Black Stools. Danger?
Loretta told her doctor her stools were black and the doctor said it was probably caused by internal bleeding and that she needed more tests, immediately. Loretta was visibly upset and anxious when she relayed her story to me.
There are some foods (red from beets) and medicines (green from Mmdroxyprogesterone) that can color stools. Color changes are common and usually harmless. Loretta said she hadn’t added any different foods but that she had been using an antacid for her heartburn. Too much of the white antacids (Maalox is one of them) can cause grey coloring or white speckling, but certainly not black.
There is one popular non-prescription product that’s known to darken stools. Pepto Bismol® (bismuth subsalicylate is the active ingredient). I asked and Loretta admitted that she had started using a generic version of Pepto Bismol® for her stomach problems and heartburn. She said it tastes great and works quickly.
Here’s what the Pepto Bismol® website says about black stools; “This discoloration is temporary and harmless. The active ingredient in Pepto Bismol contains bismuth. When a small amount of bismuth combines with trace amounts of sulfur in your saliva and gastrointestinal tract, a black-colored substance (bismuth sulfide) is formed. This discoloration is temporary and harmless.”
Mystery solved. The bismuth in the pink antacid was the culprit and not internal bleeding as her doctor suggested. Loretta stopped using the product and she reported that the blackness disappeared in a day. She’s greatly relieved.
However, we should be dismayed that a doctor reacted so quickly – and dispassionately – to a question that could have been deftly resolved without frightening his patient. Vast numbers of health care workers are strapped for time, especially doctors. It’s too bad that the small amount of time a doctor had to work with a patient caused him to overreact and needlessly scare the heck out of Loretta.
We can learn something from this story. Let’s start with the health professional, the doctor. I have to give him the benefit of a doubt, so to speak by pointing out that he is under such pressure to quickly see large numbers of patients that he didn’t have time to think before speaking to Loretta. Pressure (aka anxiety) is known to cause many of us to react rather than respond. A better approach to the concern about black stools would have been to calmly discuss the matter with the patient rather than jumping to such a negative conclusion, and instantly sharing it with his patient. While the no-time explanation helps us understand how the alarming communications arose, it does nothing to prevent things such as that from happening again, which causes distress, and maybe some serious emotional/medical results.
Yes, doctors are busy, because the current environment has shifted the professional work we have expected from medical doctors to more of a paid hourly laborer, not that there is anything wrong with jobs that pay by the hour. This arises when intention doesn’t work out the way it was hoped or planned. Working to keep health-care costs as low as possible, modern medicine has lumped the most valuable part of the system in with other negotiable costs. Doctors may well keep track of the hours they work but that’s a far cry from expecting them to be on the clock.. We should hate to see health care degrade to a place where it would be acceptable for a surgeon to halt or delay a procedure because it’s almost time to punch out. No, it isn’t that bad, yet.
Let’s all raise the cry for a return to professionalism in health care because there’s too much at stake to allow our doctors to be treated no differently than the hourly staff personnel at the local hamburger joint. Perhaps the time has come to radically reorient health care around value-based primary care while making certain to not leave empathy behind.
Larry Frieders is a pharmacist in Aurora who had a book published, The Undruggist: Book One, A Tale of Modern Apothecary and Wellness. He can be reached at thecompounder.com/ask-larry or www.facebook.com/thecompounder.