i consider the kind of question referenced in the OP to be equivalent to questions about my diet, exercise, tobacco and alcohol consumption, and illicit drug use – maybe a bit personal but for valid reasons.
It is one thing to ask a question. It is another to ask it with an appropriate lead-in… “I’m going to ask you some general screening questions”. It is another to ask at an appropriate point (generally later).
It is next level to advocate anthrophagism and make modest proposals.
The list of screening questions could theoretically be pretty long. Car seat direction. Tooth brushing habits. Even the more important ones: smoking products, supplements (which do interact with medicines), exercise routines, dysthymia, stressors, coping mechanisms, gun or medicine cabinet precautions, avoiding too much sugar, sleep hygiene… are likely to cause some defensiveness if they do not derail the greater purpose of the visit. And if time is limited probably are not done often enough - or at all.
You know there is a quote function on this board. If your going to make claims about what people in this thread said you could at least try to use. I’m still trying to figure out where someone said or even alluded to;
That’s just one of the seven points that you specifically say are;
Please enlighten me.
Sure. She’s writing satire. She’s mocking the irresponsibility of many of the posters in this thread. Satire doesn’t have to be literally true or have cites; it needs only to catch the flavor of the idiocy it’s refuting.
Virtually everybody else got this. Moreover, that it was satire rather than a realistic proposal was made explicit. And yes, I can use the quote function to cite a post that you apparently didn’t bother to read.
That’s sarcasm, BTW, another time-honored literary device.
It was obviously satire. I agree with the OP that some questions might seem strange if asked without preamble. Strangely, these are sometimes the most important questions though. And the right questions to ask are very situational.
During years of training, very few of my mentors took the shoes and socks off all the diabetic patients to see how well they cut their toenails and inspect for minor cuts. I only had a single mentor who looked at the shoes of the patients to examine for wear patterns. Does your doctor need to look at your shoes or feet in a time-limited visit about something else? Probably not, but for a few patients it is important. Does your doctor need to ask you if you have ever been threatened? This makes a difference for some patients who are. Medicine is impossible to do perfectly.
Most practioners do it adequately. If you stop trying to get better at it, then you probably won’t get better at it. Like anything else.
Doctors often should not prescribe opioids as a first reflex. But they should almost never ignore pain. Even when it seems dubious.
Of it was clutching at pears and made up bullshit. You can’t just build and attack a straw man and call it satire. Her post was designed to support one side of the argument at the expense of the other.
Can you find any post in this thread that supports what she was claiming about opioids? If it was arguing in good faith shouldn’t we at least be able to trace back what she is claiming. She specifically says “from complaints in this thread”
It puts me in a bad position. I referenced “hydros” in post #48. I know BigT referenced them at least once. But neither one of us said anything remotely like what she is saying. Was that malicious on her part? We don’t know.
Who says?
Everybody else got it. Sorry humor isn’t your thing. Most of us enjoy it immensely.
Thanks for saying succinctly and so eloquently what I was thinking. I agree completely.
Pediatric side here.
First the mea culpa for our profession. Like other humans we sometimes attend more to the bright and shiny than where facts would lead us.
In peds of course we do a lot of these sorts of questions. Not at every sick visit but at well ones for sure. Safe storage of medications, poison control’s number, car seat use, so on. My standard schtick includes moving from discussing developmental milestones at 6 months and what is likely to happen over the next three months, “object permanence” (can think of things when out of sight), mobility, fine motor skills, etc., into a discussion of why the next few months are the most dangerous age until teen-aged years and that the child safety arms race is on. Guns in house and safe storage is certainly part of it. Lots is obvious, some less so, and just today had a mom who hadn’t yet thought that Dad’s guns, that he keeps in the bedside table and in the car, need to get locked up in a safe beginning now.
Of course some will roll their eyes. Some won’t listen. But some do. The one time that I got a call from a mom who told me that after our visit her son started wearing his bike helmet, and that he had just come in thinking she’d be mad because he cracked it in a fall … paid for many thousands of times that the kids ignored me and left the house with helmet attached to helmet bars yelling “got my helmet ma!”
