......These are the words that I wailed, as I finally left my consulting room this evening. The receptionist laughed her throaty laugh, and didn't try to console me with platitudes. She knows I'm telling the truth... or at least a partial truth. The fact is, as much as you might think that patients come to see a doctor to get medical advice, this is often far from the reality. Why seek advice from Dr Jellyhead, when you can consult the latest issue of Woman's Day? Why ask my humble opinion about a symptom when you can google 'sore throat' and conclude that you have acute thyroiditis? Why bother to ask the GP what they think, when your neighbour can tell you across the fence that you definitely have what she had last week? (which needed that particular medication to clear it up). Just figure out your own diagnosis, then come to the GP to demand the appropriate tests/medication/referral to a specialist. (Am I sounding a little bit *TETCHY* here?!!!!)
Today, a young man of 16 came to see me with his mother. The boy, 'Nate', walked in with a slight limp, and his ankle was mildly swollen. He explained he'd played a game of football the previous day, and noticed his ankle to be sore as he came off the field. He couldn't recall noticing anything amiss before that moment. No pain, no' snaps' or 'cracks'. This morning he found the ankle was more sore, and had swelled up.
Now this boy's mother was a nurse, and as much as I have great respect for nurses in a medical sense, they are often terrible patients, and terrible patients' mothers (Heather, don't hate me for saying this! I'm not referring to you! And I'm sure doctors as patients must be the all-time worst!). Nurses have seen too many dodgy doctors, they have seen too many serious illnesses and complications. The nurse patients that drive me crazy have reached the stage of distrusting everything a doctor says, and fearing every illness or injury is their (or their child's) last. I understand this, but nevertheless it drives me nuts.
So I see Nate, and check him over thoroughly. His ankle is minimally swollen, not at all bruised, stable, and he was able to bear weight easily. It is not broken. I'll run up & down my street naked tomorrow if that ankle is broken. ANYWAY. I tell the mother why I think it is a sprain. I tell her that it would be extremely unlikely that someone could break their ankle and not notice it. I ask her to continue with the treatment she's given Nate so far. And, to appease her(because I know she's worried), I give her an X-ray form, to use if the ankle gets worse, or doesn't improve over a few days.
Sound like sensible advice? Well of course it was - I'm full of sensible advice. Ask me any question, I'll give you the sensibullest advice you could ever imagine. But did the bad bad Nate's mother take any notice of what I said? Nooooooooooooooo she did not. Later this afternoon, we got a from call from the local X-ray facility, asking a question about Nate's X-ray form. Nate and his mother were there, getting the X-ray already! HMMPH! Pah! Stomp! *Various other noises of the temper tantrum variety*
I'm nothing but a writer of slips, a paper pusher! I am a referral service!
Also, I'm a whiny baby. Whining in my blog, over and over...... nooooo-one listens to meee!!!!
13 comments:
I'm kinda hoping that Nate's ankle IS broken. ;-)
Seriously, It must be exasperatingly (is that a word)frustrating to have your advice turned aside. If you don't confirm the pt's. or pt's. mom's predetermined dx. you must be a quack. I find that when I recommend a specific anesthetic for a specific reason, frequently the pt will say; NO, I want to be completely out! I might say, if suitably frustrated, OK, it's your life. ;-)
rel
Several years ago I fell down the stairs of a police department. I went to a local island doctor, not to the hospital. He x-rayed the injury, and told me that I had a sprained ankle. Having played sports when I was younger, I knew what a sprain felt like. This one took about a year to get better, I kept having a sharp pain in the heal of my foot. Five years later I had another x-ray for a twisted ankle, and my regular doctor asked me when I had broken my heal bone; he could tell it was an old break, because the sharp bone had worn down. Sometimes one should get a second opinion. I should have gone to my regular doctor, or the hospital in the first place. SOME doctors are wrong, and I think SOME patients are wary. Don't take it personally!
I always listen to my doctor... as long as he agrees with the medicines the tv commercials tell me that I need.
I read somewhere recently in a blog that a man took his five-year-old son to a physician for something. At the end of treatment the doctor asked, "Any questions?"
The dad said no, but the kid pipped up echoing the tv commercial, "Dad, aren't we always supposed to ask the doctor about Viagra?"
You know...you are absolutely right. We consult WebMD figure out what we have and call the doctor for the needed antibiotic, only because we can't prescribe it for ourselves.
I admire your courage for speaking out about this problem. It's good to hear from you what our personal doctors don't tell us. They don't tell us that it bothers them when we diagnose ourselves...they just go along with us & write the prescription, which of course, they get to choose.
We have been told so many times that we should take control over our own health and know our bodies that we have apparently taken it too far.
From now on I'm going to listen to my doctor, after all she's the one with the advanced degree...And she's the one that should make the decisions concerning my treatment.
Jelly, with easy access to the internet (Google ANYTHING), reality TV, "knowledgeable" friends and family, and all sorts of self-help books, people today are much more knowledgeable about their physical conditions. We (the medical community at large) have been telling patients for years to be more proactive in their own care; to be a watchdog to cut down on medical errors; and to get second opinions if they don't agree with the dx of their primary care physician.
