* * Anonymous Doc: September 2012

Thursday, September 27, 2012

Ethical Dilemma of the Week

"Hi, I think my brother-in-law, [Patient], told you I'd be calling."

"Yes, he said you were a doctor and wanted to discuss his condition."

"Yeah, I want to know if we're at the end yet."

"Excuse me?"

"I want to know how close we are to the end."

"Um, your brother-in-law is not in great shape, that's absolutely correct.  But I don't believe he is actively dying.  We're having him come in for surgery next week, and while I don't think he's going to be playing golf anytime soon, with rehab and probably a wheelchair at least for the short term, I think he'll be okay."

"I don't think my sister is capable of taking care of him."

"She seems to be doing okay, from what I've seen."

"Well, what I want to know is whether it's time for her to just leave him in the emergency room and let the state take care of him."

"I'm sorry, what?"

"You know, they're not legally married.  So I told her, she has no legal responsibility for him.  If she gets tired of dealing with him, I told her she can just drop him off at the hospital and never come back."

"She seems to be doing okay.  I'm sure they'd love the situation to be better, but we're hopeful he can have some kind of recovery and even if it's a limited quality of life, mentally he's okay, and whether or not they're married, she doesn't seem like she would want to just leave him to die on his own."

"I know, and I'm trying to convince her otherwise.  I was hoping you might be able to talk some sense into her."

"Wait, you want me to convince her to leave him in the ER and walk away?"

"Yes, exactly.  I appreciate it, thanks."

"No, I don't think that's the best option given his situation."

"For him or for her?"

"For either of them!"

"You know you'd still get paid by insurance, right?"

Thursday, September 20, 2012

"Why am I in pain? My surgery was LAPAROSCOPIC!"

Patient calls me.  "Doc, I'm feeling really terrible today.  In so much pain.  Couldn't go to work.  Really feeling awful."

"Okay, one second, let me take a look at your chart..."

"Sure, sure.  Really, I'm just totally wiped out."

"Have you taken your temperature?"

"Yeah, it's normal."

"Okay, I'm looking at your chart.  Uh, you had your gall bladder removed yesterday?"


"Were you feeling like this before the surgery?"

"No, no, I was feeling okay."

"Yeah, you're feeling like this because you had surgery yesterday."

"No, doc.  It was laparoscopic."


"The surgeon said it would be nothing.  He didn't say anything about pain."

"Even laparoscopic surgery is surgery.  You had the procedure yesterday.  It's normal to be feeling terrible.  Have you been taking the pain medication?"

"No, I don't like to take stuff like that."

"Then it's not surprising you have pain!"

"I think he botched the surgery.  It was laparoscopic.  I'm supposed to be fine."

"You had the surgery yesterday.  This pain is normal."

"If this is normal, I'll tell you one thing-- I'm never having my gall bladder removed again."

"That's right, you're not."

"Okay, write that down in my chart."

"Uh... okay...."

Sunday, September 16, 2012

"You know, the ambulance service."

My pager buzzes.  I call back.

"This is Dr. [Me].  I'm covering this weekend for your doctor.  I got a message that you called."

"Yes, I'm calling about my husband.  I need you to send an ambulance for him."

"Okay, if your husband needs an ambulance, you need to call 911.  I'm the doctor on call, I can't dispatch an ambulance."

"No, if I call 911, they're going to take him to [Local, Terrible Hospital].  I want him to go [My Slightly Less Local, Slightly Less Terrible Hospital]."

"Can you drive him, or call a taxi?"

"Oh, he can't get into a car!  He's barely even breathing!"

"Um, you need to call 911 if this is an emergency."


"No, you really do need to call 911 if this is an emergency.  I want you to hang up with me and call 911.  Then you can call back if you still need to ask me any questions."

"No, it's not an emergency.  He's been barely breathing for weeks.  I just think it's getting slower now and I want him to be seen.  And not at [Local, Terrible Hospital], because my aunt died there."

"I'm sorry."

