Our emergency department electronic charting system is now going to start listing as separate categories allergies and intolerances.  It makes sense, really.  How many times are we told ‘he’s allergic to Lortab…it makes him act all crazy!’  (Never mind that he might have been a wee bit crazy to begin with.)  ‘She can’t take Motrin, it makes her stomach hurt.’  ‘I can’t take steroids…I’m allergic to them and get swollen, hungry and irritable.’

A lot of allergies are little more than intolerances, it would appear.  Along with that, we might add a ‘preference list.’  ‘My doctor always gives me a Penicillin shot when I get a cold, and I always get better.’  ‘Taking that Percocet is like eatin’ Goody Powders…I need Oxycontin!’  These are the everyday conversations that occur in emergency departments every day, everywhere.  I’ve often thought that we need more of a menu in modern medicine.

‘Welcome to the emergency department!  Our nurse/hostess will seat you.  Would you like some crackers or ice-chips?  Oh, of course, you have abdominal pain.  Well, we have a lovely selection of narcotics today, and some excellent antibiotics.  Or would you just like to look at the X-ray menu first?  We have a special on abdominal CT scans.  So, what can I start the gentleman with?’

But beyond drug choices and menus, I’m intrigued by intolerances.  And the idea, while sound, got me thinking about what sorts of things modern Americans find intolerable.  It would be redundant to say we find intolerance intolerable, because we really don’t.  People all over America are intolerant of those things they find disagreeable or unpleasant.  They’re even very vocal about it.  Intolerance is acceptable, almost universally, if directed against Judaism or Christianity, capitalism, Southern ideas, Appalachian culture and social conservatives.  The list could go on, but we’ll stop there for now.

So we are, in fact, intolerant of many things.  But what sorts of items might end up adjacent the ‘allergies,’ and be found on the ‘intolerances’ of our future patient charts?

We’ll skip over the obvious drugs, and go straight to the other things.  How about honesty?  Many people, doctors and patients alike, really don’t like honesty.  It stings.  It bites into our contrived perceptions of self.  ‘You aren’t really sick, but I think you’re sad and lonely.’ That sort of honesty will get you a patient complaint.

How about sincere questions about life issues?  ‘Tell me what is happening at home.  I mean really.  Is someone hitting you or abusing you in any way?’  People who are victims are often intolerant of the probing questions that we might level at them.  Sometimes with good reason.

Morality?  If we were proper physicians, we would do more than enable our patients dysfunctional lives with medication to cover up the sores and marks, the diseases and misery.  We’d say ‘your lifestyle is killing you.’  We’d suggest:  ‘Maybe you should find one partner and get married!’  We’d opine:  ‘You should keep your daughter away from other teenage boys.  Don’t let her call them endlessly and please chaperone every interaction.  Oh, and have all your teenage children at home by 9 PM school-nights, 11 PM on weekends.  And nothing good happens after midnight, so stay the heck home!’

We could say ‘your drug use is ruining your life and your family, and costing society way too much.  Cut it out!  Use your potential!’  Do we care or not?  Maybe we need to overcome the intolerance of patients, and care-givers, toward moral rules and absolutes.

There are, of course, those intolerant of knowledge.  There are others intolerant of work.  Many are intolerant of paying for their care, even as they seem to tolerate car payments and cigarettes, cases of beer and cell-phone bills without any adverse reactions.

And there are plenty who are intolerant of anyone who makes money via that ridiculously outdated system called ‘hard work.’  ‘How dare you go to school, work and succeed!  You’re ripping everyone off!’  Into that category of intolerance we may place an enormous number of politicians, whose insight into culture and economics is remarkably superficial and self-serving.

So, here’s a list we might see on the theoretical chart:  ‘Intolerances:  Education, work, honesty, morality, sobriety, success, hope, effort, pride…and truth.  Please, don’t administer any truth.  It makes me break out in hives.  But I’ll take some Oxycontin, if you please!’

Have a great day!  And may God heal you of your own intolerances.

Edwin

H