Yes, and yes, and my hair hurts. Not enough sex right?
After I gave birth the nurses kept coming by to ask how my pain was. They didn’t believe me when I said a zero, so I started taking the offered Motrin so they would stop thinking I was being stoic. I caught a sore throat on day two and upgraded to a one.
And here I thought stories like that were urban legends. 
Actually, it’s not ridiculous at all.
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A woman can be pregnant even though the pregnancy test is negative. (This is rare, but it happens.)
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A woman can have a positive pregnancy test even if she’s not pregnant. (This is rare as well, but it can be a sign of a possible serious ovarian tumor, so it’s something we’d want to catch.)
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Believe it or not, some women don’t have the slightest clue if they’re pregnant or not (or they are in denial), and they just reflexively answer “no.”
We actually don’t get a kick out of annoying patients, hard though that may be to believe. Those annoying routines are there for good reasons.
Yesterday I took someone to ER com[laining of chest pains, shortness of breath, stomach pain ann uncontrollable nausea. I sat and listened to the patient giving bad info to Dr after Dr. I finaly had to tell them she had been drinking at least a gallon of wine a day for the past few weeks. It turned out to be non viral hepatitits. A lady E.R Dr knew she was getting bad info and simply performed physical tests to see where she was tender. She was aying her pain level was a 9 but aside from being sick didn’t appear to be in any real pain. The diagnostic part including bloodwork and scans lasted almost 24 hours. The lady changer her story every 30 min, at first because she was still intoxicated and when she started getting her whits back she appeared to be lieing about some things to get more drugs.
No, you just have a very high serum porcelain level.
There’s a couple of things you miss - it’s not that mixing the Opioids with NSAID is bad - it is that any NSAID for someone with advanced kidney failure (CKD = Chronic Kidney Disease = Kidney Failure) will do serious damage to the kidneys.
Most people can mix and match - this is a disease-specific prohibition.
I know better than to use NSAIDs - I don’t even have any in the damned house, and everyone I see has gone through this idiot Q at least twice - Being a new guy who has gone to the top of the list, I don’t have a regular Nephrologist. Here’s a Q for you: Large Clinic (U of California), young doctor has been there at least 6 months and still no business cards. Why?
She was on her Fellowship - as is the guy I sell next week. He was the guy I nominally “saw” on the 3-day notice appointment. He sat looking at the laptop and asked the NSAID Q (as had the nurse), then sat there some more. At last a senior doc popped in and took over. Yes, HE did the NSAID thing again. 3 times in 15 minutes, the last 2 within 5 minutes.
Why they want to see me is a big Q - all they do is tell me the dietary restrictions.
I still have a narrow but adequate cushion before my numbers hit the zone where the chart tells them to “prepare patient for KRT”. I don’t WANT to be “prepared for KRT” - just give me a dialysis machine and leave me alone.
And show me how to tap a vein so I can mail in the blood work.
Q while we have the medicals here - can the taps used to extract and return blood for home dialysis be installed permanently, or do they need to be changed out every X weeks?
I’ll need to get another CBC and Full Metabolic Panel done next week so we can have something to talk about after the nsaid issue is out of the way.
I just hope Obamacare causes some insurance to become available which will cover dialysis. My current stuff discourages its use. I couldn’t tell how they thought about KRT.
Oh -
I am a white male with a full beard and pony tail, My presentation is unusual. The staff is 98% white at the clinics I use (the they-all-look-alike phenom, while existent, does not apply). Some of the script has to be picked up in person and delivered physically to the pharmacy - when I go in, they can immediately pull the envelope, and STILL want DOB.
Well, at least they give me credit for knowing my name and DOB
Unless that’s the set-up for a joke, you’re sweating the small stuff.
Part of what you are experiencing is a consequence of the electronic health record in its still early form. There is a template for the visit and a standardized approach. They need to go through that template and follow the script. And a senior doc is going to confirm the history a junior doc took. Also much of what the senior does is so routine that by the end he’s not sure if he asked or not. So he doubles back and asks again. Like my Dad and checking if he locked the door to his store: at the door - jiggle jiggle jiggle … jiggle, leave, wait one minute,“Dad did you lock the door?” “Oh crap. I’m not sure. We gotta go back.” … Yeah I was yanking the great man’s chain. (May he rest in peace.)
A Fellow getting business cards from a major teaching hospital? Heck, I am part of a large private practice group and getting our marketing material out is a year long process.
No idea on dialysis, ports, or the current criteria for transplant. Or coverage.
Fellows in our clinic only spend 2 years there. I’m pretty sure they don’t have business cards, but I haven’t asked. And yeah, the senior (“attending”) physician is going to recheck the fellow’s work, both for your own health and for teaching the younger doc. That’s just part of going to a teaching hospital.
