Overhearing medical advice

I will sometimes hear people talking about medical problems.  This can be at the grocery store, waiting at the DMV or any number of other places.  They may be discussing their own problems or those of a friend or relative.  It may also be an issue that was on a talk show or in a magazine.

Here’s my dilemma: Lots of the information that is passed around is not exactly right.  It’s easy to ignore the pronunciation issues.  I just wince and keep on reading my book or crocheting my baby blanket. 

What’s harder is to not comment on the medical advice.  The people that are talking are strangers to me.  I have never met them before.  They don’t know what I do.  I have no idea what they do.  I will never see them again.  Is the advice harmful?  Generally it isn’t.  

I had a professor when I was a resident who asked me: “Why do Obstetricians have wide, flat hands and smoke cigars?”  I answered, “I don’t know Dr. X, why?” “They have wide, flat hands from sittin’ on ‘em so they don’t do somethin’ that they’re not supposed to do.  And they smoke cigars to have somethin’ to do when they can’t sit on their hands anymore.” (He was from Texas and talked that-a-way)

I remember his advice when I am in this sort of dilemma.  I figuratively stick my hands under my bottom.  I literally bite my cheek.   I hum to myself.  I crochet faster.  It’s not my business.   I’d rather deliver a baby.  Hmmmmm.

Medical Office Quandaries – 5

My Patient Said What?

There are days when I just don’t believe the nerve of some people.  I have been a doctor for a long time.  When I started practice, we were just at the end of the era where the doctor knew everything.  Patients didn’t dare question what they were told.  They took their medicine, did their exercises, and had their tests or whatever.  They came back and told the doctor what happened and then did whatever they were told to do next.

Ah, those were the days.

Times have changed.  Now patients often have learned something about their problems before they come to see the doctor.  Our patients have access to the internet.  They are taught about their bodies and body systems in school.  Sometimes they didn’t get the whole message, but at least there’s a foundation to build on. 

Still…..

1.     Unless you have a PhD in anatomy, don’t argue with me about where something is in your body.  99+% of the time you will be wrong. 

2.     Don’t tell me it “has to be” some kind of disease unless you have the lab work, x-ray or pathology report in your hand.  I may very well disagree with the doctor you saw before.  I may have different information. 

3.     I will usually disagree with Aunt Mable, Cousin Herbert or most of your relatives, unless they have an MD after their name and have examined you.  Talking to you over the phone does not count.

4.     Anyone that tells me that “you’re a doctor, you have to…..” will generally be shown the door.  I have a medical license to maintain.  I do what’s best for my patients.  I have to follow the law and my best judgment.  Period.

5.     We spend a lot of time and money training and learning our craft.  Four years of medical school after college.  Then residency (three to eight years), subspecialty training for some, and continuing education all the time.  Then we keep doing what we were trained to do.  We do expect to make more than minimum wage.

6.     Remember that what you pay at the front desk covers more than the doctor’s fee.  You are paying the nurse, the receptionist, the cleaning lady, the lab person, the lawn guy, the tax man, the electricity, the computer, and on and on.  Sometimes, depending on your insurance, there is no money left for the doctor.  So don’t:

A.   Stop payment on your check

B.   Cash your insurance check and not pay the doctor

C.   Forget to tell the office that your insurance was cancelled or changed

D.   Refuse to pay your deductible or co-pay when you are in the office

E.    Argue with the office about what the insurance paid

All of those things have happened to me.  Sometimes the amounts were significant.  They destroyed my relationships with those patients.

I’m not saying it’s time to return to the old days.  But I think a little mutual respect is in order.  Doctors are professionals.  We provide our knowledge and our skill.  We try to treat our patients with respect.  We expect to be treated with respect in return.  We also expect to be paid for our time and skill.  You can “vote with your feet” about your care.  If you are not happy, don’t come back.  Consider, however that your doctor could have been right.

Medical Office Quandaries - 4

Missed Appointments

I’m sitting here staring at the walls at the moment because a patient didn’t bother to show up for her visit that was booked for an hour.  Ms Noshow also didn’t bother to cancel.  Princess called her twice yesterday and again this morning to remind her that she had an appointment.  The current phone number went to voice mail. 

She has been a patient for a little over a year.  I have at least 5 different phone numbers in her chart.  There are multiple notes in this patient’s chart about leaving messages, phone not being turned on, and her phone not being in service.  It helps to write this down, so Ms Noshow can’t say we didn’t try.

PEOPLE!  What happened to common courtesy?  It doesn’t matter whether it’s a 5 minute visit or a 2 hour visit – that time was reserved for you.  If you’re not coming, you should call.  It has gotten to be so common for people to forget that most offices call one or two days in advance to remind people. 

Several years ago, I finally instituted a charge for this.  Princess and I agree that wasting our time needs to be paid for.  Some people don’t pay the charge.  We don’t see them ever again.  Sigh.

Medical Office Quandaries #2

“Oh, by the way”

          On my way out the door after first talking to a patient, then doing an exam, then developing a treatment plan, there is sometimes a dreaded phrase.  “OH, BY THE WAY….”  Mind you, I think the office visit is complete.  I’m thinking about prescriptions and charting and a myriad of other things.  {Squeezing in a bathroom break, a quick lunch, maybe getting to the kids band concert this evening – you know!}

          Put on the brakes.  Stop everything.  Ms Wantsitall Patient has had my undivided attention and her appointment is over.  Now she has something else she needs to have taken care of. 

          Lots of times this is followed by something “simple” like

·        “it hurts when I have sex”

·        “I have trouble holding my urine”

·        “I forgot to have you look at this spot”

·        “I have a discharge”

          None of these problems can be solved with a quick answer.  All of them take a whole visit.  I have to explain this to this woman, who often gets upset.  She thinks she can get this problem solved now since she is here at the office.  She doesn’t want to pay for another visit. 

          I have to explain that she needed to tell me before she had her examination.  I might take a quick look at the spot if I have time and schedule her to come back for a biopsy or to see a dermatologist, but the rest of those are things that need special exams. 

          So, tell the receptionist everything you need to have checked.  Tell the person that puts you in the room everything that is bothering you.  Make a list if you need to.  Put the most important things on the top.  The doctor is only going to have time to deal with one or two of your problems.  You need to plan on making another visit if you have more issues.  Then your doctor won’t have more blood pressure or stomach problems.