At the free health clinic:
Doctor: Patient came in the other day with anal pruritis (itchiness). What is it?
Student: Well the only thing I can think of is from pediatrics and it's Enterobius infection.
Doctor: Okay, well if you wanted to test that theory what would you do.
Student: Scotch tape test. Would you do that here in the clinic?
Doctor: No. We don't have any scotch tape here.
Sunday, March 16, 2014
Saturday, March 15, 2014
Difficult patients
I was working with a doctor who was obviously quite jaded and angry, but rightfully so. I have become more jaded working in the hospital just from the people we have to deal with every day. It's one thing that they aren't compliant and have no desire to help themselves, but it's another thing entirely to then blame the doctors for trying to help them. Nevermind the fact that just trying to illicit a decent history or explain something to them is impossible. Also, being in a spanish heavy area is difficult. Most of them get upset that you don't speak spanish. This particular doctor had no problem saying exactly what was on his mind. I still felt uncomfortable standing next to him as he said it.
Patient: My back hurts so much.
Doctor: I sent you to ortho. They wrote here that you refused physical therapy in the hospital.
Patient: No. They said to me that I had to go to this other hospital for shots in my back and I don't know where that hospital is and they don't take my free health care there.
Doctor: I'm reading the note right now from the ortho doctor. It says that you refused to go to the physical therapy right here in the hospital.
Patient: No I did not.
Doctor: Okay. Fine. We will just assume ortho is lying then. You will go to physical therapy?
Patient: Yeah, ok. What did my MRI show? My back hurts so much.
Doctor: It showed some minor arthritis in your spine that I would expect any 70 year old to have.
Patient: But it hurts so bad! You don't know what this pain is like!
After the doctor told me that he gets upset when patients tell him he doesn't know what the pain is like. Who are they do assume he hasn't felt pain?
(Through a spanish translator)
Patient: I need a referral for ophthalmology.
Doctor: I gave you a referral last time you were here, you made an appointment, and you didn't show up.
Patient: No no no. I called and called and called and they never picked up the phone.
Doctor: That isn't the issue. What I'm telling you is that you had an appointment and you didn't go to it.
Patient: No. I called and called and called. Finally someone picked up the phone and I tried to speak a little english, but they didn't speak spanish and that is not my problem.
Doctor: First of all, you didn't need to call anyone. All you needed to do was show up to your appointment and you did not do that. Second of all, them not speaking spanish and you not speaking english is not their problem, it is your problem. How long have you been in this country?
Patient: 20 years
Doctor: Twenty years?! And you haven't learned any english?? Where are you from?
Patient: Peru
Doctor: If I went to Peru, I would learn Spanish.
These conversations are not unique. The way this particular doctor dealt with it is, but a lot of patients feel entitled. It's difficult not to be hostile when you are being attacked or getting false information or being lied to. Doctors are only human also.
Patient: My back hurts so much.
Doctor: I sent you to ortho. They wrote here that you refused physical therapy in the hospital.
Patient: No. They said to me that I had to go to this other hospital for shots in my back and I don't know where that hospital is and they don't take my free health care there.
Doctor: I'm reading the note right now from the ortho doctor. It says that you refused to go to the physical therapy right here in the hospital.
Patient: No I did not.
Doctor: Okay. Fine. We will just assume ortho is lying then. You will go to physical therapy?
Patient: Yeah, ok. What did my MRI show? My back hurts so much.
Doctor: It showed some minor arthritis in your spine that I would expect any 70 year old to have.
Patient: But it hurts so bad! You don't know what this pain is like!
After the doctor told me that he gets upset when patients tell him he doesn't know what the pain is like. Who are they do assume he hasn't felt pain?
(Through a spanish translator)
Patient: I need a referral for ophthalmology.
Doctor: I gave you a referral last time you were here, you made an appointment, and you didn't show up.
Patient: No no no. I called and called and called and they never picked up the phone.
Doctor: That isn't the issue. What I'm telling you is that you had an appointment and you didn't go to it.
Patient: No. I called and called and called. Finally someone picked up the phone and I tried to speak a little english, but they didn't speak spanish and that is not my problem.
Doctor: First of all, you didn't need to call anyone. All you needed to do was show up to your appointment and you did not do that. Second of all, them not speaking spanish and you not speaking english is not their problem, it is your problem. How long have you been in this country?
Patient: 20 years
Doctor: Twenty years?! And you haven't learned any english?? Where are you from?
Patient: Peru
Doctor: If I went to Peru, I would learn Spanish.
These conversations are not unique. The way this particular doctor dealt with it is, but a lot of patients feel entitled. It's difficult not to be hostile when you are being attacked or getting false information or being lied to. Doctors are only human also.
Friday
Chief resident: Ok residents, now that we have just presented the case, any idea what this is?
(Silence)
Chief resident: Anyone? Any ideas at all?
(Silence)
Chief resident: Is this some sort of revolt against me?
(Silence)
Resident: What was the summary again?
(Silence)
Chief resident: Anyone? Any ideas at all?
(Silence)
Chief resident: Is this some sort of revolt against me?
(Silence)
Resident: What was the summary again?
Saturday, March 8, 2014
Gonna have to be more descriptive than that
Daughter: She is having pain in the front and the back.
Me: Can she point with one finger where the pain is on her front?
(Daughter and mother exchange looks)
Daughter: She went to the ladies' room and it hurt her.
Me: Ah, so she is having pain when she goes to the bathroom?
Daughter: Yes. In both the front and the back.
Me: Ok, so when did she start having pain with urination?
Daughter: Oh dear! We don't use that kind of language!
Me: Can she point with one finger where the pain is on her front?
(Daughter and mother exchange looks)
Daughter: She went to the ladies' room and it hurt her.
Me: Ah, so she is having pain when she goes to the bathroom?
Daughter: Yes. In both the front and the back.
Me: Ok, so when did she start having pain with urination?
Daughter: Oh dear! We don't use that kind of language!
Psychogenic polydipsia
Me: So what brings you in to the emergency department today?
Patient: I drank a lot of water. I have been vomiting all day. I feel so sick.
Me: When did you start vomiting?
Patient: After I drank a lot of water.
Me: Uhh, ok how much water?
Patient: Like a gallon and a half.
Me: And why did you drink this much water? Do you feel really thirsty?
Patient: No I felt sick to my stomach and wanted to throw up.
Me: You made yourself drink water to throw up?
Patient: Yes
Me: Why did you feel sick to your stomach?
Patient: Because I drank a lot of water!
Patient: I drank a lot of water. I have been vomiting all day. I feel so sick.
Me: When did you start vomiting?
Patient: After I drank a lot of water.
Me: Uhh, ok how much water?
Patient: Like a gallon and a half.
Me: And why did you drink this much water? Do you feel really thirsty?
Patient: No I felt sick to my stomach and wanted to throw up.
Me: You made yourself drink water to throw up?
Patient: Yes
Me: Why did you feel sick to your stomach?
Patient: Because I drank a lot of water!
Tuesday, February 18, 2014
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.
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.
Monday, February 10, 2014
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!!
(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!!
Subscribe to:
Posts (Atom)