The Fourth Rule of Internal Medicine   (May 3, 2007)

Once upon a time, I heard the following five somewhat joking rules of internal medicine... which I've passed on to generations of medical students and house officers:

• If what you are doing is working, continue.
• If what you are doing is not working, change something.
• Change only one thing at a time.
• If you don't know what you're doing, don't do anything.

and

• Never send your patient to a surgeon!

But, on reflection, there's another rule that's probably should replace rule number four when caring for people with diabetes:

• If you don't know how to treat diabetes, ask for consultation from a specialist who deals with it all the time.

Over and over, I've found that some physicians would rather do nothing to help their patients with diabetes instead of consulting an expert. I've heard it repeatedly from patients and their families, and read about it in medical records. Why not refer? Is it insurance company rules? Ego? Afraid to admit that one can't keep up with advances in the field? Or perhaps simple ignorance that there are new ideas out there? Dunno.

 

But too many physicians really do think the original version of rule four is a good idea.