But the mea culpa is that while gun deaths from suicide are in fact not so far behind even motor vehicle accidents, and safe storage from the moment a child is mobile is important, as a group we likely remember to mention that more than we consistently discuss drowning risks in kids under 5, the leading cause of death in kids 1 to 4 and number 2 for 5 through 14. Quiet and quick accidents. But not as in the news.
Working on it. Or at home before the visit so it can scored before arrival and flagged. But not everyone is so technologically literate and doing it at the touchscreen which is not in private not such a great approach.
But here’s the thing. Medicine is NOT just you as the patient. Shouldn’t be. We really do need to think of the population as a whole as the patient as well: population health.
And yes MONEY comes into play. More and more of what doctor groups get from insurance companies (and thus the docs one way or the other) is not based on volume, but on population wide “value-based care” quality metrics. How well your group is doing on various population health metrics (from blood pressure numbers, to rates of colon cancer screening, to documented screening for depression, rates of documented nutrition counselling, to eye exams in those with diabetes, to immunization rates, to documentation of discussions about smoking, falls, so on) … all get measured and the group performance on these measures translates into payments received or kept back. Quality as so measured gets attached as part of a star rating as well, driving patients to choose your group.
What gets so measured gets attended to more often, and when patients do not come in for regular care, but only for problem visit associated care, those problem focused visits have to get utilized. As a group we achieve great scores on population quality metrics by designing the systems to do so. Use every contact as an opportunity. You might not get another.
Someone who never goes into the doctor except for a sore toe, and hasn’t otherwise been in for years, is going to get those metrics done then. Ideally. Yup, checking your blood pressure and bringing it up even though that is not the reason for your visit. Not treating it on that day one, but identifying it and arranging for a follow up. Ordering your colonoscopy if you are overdue, doing the advised depression screen, so on. I am not aware of gun ownership and storage as part of those value-based care metrics but it is important to know in the context of once depression risk is identified, if nothing else.
So also yup, that makes those visits crowded because, rightfully so getting those things done are important to treat the health of the population overall, and we do it when we can.
Hey, I had the jelly detatch from the back of my eyeball, and I was seeing the eye doctor regularly to monitor it, and EVERY FREAKING TIME I went in they measured the pressure in my eyeball. I mean, I get that glaucoma is a big deal, and needs to be tested for and all that… But… I was just here LAST WEEK.
(My eyeball pressure is normal)
That’s great that your pressure is normal. I had vitreous detachment in my thirties. It’s increasingly common with age, so I like to think I was just ahead of my time. 
As eye docs have explained to me, vitreous detachment is a risk factor for retinal detachment, which can be associated with glaucoma (and is serious even without glaucoma), so it’s good they check your pressure. Frankly, though, they’d check anyway, just like your PCP probably checks your blood pressure, even if you were there a week ago. And just like hypertension, glaucoma can sneak up on you fairly quickly. One visit my pressure was OK, and the next, a couple weeks later, it was high. I have optic nerve damage from that high pressure, so I don’t mind that they check every visit, even if I was in a few days earlier.
Wishing you continued good news, eye-wise.
The fact that you are in your late 60s and have health issues is probably the reason that they ask if you’re able to care for yourself without assistance. I am in the same situation as you regarding age and health, and though I’m able to care for myself now, it’s getting much more difficult to cut my own toenails. Just a little less flexibility and I might be unable to do a lot of other necessary hygiene-related tasks. I figure it doesn’t hurt to ask a question. I’ve never been asked the question about guns in the house though.
Thanks.
I don’t really mind. It’s just that usually i don’t see the doctor more than once a year, so it seemed funny to be monitoring the pressure that often, when they obviously think it can usually wait.
(And i put off this year’s appointment until summer, due to covid. I was betting on seasonality driving the numbers down, and that plus the vaccine seems to be working.)
If you want to get a long exam from someone who is really interested in your issues, go to a teaching hospital. I go in for relatively routine stuff, like having a dermatologist examine my hide. And i get some fourth year medical student looking really carefully, because he hasn’t done this a gazillion times and he’s actually interested. Then the experienced doctor comes by and also examiners my skin, answering both my questions and the questions of the medical student.
I mean, I did have some student doctor fumble around and fail to insert an IUD, and he had to pass it off the the experienced doctor. But that was only slightly more unpleasant than if she’d just done it herself.
(And you do get to consent or refuse the student’s work every time. But i always consent.)
