Question for physicians [patients exaggerating symptoms]

In My Humble Opinion
41

Yes, NSAIDs are exceedingly bad things to take with CKD - I KNOW
I KNOW
I KNOW
I KNOW

I have been told this by at least 8 different people (medical types, message boards don’t count (sorry, guys - I still respect you)).

I cannot go the a nephrologist without being told. Twice in a single hour.

I also have script for two benzodiazipine sleepers (ins only pays for 1/day and sometimes (often) it requires 1 1/2 - 2 to work (record: 4) (yes, VERY high tolerance of all forms of CNS depressants)). The damned druggist has now pulled me aside 8 times to tell me not to take them together. No shit. I’ve been running dual scripts for over 10 years, and am still alive.
Although it is somewhat disconcerting to read of a fatal accidental OD when the article lists the drugs, and realize that I have all of them in the house. The dosages I use to get to sleep would knock out a horse (mirtazipine, temezepam or clonezepam, 75 gm ms contin, Atenlol, OTC Iron and vitamin/mineral supplements.

Yes, when asked to list all meds, I include OTC. I do usually skip neosporin or other first-aid drugs.

After being repeatedly told that I have not used a NSAID in 10+ years, you’d think they would take my word for it. But no, “May this time he’ll 'fess up, and we’ll nail his ass!”.:rolleyes:

42

Hyperbole and a half! she is the greatest! I really miss her twist on humor.

sorry for the slight derailment

43

I’m betting it’s policy. They don’t want you to die - especially on their watch - and they don’t want to get their asses sued off by surviving family members who would insist “but so-and-so always followed his doctor’s orders and he would never have taken that aspirin for his heart if they’d have told him it was bad!” So they probably have a standard operating procedure memo and maybe specialty guidelines from some medical association, and possibly a checklist used for each patient visit.

44

Her excuse is always “but we have to caution you - it’s policy!”.

I finally got her to stop by pointing out that there was another pharmacy across the street which would not be a problem for her to fill one and the folks across the street to fill the other.

And my next-of-kin would be too busy celebrating my death to do anything more than profusely thank anyone who might have helped it along.

How old do you have to be before the medical profession treats you as an adult whose thoughts and observations just might be of interest?

45

I actually do have monocular diplopia (caused by map-dot fingerprint dystrophy) … and was surprised and frustrated at how difficult it was for doctors to accept this, even saying loudly and slowly:
“I see double with one eye closed.”

Another side of the coin is that patients can have information difficult to put into words. For example, I’ve had many sore throats in my life, but always know whether it’s strep throat or not. The strep throat is more painful, but it’s more than that – strep has a particular type (“flavor”) of pain. But if there are particular words for different flavors of pain, I don’t know what they are …

46

As soon as my workplace treats me similarly - I’m supposed to verify two different identifying pieces of information at each visit (like date of birth) for patients who I may have known for years, who insist that I call them by their first name, etc. - I’ll let you know.

Technically, it is entirely possible that I might bend that rule when no one else is in earshot. :rolleyes: So if you get an employee who understands you and isn’t around someone who might write up/yell at/fire/whatever that person, maybe you’ll get lucky too. I understand the irritation, trust me.

(Recently as a patient, I got The Look from an attending physician and resident when I came in with a cold that I insisted was bronchitis and which absolutely prevented me from sleeping. I wanted something to help me sleep so I could stop being a zombie from waking up every hour or so, not a damned antibiotic prescription. It didn’t help when the resident told me that my tonsils weren’t inflamed. I told her that was good, since I didn’t have any. Prescriptions for Cheratussin and Tessalon pearls later, adding those meds to a dose of NyQuil plus propping up on pillows, and I could finally sleep. And the bronchitis hung around for a few weeks.)

47

It’s not that monocular diplopia can never happen…we almost never say never. It’s just an example of a screening question to cut through the exaggerators.

Part of taking a good history is deciding what personality is sitting there. “Trick questions” are never meant to be definitive about a possible diagnosis; they are mechanisms to evaluate personality.

