Take A Second Look

I watch the TV show House only occasionally. I happened to catch it this week and the episode that aired got me to thinking about my own clinical practice.

The story revolved around this 40-something male, polysubstance abuser who collapsed in a coughing fit, in an alley, and was brought to the hospital. Further workup revealed all sorts of vague symptoms on this guy (bleeding, respiratory distress, blood clots in his fingers). The doctors attending to him were in a race to see who could come up with the correct diagnosis.

One of the doctors kept arriving at drug-related diagnoses, i.e. diseases or symptoms explained by sharing needles, using inhalants, etc. In a heated moment, another colleague confronted her about her stereotyping this guy and assuming all his problems were drug-related. She could not see past his substance abuse to the larger picture. Her colleague said it best when she finally yells, "He has an addiction!"

This same doctor, the one who favored drug-related diagnoses, tries to have a heart-to-heart with her patient at the end, as he's dying.

(paraphrased)

"You've used so many drugs and drank so heavily for so many years. Don't you have any regrets?"
"I've used a lot of drugs and drank a lot. Everything else, I regret."

We see a lot of polysubstance abusers and legitimate drug-related diagnoses in the ICU. In my own practice and conversations with my patients, it would behoove me to remind myself that substance abuse does not the individual make. That every ailment or social problem cannot be attributed to their drug use. That they have an addiction, not a character flaw. That they may not even regret their drug use. It would behoove me to step back and take a second look.