"Oh, it was thirty years ago."

"Okay.  What is your husband's name?  Let me quickly look him up in the computer."

"[Name.]  With a [silent letter]."

"Can you spell that?"

"You need me to do everything?  You're the doctor!"

"Please, ma'am, just spell your husband's name for me so I can look him up in the computer."


"Okay.  Your husband is on the hospice service.  You should call the hospice nurse.  Do you have that phone number?"

"All the hospice nurse does is give him painkillers!"

"Yes, they're trying to make him comfortable."

"I need you to send an ambulance to get him to your hospital.  That is why I called.  You are not being helpful."

"I am trying to be helpful, but this is not an ambulance dispatch service.  Your husband is on hospice.  You need to either call the hospice nurse, or you can call 911.  But, looking at your husband's chart, I'm not sure it makes sense for him to go to the hospital.  The last note from your doctor seems to indicate the goals of care are to make him comfortable."

"He's not comfortable."

"Yes, you should call the hospice nurse."

"I want an ambulance here in 15 minutes."

"Okay, I am going to see if I can get a social worker to call you back, and you can discuss your case with him or her.  I think a social worker may be able to provide more help, since I don't know your husband, and, even if you want to get him here, I'm not sure how to arrange private ambulance services."

"Not private ambulance.  I'm not paying for an ambulance.  You need to send one!"

"Do you know how to check your husband's vital signs?"

"No, I'm not the doctor!  You tell me his vital signs."

"I'm not there.  I can't check his vital signs.  Look, I want to help, but the best way I can is to have you call 911, or the hospice nurse, or let me find a social worker to get in touch with you."

"Well, don't have the social worker call between 12 and 2, because I'll be out at lunch and my husband can't answer the phone."

Monday, September 10, 2012

While I have you on the phone... do I need to put my father in a nursing home?

...so the biggest difference so far between residency and fellowship is that I have actual patients, I am their doctor, and I'm seeing for the first time what it means to be accessible to patients and able to be reached whenever they have a question.  I call back a woman who called the answering service and said she had a medication question regarding her father.

"Hi, doctor.  I don't mean to take up your time, but I was just wondering... I got my father's pills confused and I'm not sure which is the pink one and which is the white one.  I was hoping you could tell me."

"Oh.  That's really a better question for the pharmacist who dispensed the medication.  I don't actually know what the pills look like.  But if you call the pharmacist, he should have your records and be able to look at the actual pills and tell you which is which."

"The pink ones are bigger."

"Okay, that's great.  But I don't know what the pills look like.  So you'll need to call the pharmacist.  If the pharmacist needs to get in touch with me, or you have trouble reaching him, you can give me a call back."

"Great.  Oh, just one more quick thing while I have you on the phone."


"Do I need to put my father in a nursing home?"


"Well, I don't imagine his situation is going to get much better, and I'm having a rough time taking care of him."

"This is definitely a discussion you should have with the social worker you and your mother met with in the hospital-- there might be some services your father can qualify for.  Or she may have some other ideas."

"No, but, just generally, is my father the kind of person who should be in a nursing home?"

"This might be a longer discussion than we should have on the phone right now--"

"No, I have time."

"Yes, but I think this should be something we look at over time, and we can talk at your father's next appointment about what services he might need, and what the best situation might be for him, now and in the future."

"Do you have any nursing home recommendations?"

"I don't, but the social worker would be the best person for you to talk to about this.  You have her card, right?"

"Yes, could you transfer me to her?"

"I'm not in the hospital right now-- I'm calling you back from home.  So if you call the number on the card, you should be able to reach her."

"I don't have the card in front of me right now-- it's in my purse downstairs.  Could you give me the number again?"

"I actually don't have the number-- I'm at home.  If you can't find the card, call again tomorrow during business hours and I can get that to you."

"I can't call during business hours.  I'm at work."

"Okay, that's fine.  I will call you tomorrow with that number."

"You can't just tell me now?"
"I don't have the number right now."