If you know when you have a strep throat, that’s quite remarkable, although a classic acute streptococcal tonsillitis does have a reasonably typical presentation. Most sore throats diagnosed as “strep” throats are not really caused by strep, even when strep is cultured (or diagnosed with antigenic testing). The only real way to diagnose strep is a change in serologic titers and we almost never do those. Many, many people carry strep asymptomatically, so antigenic tests and cultures are not as diagnostic as people (and some physicians) think. But that’s a whole other topic…

48

Last time I went to my PCP with Bronchitis, she assured me I’d be fine. I’m a guy who can’t afford medical care unless my insurance picks up the tab. I get 5 “office visits”/year - she thought I would burn one of them for a 'nothing to worry about". I should have presenter her with the ER bill - I had to have someone else drive me - being unable to breathe makes driving iffy.

Still - why the repeated idiot Q about my recent use of NSAIDs? I know better, They never did work well, and haven’t done anything for 10 years, I have opioids in my pocket! Still, I can’t talk to anyone in dept 0200 without being asked/accused of destroying what’s left of my kidneys with “Tylenol or whatever on you use?”.

These people have a penchant for asking DOB - I can present my ID card (with DOB) and I still get asked. Like I have the card but am too stupid to know what is stamped on it? That would be up there with having a stolen ID and not bothering to even know the name on it.

49

Those overly paranoid questions about your identity, asking for twelve pieces of picture ID and your birthdate, etc., are there for a reason that patients should appreciate.

There have been too many stories over the years about patients accidentally getting treatment intended for another patient, or getting another patient’s pills, or getting diagnosed on somebody else’s blood sample, stuff like that – occasionally with tragic results, lawsuits, and bad karma all around.

It’s because of cases like those that medical providers have become paranoid about being so SURE SURE SURE that the patient they are dealing with is the patient they think they are dealing with. That’s why, for example, they ask you to verify your birthdate even when it’s right there in the chart in their hands – to make double-triple-damn-sure they have the right patient’s chart!

So it’s a good thing that they are deliberately asking you questions, even thought they already know the answers. That’s why they do that.

50

usedtobe:

So what you want from your interactions with healthcare is that they assume you know things that many other patients do not know and not ask you about those things, things that would be very important for them to find out about, information that if present would be a great risk of harm, because asking you is an insult to your high IQ? Heaven forbid your great intellect get insulted. Smart people can never do stupid things or be ignorant about something.

Policies and procedures designed to systematically reduce patient harm and prevent errors should not apply to you because they should recognize that you are special.

And if you come in you want medication prescribed even if the doctor’s assessment is that at that time there is no indication for it (because you wouldn’t be wasting an office visit unless you already knew you needed medication)?

Staff is trained to confirm that they have the correct John Q Smith or usedtobe by verifying the DOB on the chart they are opening is indeed the same DOB as the person in front of them. They are trained to do it so much that it is habit even if they have a card with the DOB in front of them. These habits prevent errors such as entering information into a wrong chart or getting information that does not apply to the patient who is there. But they shouldn’t do it to you because you will assume it means they think you are too dumb to know your DOB?

As a patient if I had to choose between a healthcare provider assuming I know something already and therefore not telling me something that would be important to know, and treating me like I know a fraction of what I already know, I would go with the latter every time. And that is something that I am at risk for: just because I am a doctor does not mean I know about things not in my immediate field. I am fine with you calling it “a numbing medicine” so long as you also give all the information I need to know because I might not know all you presume I do. I know pediatrics; I don’t necessarily know about adult medicine too well. Mind you if I knew the standard questions and disclaimers I might try to save time and volunteer the information right off: “I am not taking any NSAIDs and I am aware that I should not mix medications X Y and Z.” But that is just me.

51

Plus sometimes computers or charts are wrong, or people don’t check that stuff and shit happens. My husband was named after his father and we live less than 5 miles from them, so occasionally they are seen at the same hospital or in the same clinic system. When a 40-year-old man is getting bills for his geriatrics visits, you know someone along the line wasn’t doing their job of double-checking DOB. I work for a large hospital and it’s rare that I don’t see duplicate or near-duplicate names when I look up someone in the system.

