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Dr. Rice’s Clinical Medical Rule #1

Life medical events happen all the time and can leave us having to decide whether to tough it out or head to an urgent care center or hospital emergency department. When I get calls from family or friends or patients, I almost always fall back on what I call “clinical rule #1”. Allow me to explain, and this rule may help you make sound decisions on when to seek or not seek additional medical help.  

Rule #1 sounds like something Yogi Berra would say: If a patient is doing well, they’re likely doing well. This rule can help you think twice about running to an emergency room when you’re doing well but are worried about what might be happening.

My dad was diagnosed with lung cancer on June 24th years ago. When the family got together over the July 4th weekend, my sister was certain that he was going to die on her birthday and wanted him to go to the hospital. He looked good, was doing fine, and had no need for acute care. I invoked rule #1, and assured her that my dad would be OK for the day. And he was, although he died just a few weeks later.

A few weeks ago, my grandson ate a wild strawberry.  “What should we do?  Should he go to the ER in case something is wrong?”  He was doing fine then, and is still doing fine. BTW, little men regularly survive eating wild strawberries.

Medical Decisions

Medical Decisions

But Rule #1 is also valuable through its corollary:

If a patient is not doing well, there’s likely some underlying problem. Many medical misadventures follow from disregarding the obvious: the patient is not doing well. Call 911 if it is a medical emergency.

Not long ago, Sammie presented to more than one physician with abdominal pain that continued to worsen over time. With a white blood cell count below what was considered indicative of an infection and a slightly elevated temperature considered unimportant enough to be treated, a kind receptionist at the doctor’s office suggested Midol™ and learning to live with it. She suffered for weeks before a personal contact arranged a physician to look deeper into her case. Sammie is doing very well now that her appendix has been removed.

Just today I was speaking with a patient who is recovering from a painful urinary tract infection left untreated for weeks. Typically, urinary tract infections are diagnosed by the presence of nitrates in a urine sample.  Hers was different. Not all urinary tract infections produce nitrates, and she was left untreated until finally a specialist looked deeper into her problem.

It is unfortunate that our healthcare system is busy and many healthcare professionals are best at solving the obvious and easy medical problems.

We teach our doctors, nurses and pharmacists: treat the patient, not the numbers. But, often the time allotted for a patient visit can make it very difficult for primary care practitioners to look deeper into less typical or more puzzling medical problems. And, after all, the numbers are often good, or at least outside the threshold for immediate action.

It’s usually a matter of finding the right medical person to help. But that means keeping up the search for someone who can help. If only there were readily accessible physicians like the fictional television doc, the gruff, insensitive but knowledgeable Dr. Gregory House.

My clinical rule #1 about medical advice is, of course, NOT appropriate for long term health choices.

It’s important to see your doctor and get their recommendations for your medical situation; you need to watch your blood pressure, cholesterol, diet and observe appropriate nutrition and exercise recommendations. We have to take care of ourselves.

One of the great things about community pharmacists is that they are available almost all the time. As pharmacists, we frequently find ourselves looking at patients, or talking about symptoms, and recommending a course of action.

Most pharmacists have their own stories of recognizing life-threatening signs – like cellulitis or heart failure – and arranging or sending a patient for appropriate care.  Think of your community pharmacist as a health resource who is always there when needed.  Take good care of yourself.




About Dr. Peter J. Rice

Dr. Peter J. Rice is a professor of Pharmacology emeritus at the East Tennessee State University Quillen College of Medicine and Professor of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. --------------------------------------------------------------------------He received his BS in pharmacy from Northeastern University, PhD in pharmacology from the Ohio State University and PharmD from the University of Kentucky. He is a Board Certified Pharmacotherapy Specialist and practices in the ambulatory care and community pharmacy settings. Professor Rice is the author of Understanding Drug Action: An introduction to pharmacology (APhA, 2014) and is a fellow of the American Pharmacists Association. --------------------------He welcomes interesting medication questions and suggestions for future columns.