We’re living in a time where there is a seismic shift from odds- and averages- based medicine (because that was the best we could do) to personalized medicine, based on no end of individualized markers that can serve to make medicine safer and more effective.
Simultaneously, I’d like to hope that we’re living through a transition from a largely disease-based model of medicine to more of a prevention or wellness based model.
In the latter, I would expect a whole lot more questions on the front end – a more proactive than reactive approach.
And, like most changes, there will be some discomfort in this one. But I think both (from averages to personalized, and from symptom-based to preventive*) are the right goals.
[—]
*This is a generalization, obviously. Not every provider, and not every specialty, ignores ‘prevention’ or ‘wellness,’ but it’s not hard to make the case that we’re farther in the ‘reactive’ direction than we ought to be. It’s also hard to argue that health care, as it’s currently constituted, isn’t a textbook example of perverse incentives.
An example of the sort of questions doctors should be asking, arguably, is given by the HEEADSSS questionnaire. Pediatricians do the best job of asking these questions, but they might apply well to the elderly or many others.
https://www.starship.org.nz/guidelines/adolescent-consultation/
Do we pediatricians cover those questions with adolescents? Mostly, to some degree or another. But to the point of the complaint of the OP - not when the teen comes in with a focused complaint of toe pain. They’ll get their height weight and blood pressure done if they have yet been done for the year, but the depression screening questionnaire and such are saved for the well care visit.
And that is to the point I was trying to make. We have the luxury of usually getting those well care visits, and usually have long term relationships to boot. I’ve not only known many of my teen patients since they were newborns, for a growing number I’ve known one of their parents since they were kids. Recently I’ve had newborns who both parents were my patients as kids! No my memory is not so good that I remember all the answers to those things for each of them, but I have my chart to skim before going in the room. Doing these things as updates, conversationally, is something relatively easy to do when you’ve been seeing someone every year. Or even if it has been two. And my WAG is that most docs caring for adults do such over the same subjects when they see their patients for regular well care, with the checklist something done automatically in their head, not read off a list and checking boxes on the screen. In that context these questions are the meat of developing a relationship with a doc who actually knows who you are, and that relationship translates into the ability to potentially impact behaviors that matter.
So again, if people like our OP went for regular care visits, there would be no need to shoehorn those checklists into a focused sick appointment … and covering these items, screening for a host of issues, would feel more like natural conversation with someone who is concerned about you. (Or at least already done as a checklist before the doctor even came into the room.)
I completely agree that something like HEeADSSS should be utilized by those who care for the elderly perhaps more than by those of us who care for teens. We at least usually have parents who often raise a concern flag still. Elders, especially those most at risk, may not, and may be embarrassed to bring things up on their own.
I had assumed there were such mnemonic devices used on adultside too. There aren’t?
Most of my work has been as an emergency doctor. Focusing on the big problems sometimes means not spending enough time on the small ones. I’m sure there are plenty of mnemonics, though the activities of daily living (ADLs) tend to be a focus in the elderly. To be honest, I would tend to focus on the questions that seem most relevant to a specific presentation. I would ask an elderly patient about nutrition and weight loss, mood, exercise, mobility and risks for things like falls, fears, relationships, abuse, subjective cognitive deficits, ADLs and expanded ADLs. Things like drugs, alcohol and smoking might be more situational (I.e. in the presence of associated disease). Things like guns, drug use and seat belts might rarely be discussed at all.
That’s not to say things like vision, hearing (a whisper test), balance (get-up-and-go), incontinence and advance directives would not also be considered. I do not use a lot of mnemonics - sometimes with rarer situations, when I need the memory jog, when I’ve always done it that way as part of a complex differential diagnosis, or when something needs to be concisely documented. I do not need mnemonics for bread and butter stuff seen many times a day.
Perhaps. I walked around for a few years with a chip on my shoulder about docs because of the mistreatment of a few. (Vitamin D for chest pains??? I think not.) But then I got a nice GP, who actually listens to me after I accused her of not listening and she teared up. She wasn’t listening, she confessed, she just had too many patients to cope with the whopping 10 minutes she was allowed with each of us. So now I do major research on my issues before I visit because I know her time crunch and she listens closely to what I ask her about. Honest communication is a way we both win.