* * Anonymous Doc

Saturday, October 3, 2009

Even after just a month of outpatient, already it's pretty clear-- from the things I've posted about and the things I haven't-- that the same kinds of problems pop up again and again. I've had more than a few people trying to get me to sign disability forms for them, I've had more than a few drug addicts who show up wanting to get clean but then don't follow through, I've seen more sexually transmitted diseases than I'd like, I've seen a bunch of patients with complaints of chronic problems that probably aren't actually problems at all, and I've actually seen a surprising number of patients come in for just a physical.

That's been the biggest surprise to me-- and it's a good surprise, as opposed to the usual downbeat stuff I post about-- the number of patients who are proactively coming to the clinic for a physical, even though no urgent problem is pressing on them to do so. And it's really hard for a lot of these patients to get here. A lot of them aren't able to take time off from work without consequences, a lot of them don't have reliable transportation or child care, a lot of them don't live especially close to the clinic, for a lot of them it's a real sacrifice to come see a doctor when nothing's broken, bleeding, or causing them pain. And yet they do. They come, and they tell me they haven't seen a doctor in a couple of years and just thought it would be smart to get themselves checked out. And I find they have high blood pressure, or diabetes, or sometimes nothing at all-- they're usually not the most interesting patients, but that's a good thing for them. To find this stuff before it kills them.

The bad surprise of outpatient care-- in terms of the doctor, it's just not always very interesting problems to deal with, and a lot of the same questions and same answers, day after day. And I knew that going in, but I'd say that especially compared to what I was dealing with during the inpatient months, there was much less variety than I expected, much less day-to-day learning and surprise. Which is disappointing. I guess.

But my biggest observation as far as the patients go-- I feel like I'm regularly surprised by how little the patients know about medicine and how the body works. "I think my eye drops are making my diabetes worse," "I get this pain in my hand every time I eat chicken," "How can I have a stomach virus when I shower every day." We need to teach health in grade school, and not just sexual health the way health class is now. Why shouldn't every child graduate from high school knowing some basic medicine, some basic sense of how the body works, what each organ does, what cancer means, why exercise is beneficial, what a heart attack is, what causes a stroke, etc. People don't know this stuff. At all. They should.

I start two weeks of vacation today-- we get four weeks of vacation a year, broken up into two two-week blocks that are assigned to us. I will keep posting, but I also have a strict schedule of sleeping and TV-watching that I will be trying to adhere to. :) Trying to put together some plans to visit friends, and I wish I'd been able to be more pro-active about planning this stuff before the vacation actually started, but we'll see what happens.


  1. Good post. I definitely agree with you. We need to teach basic health in grade school, because problems begin early.

    Keep up the good work.

  2. I realize that this post is nearly a year old, but I've been reading back through your archives.

    The bad surprise of outpatient care-- in terms of the doctor, it's just not always very interesting problems to deal with, and a lot of the same questions and same answers, day after day
    But from a patient perspective, it's so important that you be on your toes. Sometimes it's not the same old thing. Sometimes there's something really wrong, so you'll need to be able to recognize the zebras. Not just the textbook cases, but the unusual presentations. Diseases don't read textbooks.

    Read some of the autoimmune boards. There are people who were told for years that there was nothing medically wrong; they were just depressed and needed an antidepressant. Except what they really had was an unusual presentation of rheumatoid arthritis and it wasn't discovered until there was permanent joint damage and deformity. The symptoms were all explained by an RA, but the dx came too late. Early, aggressive treatment is important, but patients can't get treatment if doctors don't recognize the disease.

    Read some of the Cushing message boards, and you'll learn of people belittled by doctors for years about their weight gain because nobody thought to check for Cushings. Or the doctor thought to check, but the presentation was odd.

    It sounds like you care enough about patients to want to be a good doctor. Don't get so bored and complacent that you miss the weird diseases. Enjoy getting to know your patients so that you recognize when something out-of-the-ordinary needs close investigation.

    Good luck.