I get paged in the middle of the night by a patient's wife, someone I've seen in clinic for a while now and have gotten to know. "My husband had 102 fever, I gave him Tylenol and it's down to 99, but I wanted to know what to do."
"You need to bring him to the ER. He has multiple sources of possible infection, and there's no reason to risk waiting past the holiday weekend for him to get in to see a doctor on the outpatient side."
"But it's such a hassle to get to the ER."
"I know. But he needs to get a urine sample and a blood draw, at the very least. It's possible he can just get a prescription for antibiotics and be sent home -- I'm not saying he's going to be admitted -- but he needs to see someone."
"Maybe the fever was a fluke?"
"You don't spike a fever for nothing. Something's going on, and the safest thing to do is not to wait until there's a bigger problem, but to get this worked up and see what's going on."
"Can't you prescribe an antibiotic over the phone?"
"I can't. We need to run tests and see what's going on."
"How about if we wait to see if the fever comes back?"
"I don't know what you think you'd be waiting for. He had a fever. Tylenol is not a cure, it's just a mask. I'm not saying something serious is going on here, but you called me, so this is what I'm telling you to do."
"What if we wait until the fever hits 101 again?"
"I'm not sure what you want me to tell you. You're looking for permission not to take him to see a doctor, and I'm not comfortable giving you that permission. Is waiting going to make a difference? I don't know that the answer is yes, but I don't know that the answer is no."
"You're not very helpful."
"I'm telling you to take him to the ER."
"He can't walk well enough to get into the car."
"I know. And I know it's a hassle. It doesn't have to be our ER, if that's not possible. You can call a private ambulette to take him here, or you can call 911. We can send his records wherever he ends up. I'm not trying to make this difficult for you, I'm just telling you that he should be seen before the end of the holiday weekend."
"How about tomorrow?"
"I don't know why tomorrow is different from today, but I'm just his doctor, I'm not going to force you to do anything."
"Okay, if you're not going to force me to do anything, we're going to wait until the fever comes back."
"As long as you realize you're taking some amount of risk this becomes more serious."
"You're not helping."
"I'm trying my best."
You know, there's a tremendous health education problem in this country, and probably everywhere. I feel like people think that if something is really an emergency, a doctor is going to force them to do something. That they're not going to be allowed to refuse tests or refuse treatment. That if a medication is really important, they won't just give you a pill, but they'll inject something into you against your will. That if you're really in danger, you will be dragged, kicking and screaming, into an MRI machine, into a hospital bed, into an ambulance, wherever. That nothing is serious unless you are physically being detained. That we are magicians, we can see the future, we know everything that's going to happen, when it's going to happen, and how to avoid it -- and that we can hold off terribleness as long as you can come up with a good excuse for why it shouldn't happen.
"He can't have pneumonia, there's a snowstorm, and we can't get to the hospital today!" "Oh, why didn't you say so? We'll forget the pneumonia and hold off until Tuesday, when the streets are clear." "I can't take my pills, because I dropped them down the sink!" "Oh, you dropped them down the sink? Then I'll snap my fingers and cure your infection on my own. And, I'll magically make your insurance company send you new pills without you even having to call them." "The fever's a fluke. I don't want to go to the emergency room." "Okay, well, as long as it's a fluke."
Guess what? You're in charge of your own health. You want to call a doctor and ask what you should do? Great. But if you're not going to listen, why are you calling? Are you just trying to see how much the doctor is going to insist, and then decide, based on tone of voice, whether to take the advice seriously or not? Your health-- surprise-- needs to matter a lot more to you than it matters to your doctor. Because even if your doctor cares, your doctor doesn't care enough to chase you down and force you to be smart about your choices.
Your doctor is going to feel sad, and maybe even guilty, if something happens to you that could have been avoided -- but sad and guilty are a lot less serious than dead. Your doctor can be really sad and really guilty, but you are still going to be the one to suffer the consequences. You are still going to be the sick one, the sicker one, or the dead one. Not your doctor.
There is only so long someone will stay on the phone with you and explain why you should do what he just told you to do. And a lot of times, that amount of time is zero seconds, because it is more important to deal with the people who actually want your help than the people who are pretending to want your help, or think they want your help but actually have no interest in your help, no matter how many different ways you try to say the same thing.
If you are not going to go to the hospital, under any circumstances, don't ask whether you should go to the hospital. Ask something else. And ask someone else. Ask your plumber what he thinks you should do, because he might have a different answer. My answer, apparently, doesn't really matter.