Pinky

Not to make this all about work, but. . .

Put simply, I'm sort of trying to figure out if there is anything doctors can do that prevents teenagers from using lottsa drugs. It would make a huge dent in the following things: car accidents, violence, and pre-newborn exposures. I read a nice little journal article about a really gentle and possibly effective interview technique. I researched this interviewing technique. I went to very optional lectures. I read more articles, and then I presented it at a grand rounds of sorts.

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The thing is, it's not proven to be that effective. And the research gets pretty complicated and kind of difficult to interpret. Post-presentation, the neonatologist and I chatted and agreed that it would be most hopeful (helpful) if teenagers regularly saw their doctors. Which hardly ever happens. We (along with the nephrologist, who makes me smile in his strong opinions) sort of sighed collectively and shrugged our shoulders, and I allowed my mind to wander to the idea that primary care doctors probably aren't the ones that have that kind of power. Or. That there needs to be research with a completely different approach. Shrug. Oh well. It was an interesting mental exercise?

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Three days later, an "expert" in the field gave a lecture on the subject (whoa timing). He discussed an interview technique that I know (now, after having read about it a lot the week prior in preparation for my own presentation) has been pretty much proven to cause people to rebel/do exactly the opposite of what a physician recommends. One tiny part of it involves making eye contact "to the point where you are both uncomfortable."
I was still in my helpless there's-nothing-we-can-do state of mind, so thought that maybe it was worth a try. Maybe those dang papers and studies don't mean as much as someone with experience speaking on the subject.

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That afternoon, two hours after hearing that lecture (huh timing), in the midst of a busy clinic filled with new babies and skin infections, and runny noses, I saw one of my 15-year-old patients. I have a reputation for sort of collecting difficult families and patients. I have no idea why. My attending refers to me as "the black cloud of clinic" because if one of my kids has diarrhea, they won't just have diarrhea. They'll also have an obscure genetic disorder or a bizarre social situation requiring police involvement. Etc. Anyway, so this 15-year-old is one of a very few patients I've seen a lot of in the past few months. She keeps coming back. And, as predicted, it wasn't just for a "follow up." It was to relate an epic tale that involved many more details than anyone needs to read. But it did involve the use of an illegal substance. Mostly we chatted, but I also tried the techniques I had read about. Maybe we made progress? For a second, I gave the uncomfortable eye contact a try, in an attempt to "get through to her." It immediately felt ridiculous and it seemed I might lose her, so I abandoned that tactic quickly. The funny thing was, after all the gently-directed chatting and the clarifying (misconceptions are horrifying), the end result (as opposed to an open-ended conclusion where she will magically go home and never do drugs or drink again) was her spontaneously offering up her hand, little finger extended, "I won't do it again. Pinky swear."

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Maybe it doesn't need to be so complicated?
Let's research the pinky swear.

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edit. no joke. as i was typing this up, i received a new e-mail. the subject line and the enclosed link: http://www.abc.net.au/health/thepulse/stories/2010/11/04/3057269.htm