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Tough Love: When Should Physicians Use This Strategy?

Have you ever stopped bothering to care about a patient?  A doctor sent me his own personal account of the smoking Mr Jones:

Dear Happy.  I read your article on bounce backs with great interest, and was astonished by some of the vitriol it elicited.  I remember having one COPDer bounce back to me three times within a month at the VA when I was a medicine resident.  He would leave, smoke and drink, and then come back and be readmitted to my service with exactly the same course each time.  It was like Groundhog Day.

Finally I had a little talk with him and said: “Mr. Jones, each time you come in, you’re on death’s door.  So I come down to the ER, stay up with you all night and save your life.  But you know, I’m really getting tired of having you come in after drinking and smoking and then working like a dog to save your life.  So let me tell you, if you don’t quit smoking, the next time you do this there’s a good chance that I’m not going to bother.  Why should I?  It doesn’t seem to be doing either of us any good.”

To my complete astonishment, he actually quit smoking and stayed quit for about a year.  Then he fell off the wagon, deteriorated too far before getting to the hospital and died.  I was frankly proud of him for the effort, but somehow suspect that I’d be shot in a drive-by if I ever told that story in public. Read more »

*This blog post was originally published at The Happy Hospitalist Blog*

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