* * Anonymous Doc

Friday, April 8, 2011

Requested post-- what you *do* want from a patient.

-- Tell the truth, the first time. "Do you always take your medication?" "Yes." "Every day?" "Yes." "So you never miss a day?" "Oh, I miss days sometimes." Argh.

-- Answer questions like we're on the same team, not like we're the police investigators. "Can you describe your pain?" "No." "How long has it been going on?" "I don't know." "Is it always in the same place?" "Sometimes." This is not that helpful.

-- Realize there is uncertainty in medicine. Even if we run tests, we might still not find the answer and that doesn't mean we're bad doctors. Things don't always show themselves right away. Things aren't always clear. There is ambiguity.

-- Not think they're an expert because a friend told them something crazy. If your friend tells you cholesterol has to do with how many times a week you shampoo your hair, that doesn't make it true. If you think you have three lungs and one eye, that doesn't mean you're right. If you do actually possess knowledge, terrific, I am happy to talk about it. But "I thought meat doesn't have calories, and there's nothing you can tell me to change my mind," is nonsense, and if you won't let me tell you things that aren't nonsense, we are wasting our time.

-- Have appropriate patience. Scans take time to get read. Tests have to be scheduled. There are other patients. We can't spend three hours with you when someone's coding in the next room. We can't call twelve of your family members and tell them all the same thing. We can't track down your cat. We can't always give you an appointment at the most perfect time for you. We can't respond to your 3AM phone call about your gas pain. Understand that we're trying our best, but you need to accept the uncertainty in the system and have some flexibility.


  1. I usually agree with you on everything. But not today. I have to disagree with you on the first two points.

    The first: from a patients perspective, this is how it works. Honestly, I don't forget my medication, I choose not to take it sometimes. Doing a round of 4 different meds twice a day gets annoying. And missing one round once every few months, isn't too bad. So if my doctor asks me did I take my meds, I say 'yes'. If she asks did I miss days, I say 'yes'. I think we have a mutual understanding of what it means to take the medication properly, but still, I do sometimes NOT take them.
    Though, as a doctor, I do get what you mean. I've had patients who lied to me about trivial things, too. And it's terrible. I once had a patient with an addiction problem, who came to see me. I didn't know him, and I hadn't read the chart well enough. My bad. But still, he came to see me, and he was looking for help. Except that he lied about his history, about the amounts he used, about the social consequences etc. The thing is, I believed him. I only found out he'd lied about his addiction history when I wrote the referral and checked back his file more thoroughly. I felt misled, betrayed and used. And I actually was about to call him to tell him that if I couldn't trust him in telling the truth, he'd better find someone else to mislead. But then I remembered it's a tell tale sign of addiction: lying. I didn't feel any better, I just knew he wasn't lying about the addiction.

    On the second: most patients don't have a university degree, or anything close to that. And everyday I see patients who honestly don't know. Whether they don't understand my questions, or haven't paid attention to the complaints before, I don't know. It makes it challenging, because *you* have to fill in the blanks and get the diagnosis right anyway.

    I agree with you on the patients demanding tests. Have you seen the line? Because if you haven't, it doesn't mean it's not there. NEXT!

  2. I also have to disagree on the first two points. A patient can always take their meds and still sometimes miss days. If 100% compliance, never a missed day, is your only definition of always taking meds - every day - you'd rarely get a patient (on any kind of long term med regime) who could answer yes. Like laui said, a mutual understanding.

    As for pain, I've given answers similar to that on occasion,(with explanation) but not because I consider the situation antagonistic in nature. The problem is that the pain is vague, and difficult to describe, even in my own body, and has been coming and going for so long I just don't remember when it started. I've talked to friends with similar experiences with pain. I realize that it's not a lot of help to you, but it's not a party on our ends either. ...not sure how a university degree helps this...

