Who’s the doctor here?
Nursing home patient: *Has dementia, always complains of back pain, doesn’t remember to ask for her Tylenol that is ordered as-needed.*
Wayfaring: *Changes Tylenol order from as needed to scheduled twice a day.*
Patient’s family member: Dr. Wayfaring, why does she need Tylenol?
Wayfaring: Because she complains of back pain and looks like she hurts and she feels better when she takes it. But she doesn’t remember well enough to ask for it when she needs it.
Family member: Is she really in pain?
Wayfaring: Well, every time I see her she tells me her back hurts. She walks very stiffly with her hand on her back. So yes, I’d say she’s probably in pain.
Family member: Are you checking her liver? Did you even know that Tylenol hurts the liver? What are her liver functions?
Wayfaring: Yes ma’am, I am aware that Tylenol can potentially cause liver damage. We are checking her liver enzymes periodically and they are normal. And the amount of Tylenol she is prescribed is well below the maximum daily dose.
Family member: Well why can’t she have ibuprofen instead? Or mobic? That’s what I take and it’s better.
Wayfaring: Because she has chronic kidney disease and a stomach ulcer and those medicines will make both of those conditions worse. And the Tylenol seems to be working for her.
Family member: Does she really need pain medicine at all? I think you should just stop the medicine.
Wayfaring: You know, generally families are happy when their loved ones aren’t in pain. So I tell you what… why don’t you come visit her sometime (thinking: since you never do) and ask her how she feels? I’d be happy to do whatever she wants.