I had to register a new patient in the hospital’s system, and called the clinic (not on the same system) to get DOB as one of the minimum pieces of info required. Since he was new to them too, they didn’t have much demographic info, but I verified what doctor he was a patient of and on what date and time he was due in the clinic, so this was the guy. I put it into the system. Later, Registration called me to warn me that they called the patient to complete the registration process, and this was not the correct birth date, as in wildly different so it wasn’t just a transposed digit! The clinic had somehow received the wrong date of birth on a patient they hadn’t seen before.

As a patient, someone managed to associate the wrong chart with my (outpatient clinic) exam room in the short time between showing me into the room and about a minute later when the chart went into the door pocket. The nurse had read my name off the chart (and it’s definitely not common), weighed me, then put me in the room, and shortly after that, the wrong chart was put in the bin on the door, as my doctor asked me if I was there for surgical clearance. Nope. She excused herself and stormed out of the room for a couple minutes’ worth of “discussion” with her staff.

52

As mentioned by other posters, but heck, I’ll say it again, just like I’ll ask your date of birth again - it’s not always to identify YOU in a practical sense (in a legal sense, it is)…it’s to make sure I have the right chart. I don’t mean to be rude, but…you may have half a dozen nurses. Your nurses have hundreds of patients. It’s a lot easier for you to remember them than for them to remember you. You’d be surprised how I can remember how many kids you have, that one’s in the Navy, and how’s your dear old mum who fell and broke her hip? I can do plenty of detailed small talk that makes you think I remember you, but on the other hand I can’t recall if you have ESRD or pancreatitis, much less if you’re the one who’s good about not taking NSAIDS (and Tylenol isn’t one, by the way, and it’s not particularly hard on your kidneys, so no, you don’t know as much as you think you do).

My teacher in nursing school intentionally gave me Mary A. Smith, DOB 01/10/1928 and Mary E. Smith, DOB 01/01/1928. Same hospital floor, two doors apart. Both there for complications of a UTI. One was allergic to the medication the other was taking. Can you say final exam?! (I passed. Didn’t kill either of 'em.)

So yes, I check DOB, and full name. It was an effective lesson, and one I’m genuinely proud that I passed as a student. Didn’t stop me from nearly messing up last month, when I went to visit two new patients who lived in the same building. Luckily, I didn’t get past the name check before we figured out I’d gotten turned around at the elevator, and knocked on 2D when I’d meant to knock on 2B.

It’s not because I don’t trust YOU to know your birthdate. It’s because I’m human, and I fuck up, too. I’d rather we find out I’ve fucked up *before *I have to go running for an epi-pen.

53

I don’t mind the constant reconfirmation of my name, DOB, etc. but what gets me and things like:

“Are you pregnant?”
“No.”
“Are you sure?”
“Absolutely.”
“OK. Now pee in this cup so we can do a pregnancy test.”

WTF? Look, if you’re going to do the test anyway why bother to ask me? Really, that is just ridiculous. I know why they want to check for pregnancy in many cases, what with all the complications that can bring to medicine, but don’t give me a third degree then do the test anyway. Just do the frickin’ test already, OK?

There is a nasty, damned-if-you-do, damned-if-you-don’t aspect to medicine these says. My spouse keeps an updated list of his medications and supplements and when he’s going to a doctor he prints it out and when the inevitable questions about “what are you taking?” come up he just hands it over - it’s been completed in non-stressful conditions, it’s neat and readable, and nothing is forgotten. Some doctors love it. Some act like it’s proof of being psycho, overtreated, or drug-seeking.

