When I was a child, we were taught about the five senses, but today young people are taught about additional special senses. Why is this important to NPs and PAs? When a patient presents with a constellation of signs and symptoms, it is expedient to understand the world that they live in. Without this valuable information, how can we determine a final diagnosis? Sight, hearing, smell, taste, touch, balance and interoception. The brain is the collection area and interprets information by previous experiences and a combination of all information from all of the senses. Senses assist the brain interpret our world and our own bodies. This complex data is transmitted by our eyes, ears, nose, tongue and skin.
My mother-in-law was a Nurse Educator as well as a Director of Nursing. She gave a simple lecture to all the new hires in a group on this subject. She placed Vaseline on a pair of glasses and gave them to one new person, next she gave a pair of shooting ear protectors to another, a pair of Alaskan mittens to yet another, cotton balls to yet one more and a winter coat to the last.
The person with the ear protectors now sat in the back of the room, the person with the eyeglasses sat 20 feet from a Snellen Vision Chart, a vial of ammonia to the one with the cotton balls who had to stuff her nose with them, while the person with the coat had to sense a touch to his arm. By speaking in a normal tone and amplitude, the person in the back was unable to hear her voice. The person 20 feet from the vision chart could not read even the first letter. The woman with the vial of ammonia and cotton in her nostrils could not smell the substance nor could she taste a variety of foods with her eyes covered. Light touch was imperceivable with the person wearing a coat. The person with the mittens was unable to pick up pills needed for daily use. This illustrated in a memorable manner that people with impairment cannot adjust to this world without some assistance. It also illustrated many people in the geriatric age group who suffer from cataracts, poor hearing, lack of dexterity, poor temperature sensation and loss of smell or taste such as those who are unfortunate and have long Covid. If I can remember this story from almost fifty years ago, it also made an impression on this young PA.
This short and simple study heightened the understanding of the patient/provider experience and emphasized that many of our patient’s signs and symptoms are directly related to their disabilities. But are we aware of these disabilities and do we have an action plan? Some will need to see an ophthalmologist or optometrist and get prescription glasses or a cataract operation. Others may need to see a neurologist for their problems relating to sensation. A fair number of patients will need to go to an ENT and have their ears examined to discover whether or not this is from wax in their ears which is simply remediated to need to see the audiologist for hearing aids. The otolaryngologist can also be the person who treats the problems relating to smell or taste and then if they have unsteadiness, creating falls and injuries they can perform balance exams and send them to physical therapy.
As a provider of healthcare, we too may have many of these problems. I had two cataract operations with an IOL and now have perfect vision. As I grew older, I began to feel increasingly isolated in social settings due to my hearing loss. When I lectured, I responded to questions while walking the floor rather than hiding behind a podium. I recently returned from Rome and Florence and was unable to smell or taste most of my food because of long Covid. This was devastating to me. My balance was also affected and while in Rome, I stepped from a balcony and missed a small step causing a fracture of my 4th and 5th metatarsal. We had to leave Florence and a fully paid villa, three days early. In addition, we had to change all our travel arrangements, which cost an additional six thousand dollars of which my insurance only paid $2,400.00. I did get to experience the Italian health care system which was only a bill for $340.00 with x-rays and a boot, plus an exam and check-up by an orthopedist. Yes, we have a fractured healthcare system that is far more expensive than in Europe. That will be a future article.
The last sense that I want to discuss is for you, the PA or NP, it is called common sense. I don’t care about which specialty or sub-specialty you are engaged in; you are a moving target and a slow-moving target at that. You are not a seer or mind reader and therefore do not know what your patient may have concealed from you. You do not know if they co-operated with your treatment plan or took their medicine as prescribed. We have learned that t.i.d. or q.i.d. medications are often forgotten and therefore they are receiving a sub-therapeutic dose. Patients sometimes adjust their own medications causing overdoses, accidents in the home and while driving, particularly patients on antihistamines which can be as dangerous as alcohol or street drugs. We do not know if our patients are taking their own drugs in addition to those, we prescribe which can cause a catastrophe. WE believe our SP’s when they say we are covered for malpractice and never look at the policy or check on it from year to year. We discover through our own misinterpretation of malpractice insurance that it does not cover you for any Lone Ranger activities that were not seen in your office or hospital. I can only say one thing, common sense dictates your effort in securing a personal liability policy and one that is comprehensive and does not require tail insurance. This is known as occurrence policies. The best companies are those with the highest ratings who are consistently solvent. I sincerely hope that you have engaged your senses in reading this article. Ciao for now.
Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor
