally did something useful in my capacity as a medical student. It was reported by the nursing staff in morning report that a normally compliant patient refused to take his medication last night. This came as a bit of a disappointment to the medical staff as we had had a very pleasant meeting with him the previous day about reducing that medication but in a safe, controlled way. As my supervising doctor was very busy this morning with some new admissions, I was given the task of interviewing the handful of his patients that I'm familiar with, one of the goals being to figure out why the patient had refused his meds. A common reason on a psych ward is a paranoid delusion that the meds are doing something other than what the doctors/nurses say they're doing.

The answer turned out to be very simple. I asked him why he refused the medication and he very reasonably explained that the nurses were giving the medication later at night than the patient was comfortable with. All it took was someone (like me!) to ask and for the doctor to schedule to medication at the evening dispensary time instead of the night one and we were good to go.

I know this is a tiny action and the mystery would definitely have been solved by someone else if I weren't there, but it still felt nice to be actively involved in improving a patient's care.

This case actually has another interesting point. The medication was at the center of our efforts to pin down what was ailing the patient. He had been on this med for years, but we are concerned that it may be treating a condition he doesn't have. So we began weaning down the dose to see if one of three things happens:

1. The patient gets worse, showing that the meds were doing something right
2. The patient gets better, showing that the side effects were severe
3. Nothing happens, showing that the medication wasn't doing anything and should be discontinued

TIL: Don't prescribe benzodiazepines to recovering opiate abusers as both drug classes depress respiratory function and if the patient falls off the wagon, they risk life threatening drug interactions.

Double depression is a term for when a patient with dysthymia (chronic atypical depression) develops a major depressive episode as well.