Then there are my allergy problems. If I hear “multiple food allergies are rare in adults” with that condescending tone that says the medic thinks I’m nuts one more time I’m going to scream. I KNOW it’s rare! It’s not MY fault I won the allergy lottery! I suppose I could just NOT tell you and erupt in hives or rashes or just up and stop breathing, would that be better? Although, despite also having a complete, updated list of my allergies much like my husband has for his medications (though not nearly as long) the local hospital still has one of them wrong - they have me as allergic to “citrus”. I’m not allergic to all citrus, just oranges. Why just oranges? Damn if I know. Grapefruit, limes, lemons, etc. all no problem. Oranges result in hives and wheezing. I can NOT get them to fix it, it makes me wonder what ELSE they have wrong in the chart… on the other hand, being limited to non-citrus won’t kill me so I stopped trying, I didn’t have the energy for it. It’s bothersome, though, that there’s an inaccuracy in the records I can NOT get fixed. And even so, I had them trying to feed me orange jello at one point. Granted, it was artificially flavored but I didn’t know that when they put it in front of me, it wasn’t labeled, excuse me for being paranoid but, you know, I’m just recovering from a week-long severe illness I don’t want a severe allergic reaction on top of that, m’kay?

At least my PCP is decent about all this (and I forgive him for calling me “the allergic one” as it is, unfortunately, a good descriptor for me). Then again, he’s seen enough of me being highly allergic and reacting to things to no longer doubt I’m allergic. He’s also figured out I have a high pain tolerance, so if I come and say “it hurts” he believes me without diminishing my symptoms.

But when you’re sick/injured/in dire straits and you have the eleventy-seventh person come in and ask you the same damn question AGAIN it gets just a touch annoying.

54

Because when your test comes back positive for pregnancy, I want to know how many bodyguards I’m going to need when I tell you. Each level of surety gets me another guy in the hall. :wink:

55

This is cracking me up, I’ve been getting emails from my doctor’s office, “VOW missed an appointment in Radiology.” Hubster would call, and he’d be told the doctor wanted an xray of my back.

I’ve had everything else xrayed, but my back has never been discussed.

Finally, one day when we were making appointments at the clinic, I told the MA at the front desk, “Get rid of that referral to radiology.”

“Doctor wants an xray of your back.”

“No, Doctor has never even LOOKED at my back. We’ve never even DISCUSSED by back.”

“Just go get the xray.”

“NO. Talk to Doctor, do what you need to do, but get rid of the request.”

Then I opened a new can of worms. “I need a referral to get an MRI of my knees.”

“Well, you should get an xray of your knees first.”

“NO. I’ve had repeated xrays for years, and they don’t show anything, which is why I need the MRI done. NO XRAY.”

I felt like banging my head against the counter, but I probably would have had to get an xray for that.
~VOW

56

This made me laugh. Have you ever had someone who claimed she’d never had sex come up upreg positive? I have. It turns out that there was this one time last summer…

57

Not yet! :smiley: Did you have to tell her, or is that something we can pawn off on the doctor? I’d be all, “Nuh-uh, I ain’t telling her - YOU tell her!”

58

There are nurses who will have that conversation with the patient? In my ED the nurses bring the result to me and let me deal with it. “Hey doc, does the patient in 6R know she’s pregnant? Because, ummm…” Especially fun in pediatrics.

59

Hell, I had a woman who delivered her baby on a gurney in the hallway tell me that the baby wasn’t hers, it hadn’t come out of her!

60

I’m really not trying to be nitpicky here, but Tylenol isn’t an NSAID. And, as I understand it from my admittedly limited exposure to pain medication, one can take NSAIDs with Tylenol if there are no contraindications for either medication. Most formulations of narcotic pain medication, though, contain between 325 and 500 mg of acetominophen per pill and if a patient is taking any OTC, he can easily overdose. On the other hand, I once was prescribed hydrocodone with acetominophen and the doctor also suggested I take ibuprofen in between doses to bring the inflammation down.

I get your point: you’ve probably been a patient longer than some of your providers have been practicing medicine, and you’re intimately familiar with your condition and your medications. However, I can see why medical professionals of all types would rather err on the side of caution and annoy you with repetitive questions than possibly miss something and end up making things worse.