"And you can't transfer me?"

"I'm sorry, I'm not in the hospital right now."
"Wait, one more thing-- are you sure you don't know which is the pink pill and which is the white one?  I'd hate to bother the pharmacist."

Saturday, September 8, 2012

"Urgent Question For Doctor"

I got an urgent page from a patient.  I call back the first chance I have, about ten minutes after I get the message.

"I got the message you called-- I'm sorry it took a few minutes."

"That's okay.  I have an urgent question."

"Okay, what's going on?"

"I wanted to know how Medicare will be affected if Obama becomes President."

"That's your urgent question."


"For your doctor to answer."


"Obama is already the President."

"Oh.  Is he?  The election already happened?"

"No, he got elected in the previous election."

"Oh.  And how is my Medicare doing?"

"It's okay."

"Is something going to change?"

"No.  Are you feeling okay?"

"For now."

"Are you taking all of your medication?"

"Yes.  When I remember."

"Are you still living alone."


"I'm going to give your daughter a call, is that okay?"


"For now on, only tell the answering service your message is urgent if it is a medical question.  I'm not the right person to answer questions about your health insurance, okay?"


"I'll see you at your next appointment."

Wednesday, September 5, 2012

Irregular periods and premature ejacularies.

"I don't think the medicine you prescribed last time is agreeing with me."

"No?  What have you been feeling?"

"Well, I've been dizzy and lightheaded and haven't had much of an appetite."

"Okay, those are all potential side effects."

"I've also been having headaches and irregular periods."

"You've had something that seemed like a menstrual period?"

"If that's what I said."

"You're 77 years old.  You were having bleeding?"

"Bleeding?  No.  Dizzy, lightheaded, loss of appetite, headaches--"

"You're just reading off the list of side effects.  I have that list too.  Are you actually experiencing these things or you just don't want to take the medication?"

"No, I've had headaches, irregular periods, premature ejacularies, dry mouth--"

"I'm sorry, premature what?"

"Ejacularies.  I think that's what they're called."

"You're a 77-year-old woman.  And you're telling me you're having premature ejaculation?"

"I don't know.  Whatever I said."

"You don't want to take this drug."

"No.  I don't need it."

"So you're telling me you're having all of the listed side effects."


"Why don't you want to take this drug?"

"It's expensive!"

"Oh.  Do you want me to prescribe you a similar drug, that has a generic alternative?"


"Great.  Do let me know if you're actually having either a menstrual period or some sort of ejaculation, because then we may have to call the record books."

"Okay, thanks."

Tuesday, September 4, 2012

"Nope, you should actually take your pills EVERY day."

"Your blood pressure's really high.  Are you sure you're taking your medicine?"

"Yep.  Every time I feel it acting up, I take a pill."

"Every time you feel what acting up?"

"My blood pressure."

"And what does that feel like?"

"You know, like a sensation in my blood vessels."

"What kind of sensation?"

"Like a pressure, sort of."

"Okay, that's not good.  You realize you're supposed to take the pills every day, right?  We talked about that last time."

"Yeah, yeah, that's what you said, but I don't want to overmedicate.  So I just take it when I feel something.  Otherwise I don't need it."

"No, you do."

"I don't like taking something every day."

"Yeah, but you need it."

"I just want something that can treat the problem when I have it.  Like Tylenol, or vitamins."


"Yeah, when I eat something unhealthy, I take a vitamin afterwards, to balance it out."

"That's not how nutrition works."

"No, it works for me."

"No, it doesn't."

"I just don't like the way medicine feels.  I don't want to take too much."

"This is a very low dose."

"Can I cut the pills in half?"

"No, it's a very low dose."

"I'm going to cut the pills in half."

"If you're going to do that, I'll give you a larger dose."

"Oh, you can give me a larger dose and I can just cut them in half?"

"Uh, I guess.  If that means you'll take them.  Sure."

"Great.  I mean, I'm not going to take it every day, but I'll take it more if it's only half."