Patient yesterday afternoon:
"I didn't tell anyone this the last time I came in, but I trust you--"
"For the past ten years-- wait, do you have a pen and paper, I'll draw you a picture--"
"Um, sure." (I hand him a pen and paper)
"For the past ten years, I go to the bathroom and the pieces are very small." (He draws some circles on the paper) "They're less than a centimeter. I've measured."
"I'm not sure this is really--"
"They're brown, but not always exactly the kind of brown you expect they should be, you know what I mean?"
"And I go like three, four, five times a day. Almost every day. Is this normal?"
"Everyone's system works a little differently. You might want to--"
"And I'm very itchy down there."
"No, for ten years, very itchy. All the time."
"Have you been checked for hemorrhoids? You might want to try some Preparation H."
"Oh, I tried that. Believe me, I tried that."
This went on for a few more minutes, before I was able to convince him that if it's been this way for ten years, and this is the first time he's told a doctor, he's probably okay.
It's interesting-- patients seem to all think that the longer they've had a problem-- whatever problem-- the worse it must be. And we're trained to think exactly the opposite-- if something's been going on for years, it hasn't gotten worse, you've never felt compelled to seek treatment-- well, maybe you're fine. I had a patient tell me his wrist hurts "twice a week, for three years." On a schedule? This is not a complaint I can bring to an attending, this is a magic crazy person complaint. "This started this morning and is getting worse" is something I'm going to look at. "This started a generation ago and most of the time I don't notice it" is not.
The corollary-- patients convinced one thing is causing something else, when it makes no medical sense. "I think the antibiotic is causing pain in my left thumb," one patient told me. Pain in one thumb? This is not from the antibiotic. "It sort of feels like something is twisted inside of me," one man said. "Could I have accidentally knocked my kidney out of place?" No. You didn't. "When I brush my teeth, my nose itches." I have no idea how to help you.
So do I save this guy's drawing in his file? Do I throw it out? I put it in the file. I didn't know what else to do with it. The next doctor who sees him in the clinic is going to see this picture of his poo, and probably ask him about it. And then they can be punished too.