  3. Blogger ate my comment so...

    1.I consider myself 100% compliant with meds even though there have been issues with actually getting medication. Per the blog post I typed here today: http://pissedoffpatient.blogspot.com/2011/04/imperfect-design-for-imperfect-patients.html

    2.I can no longer remember my medical history sufficiently to accurately report it to anyone. Further, I have yet to meet a doctor who is happy to see a typed up history (the only shot I have at being accurate). So. Whatever. I've kind of just given up.

    Also, some things have become normal to me, so it does not even occur to me to respond positively to some questions. Yes, I have muscle pain and cramps. I've had problems ever since the last time my HPA axis was suppressed.

    But ask me if I have muscle pain or cramps and I will say no. Because it's my baseline so I don't consider it abnormal at all.


  4. *I always take my meds - except there's one day of the month that things are extra chaotic. On that day, I have about five minutes to eat lunch (if I'm lucky to get that long) and it's not unusual about 3 in the afternoon once things settle down to discover that I missed my lunchtime dose. What this means is that on the first Monday of the month, I usually take my lunch dose with a snack in the mid-afternoon, then push dinner a little later that day so I don't miss the dinner dose. If I don't notice until 4:30 that I missed the lunch dose, I figure it's a lost cause and just skip that one. Do you want to hear "sometimes, once a month, I either miss one dose, or take it a couple hours late" or do you want to hear, "yes, I always take my meds"? I've also been known to skip my meds if I've been puking my guts out; it doesn't make a lot of sense to swallow all those pills just to send 'em back up again.
    So, yeah, I'll tell you that I always take my meds. And, yeah, I admit that on rare occasions I miss a dose. And I don't think there's really a contradiction there.

    *Pain is hard to describe. Maybe doctors are taught certain phrases, but patients don't automatically know how to classify different kinds of pain. It's easier to answer questions: does it feel like it's throbbing so that you can feel your pulse in it? does it feel like you're being stabbed? and so on...

    *How long has it been going on? It's possible to narrow things down by asking if it's been just one day, or a few days, or a week, or a month, or...

    *My doctor is good about saying why a test is being ordered. He'll say, "If the results are ___, then we'll treat this way; if the results are ___ then the next step is ___." I like knowing what to anticipate next.

    *This might not be as possible until you're done with residency, but it would be so nice to have my doctor's office have a helpful website with links to reliable information - whether it's uptodate articles, or on one of the other reputable medical sites, or a YouTube video made by a doctor. Patients could be easily directed to reliable information to counteract the nonsense that's so easy to find.

    I agree with the other commenters; if you live with something all the time, it's easy to forget to mention it. I breathe all the time, but have never thought to mention it because it's always there - I have Raynauds, but didn't realize it was something that I should mention to my doctor because I've had it since I was ten years old and I just learned to live so that I minimize the problem. Sometimes patients aren't trying to hide things; we just don't think about mentioning what we always deal with.

  5. Anonymous: i think I might have phrased my reply a little to harshly. But I do know from experience at the other end of the table, that there is a huge difference between a person with an IQ of 100 (normal in my country) and 120 (university degree), and 80-90. I don't mean any offense with that. The thing is, being the one with an IQ >130 (estimated guess), it's sometimes difficult to communicate. You use words people don't understand, and as a beginning medical professional it's even harder to switch between layman's terms and the terms you're supposed to use when talking to colleagues or professionals. If I ask a patient with an average IQ something and I use the (more) medical term, oftentimes they absolutely don't understand, and they'll just 'guess' the right answer. This happens all the time, I can see it in their faces and it is frustrating, but I only have myself to blame, I should be using the layman's terms.
    (Plus, I'm not a native in English, which might not help in my way of expressing myself here, but that's not an excuse, really.)

  6. Laui: ok, now I see what you were getting at. I'll be receiving a BS degree in 12 or so months, and I was trying to imagine how that was going to change my interaction with doctors (from how they currently go) and coming up blank. It being a matter of intellect/general education as opposed to specific diploma makes more sense (to me).