The “Sign” … Patient’s reclaiming ownership of their health 🙂
First of all, I want to thank Dr. Bedi for his time and effort in sharing his perspective- and it is his insight suggested below that brings me to the point of this note…
I find it amazingly refreshing to witness a merging of cultural positions when it comes to medicine. I think we all realize that the patient themselves- are the true mediator for good or bad outcomes (assuming that clinical competence is the Konstant). It is their spirit and soul- their intimate knowledge of their own bodies, and their self awareness/desire to live that that draws the line for delineation of success or failure.
Here in America, we acknowledge pieces of the information that patients render us, but at times have become slaves to the engineering we ourselves developed in terms of relying on algorithms as opposed to gut feelings or unstated clues in terms of how we assess our patient’s health status. It becomes a numbers game, and with the advent of EMR’s (Electronic Medical Records)- we blindly follow the course dictated by the very first entry- which for example was the other day- when the record stated that the patient weighed 215 Kg, had a BMI of 86, and was 167 cm tall.
No one questioned it, as it was a number put in upon first admission to the ER. (Well I questioned it- because it was the difference between putting an ordinary sized man on bypass versus Godzilla!). The point being- we ignored the primary rule- I looked at a computer screen, and never looked at the patient.
We tend to focus on avoiding mishap and potential death, and arm ourselves with an arsenal of pertinent physiologic and anatomical details regarding the patient’s history. At the same time, the most obvious historians in front of us are the patient’s themselves. To miss the clues in front of you- can lead to poor outcomes that may have been avoidable.
Case in point:
The LipStick Sign: – RECOVERING from CPB
The ‘lipstick sign’ – When patients are very ill, or in significant pain, one of their last priorities is their appearance. When they begin to feel better, their appearance becomes important again. Within the medical profession, this phenomenon is known as the “positive lipstick sign.” A charming patient from Lucknow (an old style town of India) – had come with a bit of a problematic heart condition – did well after an emergency on pump bypass surgery with IABP . She was in a bit of a bother for the first few post op days – but then rapidly recovered – and now wants to look good – a sure sign that she can be discharged !!! Surprisingly all my residents were unaware of this very important pointer to patient well being – so posting this so that other youngsters can know about this useful sign . In fact I have renamed it the ‘lipstick and nail polish sign’ for obvious reasons (see pic).
The application of lipstick is not vanity – it is the re-gaining of dignity !. In hospital all patients do get a bit dehumanized to some extent – (try wearing a hospital ICU gown for 5 minutes and see how it changes you !!!). For some care givers the patient becomes a case number or bed number or the patient with the really bad lesion !!! (never , never say this in front of the patient – they listen to every word we utter on rounds !) . I emphasize on my doctors and nurses the importance of referring to each patient by name.
I value the lipstick sign as much as the vital signs (pulse , blood pressure etc ).
For male patients – a similar sign would be a freshly shaved face !
In Sikh patients it is the tying of a turban before the doctors rounds..
Dr.Harinder Singh Bedi
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