Answering Patients' Questions
Lately it seems a rash (no pun intended) of patients have
asked me how it was that they contracted their Staph infections. Some had MRSA,
others MSSA. Some suffered from bacteremia, others osteomyelitis, and others
still were challenged by skin/soft tissue infections in the form of painful and
unsightly abscesses. Some had recently undergone surgical procedures, some have
a history of IV drug use, and others had not set foot in a medical facility in
years - which is to say, they didn't have any recent, relevant past medical
history that correlated well with their current diagnoses.
Where to begin? Or better yet, how to answer an unanswerable
question? With the exception of the IV drug user, it is impossible to say with
100% certainty where and how patients contracted their infections. This is both
a tough pill to swallow and dispense.
In the event that they have recently undergone a surgical
procedure, likely the infection is the consequence of that procedure, or it was
most certainly conducive to its presence. When I inform the patient of this
reality it is as if they have never, ever heard of any risks associated with
surgery. The follow-up question almost always goes something like this:
"So I got this
infection in the O.R.?"
To which I must answer, "I have no idea, and likely we will
never know, but infections are definitely a risk associated with surgery."
"So if I never had
surgery then I wouldn't have this infection?"
"Again, we will never know, but any time there is a
perturbation of the skin, like when a scalpel makes an incision, you run the
risk of introducing bacteria that exists on top of the skin inside the body and
this can cause various types of infection."
Trying to explain the phenomenon of colonization is cause
for even greater consternation. Thank goodness for the CDC. I often solicit the
website's patient information; why reinvent the wheel?
But moving forward, I do
find that one common denominator and subsequent risk factor for infections is
uncontrolled diabetes mellitus. This commonality is something that makes my
inner primary/preventative care provider's heart beat faster. I eagerly
champion this detail because it provides the patient with some kind of concrete
information and affords me the opportunity to engage in some good old fashioned
While I never say that any infection is the direct
consequence of a patient's diabetes, I refuse to overlook its contributions.
Ultimately, if delivered kindly and intelligibly, this connect the dot exercise
is empowering and illustrative. An NP should never pass up the opportunity to
practice health promotion; it's what makes us great.