Monday, April 8, 2013


Mrs. Adenoca: "I want you to know, right now, that I won't take any medications. I don't believe in your pills. I'm an intelligent woman, and I do a lot of research on my own. Every drug you use has the potential to cause cancer, and I know you doctors lie and say they don't. I'm smarter than that, and refuse to take anything that could do that to me."

Dr. Grumpy: "Didn't you tell me earlier that you smoke?"

Mrs. Adenoca: "Yes, 2 packs a day."

Dr. Grumpy: "And you don't think that causes cancer?"

Mrs. Adenoca: "You guys lie about that, too."


Jaxxy said...

She's onto you!

Mal said...

So she's here for medical advice she won't believe, and treatment she won't follow. And she thinks you're a cancer-dispensing compulsive liar.

So wait, why's she here again?

Anonymous said...

Why did she waste her and your time by making and keeping an appointment ?

I know someone like that though. Won't take or believe anything the Dr says but any idiot in a bar,grocery store,bank, etc is believed.

Anonymous said...

Clever patient name.

Abigail Cashelle said...


And yet she's willing to pay for a consult!

Moose said...

So, technically, she's right.

If tobacco caused cancer, every single smoker would always get cancer.

It doesn't work that way.

The nitpicky truth is that tobacco increases the likelihood of developing cancer in those who have the susceptibility to get it. Not everyone has that susceptibility, and not everyone who does will develop cancer.

The weirdest is lung cancer. About 15% of the cases are in people who have never smoked. And that's primary lung cancer, not "it spread to your lungs" cancer.

The truth is that cigarettes are more likely to cause other things which (arguably) may be even worse than cancer. Cancer can often be cured. Cigarettes can cause, at minimum: COPD, emphysema, and other breathing disorders; vascular changes which lead to blood pressure changes and increased risks of clotting; possible changes in cholesterol.

The blood vessel damage alone is probably the biggest mess of all.

These are why cigarette smokers are more likely to have strokes and heart attacks, and why diabetic smokers are far more likely than diabetic non-smokers to lose a limb due to diabetes complications.

And before someone insists I'm "defending" smoking -- I've never smoked a day in my life, never wanted to, and think it's a vile and disgusting habit.

Packer said...

Adding yet another ill to the list of smoking ills. Smoking makes you stupid.

The easiest way to get people to quit smoking is to say " I used to smoke, then someone mentioned how much they hated the way I smelled, I never knew how bad it was until I quit"

Whelk Lad! said...

"I first became aware of this about ten years ago, the summer my oldest boy, Bill Jr., died..."

Anonymous said...

Another banging-your-head-against-the-wall patient. We used to see them in the ER all the time.
"What brings you in today, Mr. Smartass?"
"A car."
"Ok, cute. What is bothering you today that made you come to the ER?"
"You're the doctor/nurse. You tell me. That's why I'm here."
"What are your symptoms? Are you having pain?"
"You people are all alike. You can never get a straight answer. You don't know anything. Get me someone who does, or I'm getting out of here."
(This usually goes on longer than repeated here, but it is too frustrating to recall, much less write.) Tricia

BobF said...

So, just hypothetically mind you, what DO you do when a patient tells you up front they won't take ANY medication?

I realize not every complaint results in medicaton, but the odds sure seem heavily in the direction that eventually one arrives at that point in the road.

Anonymous said...

You should have told the patient that she is way too smart for you, and that she needs to find herself another (smarter) doctor.

Moose said...


Swear to God!

Anonymous said...

First clue...patient tells you that they've done their the Good Housekeeping magazine and the Letter to the Editor in their local newspaper.

I dunno 'bout you, but some statistics was a prerequisite to the semester-long class on Drug Information and how to assess those 'drug studies'. Doubt this woman really has any idea... .

Some people think that if something is said often enough in their hearing there must be a kernel of truth in it somewhere i.e. rote-learning; did the quick brown fox jump over the lazy dog, or what?

Mrs. Widget said...

I must agree with "moose". Though I am a layman, I teach science and I have an issue with "cause". Though I have a sister who died of cancer that I know smoking contributed to her death.
I imagine that as a physician, you would give anything to walk through a group of people and completely remove cigarettes from their lives.

Ivan Ilyich said...

This quibbling about "cause" is, indeed, nit-picking. Dr. G. Was just having a brief, informal conversation with the Pt. In such a context, it is not unreasonable or misleading to say "A causes B" instead of "A significantly increases your risk of B." In the case of smoking and cancer, the link is so strong that I don't see anything wrong with the characterization, even though the correlation is less than perfect.

jen said...


C said...


/movingon *send in the Diet Coke*

Moose said...

Actually, "quibbling about cause" is actually simply exposing the fact that most people do not actually understand how science works, and the basics of logical arguments.

I know Dr G posts things because they sound funny, but often these same things reinforce this ignorance.

Correlations are not Causation. When there is a "link" between something that is a simple correlation. Science demands proof of an actual cause, not a wild guess because A and B appear at the same time.

Here's a classic example of a correlation:

Bob travels a lot for work, mostly to ten different cities. In each city he stays in a hotel from the same chain. During each stay, his hotel room always has a blue carpet.

What conclusion can be drawn from this?

The answer is: Nothing.

You can (and some do) argue that you can conclude that that hotel chain uses blue carpet everywhere.

But without seeing that a majority of the hotel chain's rooms use blue carpet, or seeing a statement from the hotel that says "We only use blue carpet in our hotel rooms", you're just making a correlation.

A guess.

Yes, there is valid proof that the majority of people who develop certain cancers are or were smokers.

But A->B does not imply or define B->A. If smoking "caused" cancer, then everyone who smoked would get cancer 100% of the time.

Yet, they don't. Because neither logic nor science works that way.

Lesson over. Tomorrow, we'll watch a film strip on the history of wheat.

Anonymous said...

@ Moose,

Smoking causes mutations in the DNA of lung cells. Some of these mutations are harmless, some of these lead to cancer. The more you smoke the more likely you are to get a mutation that leads to cancer. If you are a smoker and you get lung cancer, odds are that smoking caused your cancer. Your argument is that some people who play Russian roulette, pulled the trigger and didn't get their brains blown out; so therefore pulling the trigger doesn't cause your brains to be blown out. Sure is requires a bullet in the chamber, but if you don't pull the trigger, you don't die, so I would say pulling the trigger causes death.

Aeris said...

So I finally got the "Adenoca". It took me a while. I had to sound it out. But her first name would be Arcenoma?

Vicki said...

Moose, try teaching that in college freshman composition classes! Sometimes I used to see the craziest logical fallacies by my students when I well enough to work.

The example I use among students about cause and effect fallacies is related to my own disability, migraines. I'd ask what causes someone to get a migraine, and inevitably one of the very first answers would be chocolate. Then I'd show them an article where researchers got migraineurs who claimed to have that cause and made them eat chocolate at specific times. There was no greater incidence of migraine then.

They now believe that the correlation people see between chocolate and migraine is that the prodrome phase of the migraine, before either an aura or the pain hits, includes sugar cravings. What is most Americans' favorite source of sugar? Chocolate! So, you could even possibly say that not only did the chocolate not cause the migraine, but the migraine caused the people to eat chocolate!

How's that for post hoc, ergo propter hoc?

peace said...

I'll make sure I'll use that. But I'll add a friend told me. Thank you

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