After all this "free" advice from everyone under the sun, how can we not complain when the patients do not take the advice given them. They have been taught to distrust.
I can understand your frustration in dealing with non-compliant patients. I, personally, do EVERYTHING my doctor tells me to do. He's the one who graduated top of his class from medical school; he's the one who has been practicing for almost 30 years; he's the one who knows me best after having treated me since he began his practice. Why wouldn't I trust his judgment? If I wanted to act like a physician, I would have gone to med school myself.
Thank you for sharing this intimate moment with your patient "Nate."
BTW, I loved John Cowart's little story.
I've really enjoyed reading all your comments so far. I am reminded again that people DO need to be pro-active about their health, and that it's good to have health knowledge, and to ask questions. I regard the patient-doctor relationship as a partnership, where they give me information (about their symptoms, about what THEY may have read or researched, and by allowing me to examine them), and then I offer my opinion, and suggest options for treating their problem. Often, formulating this management plan is a process of consultation and negotiation. I have no problem with any of this. In fact, I enjoy the fact that patients these days don't put all the responsibility for their health care decisions onto me. They have choices; they can express preferences.
What I DO dislike is being treated as though my opinion is to be disregarded completely; as though I am merely the means to an end - an end that the patient has decided on by themselves. Take Nate's mother - she has spent money from the health care dollar, she has caused Nate to be exposed to unnecessary radiation (albeit a small amount), and she basically ignored everything I said to her. Why? I suppose she think she knows better.
Tuff, I absolutely agree that fractures can be missed. And I am a cautious doctor, and would have been happy if Nate went ahead with the X-ray if he didn't improve. But your case was quite different - you fell down a set of stairs! This kid didn't even notice his injury occur!, and was walking on an ankle that was only very slightly swollen. I guess I am a fairly conservative doctor, who will always look into things further if I even have a shadow of a doubt. I didn't have that shadow this time, but I still allowed for the fact that I could be wrong, by suggesting an X-ray if things didn't settle. That was all ignored by Nate's mother.
I guess I am just being sulky! It wounds my pride to be so blatantly disregarded. But you're all right - I shouldn't take it personally. This lady may have an excellent reason to be so mistrusting of doctors, and I need to understand that.
I Listen to you Jellyhead!!! And I really would if you were my Doctor too. If I do go to the Doctor I usually say "I am only here so you can tell me there is nothing wrong".
Hope someone listens to you tomorrow!!!
shelly
How exasperating for you. One of my biggest peeves at work is when people don't listen to what I have to say in my area of expertise. I don't know everything, so I rely on professionals in their field to advise me on the best course of action. I would feel truly guilty if I wasted a professionals time (and to a lesser extent, my time and money) by completely disregarding their advice. This doesn't mean I follow things blindly - nobody ever said I couldn't ask questions.
We're listening, Jelly, that's why you have a blog, 'cause you know all of us will listen to you!
You want to be our physician? We could blog medical questions to you and you could treat us over cyberspace... whatdyathink?
Aw honey, I know, no one listens to you...I know people think you're "only" a doctor, and that's not a reason for you to diagnose illness & injury...damn psychotic hypochondriacs! (just giving you a verbal HUG here!)
Oh I can understand your frustration. My husband used to work at a community hospital so through his relationship with various doctors I think we've become more understanding of what they sometimes go through with stubborn patients. Plus there is Gramma A, my husband's 82 year old grandmother who is convinced that all doctors are in on some sort of conspiracy theory to empty her wallet of every penny. Crazy!
Frustrating indeed! I'm always SO interested in what you have to say Dr. Jelly, and I listen to EVERY word...if that's any consolation :)
Seriously, I don't blame you a bit for being so aggravated. Some people can't be told ANYTHING! I feel sorry for Nate!
I enjoyed reading what u had to say. However, being one of those RN mom's I have never doubted what my doctor has told me about my children's health or mine for that matter. I have a great rappore with my doctor. I don't question his dx or choice of treatment I do ask questions about what he knows or heard about certain treatments. I ask him about medications and interactions. I think it should be team work....the doctor and the patient working together to maintain ones health.
Now with that being said. My youngest daughter in her short 13 years has had to deal with her share of mishaps. It's funny u should mention about the young lads foot. My daughter use to do gymnastics lots of tumbling etc. She isn't a complainer. After about 2 weeks she says to me mom, you know my foot is kinda of bothering me. Let me have a look I say. Asking her all the pertinent questions it was determined that she couldn't pin point when she could have injured it. It didn't look swollen or bruised but there was a prutruding bone on her foot. She was still able to run around but it just hurt she would say. So when we had to go to the doctors for something else which I didn't take to serious at first but turned out to be cancer,I mentioned it to him. long and short of it was we had it xrayed and yes she had broken the bone. But because it was such a long time ago it didn't warrant further treatment. So I guess what I am saying....I think I am one of those RN's who doesn't like to go to doctor's as I fear they will think just as you think...that we think we know it all. I am far from that. I am a critical care RN but like motherkitty said if I wanted to be a doctor I should have gone to med school. I respect what most doctor's have to say. But in any profession there are people who don't stay current etc. on things they should. Hence one might question the individuals actions.
Thanks for sharing....I really enjoyed reading your blog
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