When I first stepped foot into the hallowed halls
Of the school teaching me medicine, they quickly said to us Day One
From now until you’re licensed,
you can never ever say
“You should drink some water”
Or “get more sleep” off hand
Because –did you know– that’s medical advice now, as you’re a medical student and
YOUR WORDS CARRY WEIGHT
You have power and knowledge but you also have responsibility
Because you’re Practicing Medicine
Is that person your patient?
Have they consented to your care and do they know what it entails? Do they know what you do? Do they know why they’re there with you? Do they want your advice? Do they feel they can say no?
Have you taken a good history?
And done physical exams and labs?
For example, how are their kidneys? And what about their heart?
If they were to drink water, would it cause their organs to fail?
Or what if they have an eating disorder
And they drink it to feel full?
Have you just added to their malnourishment to the point that their heart stops?
And why do they not drink water? Why would they need you to recommend it?
Are they taking a medicine that makes them dry, that makes them thirsty but not quenched? How about one where they forget to drink? Or one that pees it out?
And do they have access to clean water? Can they get enough to drink?
What if soda is really safer because of toxic lead and benzene?
What is your medical assessment of why they need more water?
Is it chapped lips that you’re treating? Or heat stroke from exposure instead?
And when you give that treatment plan of drinking extra water
What is your follow up? What will the effects be?
Give a good PARQ conference:
Plan, Alternatives, Risks, Questions answered
For example, is tea good too? Should they be starting with IV fluids, or can chewing ice suffice?
When will they feel the difference? How much water is too much?
What are the risks of drinking water? What are the risks of not?
And if drinking water doesn’t help, what’s your plan for what comes next?
What differential diagnoses would cause this thirst to be?
Will drinking that water just disguise a deeper wrong that’s underneath?
What have you missed by saying that? What care are you delaying?
Do they need to see a specialist? Do they need some social work?
Do they need an act of Congress, to make sure the water is there?
From now until you’re licensed, and even after that, you can’t tell a person to just drink water
Or get sleep
Or try that OTC drug
Because you are Practicing Medicine and there are steps required
Unless they’re fat
Then you don’t have to practice medicine
You tell them to go away and lose weight.