February 22, 2012

• A Panoply of Patient Interactions

  I am backlogged up the wazoo with post ideas, so I am going to vomit one or two out and then hopefully blog em as I think em:

   

  1) Histories

  If you ever wondered why the doctor presses you to give more specific information, it’s because we don’t want our dictations to sound like this:

  Mr. Smith is an old man with pain everywhere for an amount of time he won’t tell me. He rates his pain as “okay” out of 10, can’t describe it, and says it is associated with a funny feeling in his legs. He takes a medication for the pain that starts with the letter R. He is not sure of the dose. He went to an emergency room somewhere for the pain a while ago and they took X-rays and gave him a shot of some kind, which didn’t help. He had an MRI ordered by some doctor. He doesn’t have the MRI or report, but he thinks it showed a disc

  This is how every one of my histories starts, and most of the doctor training is learning how to guide your questioning and direct the pain into something more like this

   

  Mr Smith is an 70 year old gentleman with a history of lower lumbar pain for>5 years as a result of a slipped disc from a skiing injury taken with his grandchildren in 2004. Recently after falling at home, he has noted increased pain sharp in nature radiating down to his legs bilaterally. This feels similar to his exacerbations of his herniated disc in the past, and he went to an ER 1 month ago where imaging confirmed herniation, for which he was evaluated by ortho and given norco until follow up with spine surgery

  See the difference? That’s 3 years of training right there. btw mr smith is entirely fictional

   

  2)Ethics

  I cant believe this actually happened. Via FB message and then chat no less from someone I havent seen since my highschool reunion but is on my friends list because, internet.

  “Hey, I know we haven’t talked in a while, but I just thought I’d call to catch up.”
  “Oh. Okay. Great. What’s up?”
  “I don’t know. Not much. You’re still doing the whole doctor thing, right?”
  “Yep. Third year of residency. Almost done.”
  “Great. So you already have a medical license and everything.”
  “Yes. That is something I have. 
  “Yeah, yeah. So, I was just thinking, you wouldn’t happen to be able to prescribe me some Ambien, would you? I’ve been having a lot of trouble sleeping.”
  “Uh, you should talk to your regular doctor about that.”
  “I don’t really have one. I just thought this might be easier.”
  “Easier, maybe. But I really can’t. I’m not your doctor.”
  “I don’t really have insurance anymore.”
  “Free clinics…”
  “Come on, what kind of doctors are working at free clinics?”
  “Doctors like me. Residents. I think it’d be fine, especially if you’re not working and can wait for a couple hours in a waiting room.”
  “Ugh. That sounds terrible. What if I pay you– not like you’re selling drugs or anything like that, but if I’d have to pay a doctor anyway, I may as well pay a friend what I’d pay.”
  “Not from me you won’t.”
  “Come on. Be a friend?”
  “Not a cool thing to want me to do, I promise.”
  “Oh, well. Figured I’d try. See you around?”

  I mean, really? We dont talk for years and then you hit me up as a dealer? I though I would be further into my career before that started happening

  3) Fun

  Oh clinic Patients, how I have missed you

  “If I use the nicotine patch and the contraceptive patch, do they cancel each other out?”
  “No.”
  “What if I get them confused?”
  “Don’t.”
  “If my boyfriend uses condoms while I’m using the patch, do they cancel each other out?”
  “No.”
  “My friend has some kind of ring she uses as birth control. Can I get that even if I don’t know my ring size?”
  *facepalm*

   

  my schizophrenic patient is telling me she doesn’t want to take her very much necessary medication, because she doesn’t like how it looks.
  “If you don’t take the medicine, you’re crazy.”
  [long, awkward silence]
  “I didn’t mean it like that.”
  “No, it’s okay, I am crazy. I know I’m crazy.”
  “You’re not crazy, you have an actual illness. I didn’t mean to call you crazy. The medication is important.”
  “Well, if you think I’m taking it, you’re crazy.”

   

  Really these should all be separate posts, but it’s just easier to stuff it into a super special post for you guys and then try and get back on track with multiple mini posts as they occur. Thank you, that will be all

   

  -Dr J

  

   

  • 11:57 pm
  • 3 Comments