Bathroom Surgery

What follows is a story from what I observed in clinic as a student. A Spanish speaking, uninsured patient came into the clinic with an ingrown toenail. Not terribly exotic, as far as podiatry goes. However, he complicated the matter by attempting to trim away the growth—what the attending podiatrist referred to as "bathroom surgery." She then verbally expressed frustration to the three students in the room, in front of the patient, since the patient's work actually made the procedure more laborious.

I think there are two insights to be gleaned from this.

The first is for patients. Quite simply, leave the surgery to the doctors. Don't try to fix something on your own, because you might make it worse.

The second insight is for the doctors and is a bit more nuanced. When is it appropriate to criticize patients? Would you exploit a language barrier to say things you wouldn't say in front of an English speaking patient? Is it unreasonable for doctors to expect patients to avoid attempting to solve their own medical problems? We self-treat for colds and headaches. Maybe this patient believes (incorrectly) an ingrown toenail is in the same category.

Also, economic considerations will make an uninsured patient more likely to take matters into his own hands. The patient reasons that he can either self-treat or pay for the office visit. If self-treating works, the patient saves money, but if self-treating doesn't work, the patient might not bear any additional costs other than what he would have paid by seeing the doctor from the beginning. So, from the patient's perspective, why not give it a try?

Lastly, the patient simply could be nervous about going to the clinic and wants to avoid going as much as possible.

The intent of this post is not to criticize one doctor. Perhaps she is a phenomenal doctor who was having a bad day. In medical school, we are taught to have empathy for patients, but putting that lesson into practice is clearly difficult. The real lesson is that, while we are talking about the tiniest of ethics violations (if you even consider it a violation), we nevertheless hold ourselves to higher standards as health care professionals. That means having understanding for patients who do things that we discourage, like performing bathroom surgery.