What patients want

I recently spent some time with a doctor. In the few short days I spent with him I noticed a few trends. Every new patient got AB index done by the nurse with the doppler. Every new patient got a full lab workup with everything from Lyme titers to ESR. Most patients got PFTs. Every patient was either given an ultrasound and a joint injection or given a perscription of whatever drug the rep serving us food in his office was pushing.

Examples:

Woman with diabetes comes in uncontrolled on her current drug regimen. She isn't taking the drugs at the prescribed time. She admits to feeling "low blood sugar" every day after she takes her medication so she eats whatever is in the vicinity such as cookies to bring it back up. Her A1C was like 15. No diet or medication counseling was done. Instead he grabbed the rep that was in his office pushing some drug class I never even learned in med school (it was that new) and had him explain the drug and then gave it to the patient.

Woman with hypothyroidism gaining weight. He sends her for gastric sleeve at her request.

Guy with outrageous uncontrolled hypertension on 4 different medications. He decides those aren't working (none of them are maxed out, or the correct combination of medications you are supposed to put patients on) and switches him to the newest combination hypertension pill that I have again, never heard of.

Guy with abscess. He drains it and then proceeds to give him a few specially formulated tubes of stuff to put on the wound that he has specially mixed and delivered to his office. It was basically flavored neosporin. I bet you anything he's charging a good bit for that.

The kicker? He's one of the highest rated doctors around. Patients LOVE him. They eat this crap up. He practices the worst medicine I've seen, but he makes the patients all feel like they are celebrities. He profits from a bustling practice built by robbing these patients not only of their health, but their money.

Patients love expensive medicine. If you go to your doctor feeling really crappy and he tells you that you have a virus and don't need an antibiotic what will you do? Well, most people will whine. "My last doctor would give me an antibiotic". "I had this a few months ago and I took the antibiotic and it helped." "I got this from my husband and he got better on an antibiotic." Everyone thinks they are doctors. And most doctors will cave. Otherwise they get bad reviews online and their practice tanks. No one can trace antibiotic resistance back to that doctor, but they sure as hell can trace crappy reviews. I can make the same argument for pain medication, lab tests, etc. The list goes on. Patients want what they think they need.

If you go into an office and get told you have this and that wrong with you, but don't worry it will be fixed with a knee injection and this brand new medication, you're elated. This doctor is so smart he found things wrong with me other doctors didn't! And he hooked me up to this crazy machine and measured my blood flow! No other doctors do that! And he checked every single one of my labs (including PSA and all the other ones no longer recommended) because he really cares to make sure I don't have cancer or liver disease or kidney failure! And he has all these new medications that work better than the old ones! And he fixed me all up by doing an ultrasound in his office and injecting me with medication right there!

And people complain that medicine is too expensive. It's a vicious cycle. People want to be validated for going to the doctor. They think they know what's best for them and want a doctor who just gives them what they want. They don't want good, efficient, smart medicine. Then what happens to the good doctors who only order the necessary tests, only give the generic medication, only practice evidence based medicine? Patients don't read the literature, but they do watch the TV and read the internet and listen to their friends.

The ED is a nutty place to be.

Ms. Demented: Doctor! Doctor! Doctor! Doctor! Doctor! Doctor! Doctor! Doctor! Doctor! Doctor!

(This went on for a while to a pretty regular beat that the nurses broke into song)

Med student: Hi, I need to take off your bandage.

Ms. Demented: No oh no doctor! Oh doctor! No! No! No! No! No! No! No! No! Oh doctor. Doctor! Doctor! What is your name?

Med student: Sam

Ms. Demented: Oh Sam! Oh doctor! Just like that! Yes! Yes! Yes! Yes! That's good! That's good! That's good! That's good! No! No! No! No! No! No!

(Sam leaves to get supplies)

Ms. Demented: Sam come back! Sam! Where is Sam! I only want Sam! Samuel! Samuel! Where are you? Come back! Doctor! Doctor! Doctor! Come back!

(Sam re-enters)

Ms. Demented: Samuel. I only want you Samuel. Oh Samuel. Oh doctor! Doctor! Doctor! Doctor! Doctor! Oh Samuel yes. I love you I love you I love you I love you I love you Samuel. I love you. Oh push me up Samuel! Oh jesus god push me up! Oh my god! Push me up! Oh Samuel! Oh doctor doctor doctor doctor doctor!!

The reason we ask your history is because, well, it's important

We recently had a patient who came in with a whole body reaction to a medication she had received a week ago. Her skin looked terrible. All over discoloration, thickening, swelling, painful lesions. Certainly she was having a reaction, but just how much was acute was difficult to discern. She was also African American and that makes it much harder (especially for me) to tell the extent of erythema.

We asked her if she had any other medical conditions, had ever had anything like this happen before, what her skin usually looks like. She pointed to an area on her wrist that was smooth and much lighter in color than the rest of her skin and said that her skin always looks like that. We admitted her for fear of SJS/TEN (really bad necrotic skin conditions that can be due to drug reactions).

Later we called her primary care doctor to find out that she has a chronic skin condition and has been seeing a dermatologist for years.

........

So you just happened to forget that you have a chronic skin condition and see a whole separate doctor for YEARS to treat it? That just happened to slip your mind when we specifically asked you what your skin normally looks like and if you have any other medical conditions??

:yawn: I'm a 10/10

For every patient in pain you are expected to ask them to rate their pain on a scale of 1-10. It's annoying because it's completely subjective and I have yet to meet a patient who understands this scale. Yet we still are forced to ask them, and to record it.

As far as I'm concerned, a 10/10 pain is excruciating. It means you should be screaming in nonstop agony. A 10 would be like having your arm ripped off or someone stabbing you over and over and over. You can't be asleep and in 10/10 pain. If you have 10/10 pain, you better be screaming. Or at least moaning...even a LITTLE. I get that your pain hurts a whole lot. Give it a 7 or 8. Or hell, even a 9. But it's always 10. Always.

I walk in the room of a patient who I already had a feeling was going to be annoying so I guess I had a bias. He was sleeping so I woke him up. He said he had horrible pain in his leg. I asked him to rate the pain out of 10 and prefaced it, as I always do for the hope that maybe one day a patient will understand, "...with 10 being the most horrendous, awful, terrible pain you can think of." And of course, he was a 10.

Later when we went in to see him he was watching TV with his hand behind his head, lounging in the bed and when asked the question again he drowsily looked up at us and said., "What? Yeah it's a 10."