Prescribe your patients a healthy dose of common sense

I don't claim to have the most abundant common sense.  I've been known to make problems much more complex than they need to be and spend lots of time puzzling about questions that a clever child could solve in an instant. Just the other day I spent about 15 minutes struggling with the tricky front door lock at my house before checking to see if the back door was open. (It was.) So I wasn't surprised to read in this morning's New York Times about an apparently widespread clinical problem resulting from a common sense deficiency – accidentally sharing topical hormone therapies with children and pets.

Veterinarians and pediatricians have witnessed a spate of hormonally charged kids and animals ever since transdermal estrogen creams became popular. These preparations are widely thought to carry less cardiac risk than systemic products, and are often used as first-line therapy for menopausal symptoms. So what's the moral of this story?

Don't neglect seemingly common sense aspects of patient counseling.  Tell your patients that use creams – be it hormonal, steroidal, analgesic, or otherwise – not to let anyone lick their skin.  Remind adolescent patients to wear seatbelts in the car, and helmets on a bike.  Counsel patients about dark curtains and other seemingly obvious ways to promote healthy sleep.

My patients often express surprise at the most mundane gynecological advice, as if no one ever mentioned that it's a bad idea to wash inside the vagina with antibacterial soap, or to borrow a roommate's dirty razor. Save your patients time and money by restating the obvious. The things some of us miss might surprise you.

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