We had a patient a couple weeks ago who was in the exam room (in Ophthalmology) and insisting that she didn’t want anyone but an attending physician doing anything to her, including dilating her eyes. Yeah. You have people with less education than a medical student doing that in a lot of places, and it’s just putting special eyedrops in. The attending said no.
(List of reasons to test snipped)
No, actually it IS stupid. If you’re going to run a pregnancy test regardless of what I say why the hell bother to ask me? Seriously. Why waste the time? First I’m asked multiple times if I’m pregnant or not, as if you don’t trust me to answer truthfully, then you go ahead and run the test anyhow, thereby proving you don’t believe a word I say. Just run the damn test and STFU about it if you’re going to simply discard anything I have to say about it.
Look, if you’d just say “Are you pregnant?” and I say “No, absolutely sure.” and you say “Our policy is to run a test just to be absolutely sure, you understand we’re covering our butt here.” I’m totally cool with that. But to be subjected to several minutes of, essentially, “Are you sure? Are you sure? Are you sure?” THEN to be told we’re running the test anyway is just… insulting. Demeaning. I don’t care what you’re taught in medical school, that’s how you’re coming across to the average patient. What do you bother with the third degree when you’re just going to run the test anyway? What do a half dozen or more “no, I’m not pregnant” statements from me gain you? This isn’t an isolated occurrence. I run into this shit every time I land in an ER, and other times on top of it.
Especially the bit about the tumor - let’s say I’m not pregnant but come up positive anyway due to hypothetical tumor. What the hell makes you think I’m going to know I have a tumor rather than a pregnancy? Or that somehow magically this going to be figured out when I say “no, I can’t be pregnant”? What’s going to happen is the medical world will assume I’m a silly ditz who can’t remember if I’ve had sex or not, or if I’ve had sex I’ve messed up with the birth control or, if I say I’m married to someone sterile I’m going to be asked who else besides my husband I’ve had sex with (answer: none although the assumption will be I’m lying) and assume I’m pregnant without realizing it. That tumor isn’t going to be diagnosed for months at best.
The only thing more fun than that is when I get to explain to some ditz that I’m not using birth control because my husband is sterile and we don’t need it. How can I be sure he’s sterile, right? Well, let’s see - 25 years of having sex without protection and no pregnancies, huh, that just might be an indication, right? But wait - he’s actually had a work up in regards to that, it’s medically documented he’s shooting blanks. I just about punched an OB/GYN who then asked me what birth control I used when having sex outside of marriage. WTF? Not “do you ever have sex with people other than your husband?” which I at least understand why a medical professional might ask, because that does happen but “What do you use WHEN you cheat on your husband?” Seriously, the doc can’t figure out that might be offensive, the assumption I’m cheating?
Admittedly, the multiple repeat questioning is dumb. But I guarantee someone’s going to be pissed at being tested even with your suggested method. Can’t make everyone happy.
I agree some docs can use extra “bedside manner” courses, definitely.
The “when” style of question was hotly debated in my nursing classes, and continues to be among the nurses I know. Some people find it offensive for just the reason you say - it assumes you’re acting “badly”. Others find it puts people at ease, because it normalizes “bad” behavior and gets us more honest answers. It skips the step where you have to admit you do that, and that’s often the hardest step to get people past.
“Do you do street drugs?” “No.” (Hell, no! Not gonna admit to that!)
vs.
“What street drugs do you use?” “Just weed sometimes.”
I go either way, depending on the patient and my read of the situation. When there’s a half smoked joint in the ashtray between us, I find the second option more honest.
And I know I’ve shared this before, but here’s why I sometimes repeat questions: First of all, I don’t trust other nurses or doctors. They often don’t ask, or don’t chart accurately. Also, I know patients don’t trust nurses or doctors, or have a rocky start to their relationship and won’t be honest with them, or don’t understand their accents and often can’t understand the question. I’m legally responsible for the accuracy of *my *charting, and if I just copy “No Know Drug Allergies” because that’s what the person who asked you 5 minutes ago put into the computer, I’m fucked when you turn out to have a known drug allergy. Like, lose my job and my license fucked.
But I also cannot tell you how often something like this happens:
“Have you ever been hospitalized?”
“No.”
“Any surgeries?”
“No.”
“Ever have any health conditions more severe than a cold?”
“No.”
“Okay, let me take a look at you. Um…what’s this big scar from?”
“Oh, I had my appendix out when I was 16! They said I almost died, and if they hadn’t gotten me to into surgery right then, I wouldn’t have made it!”
:dubious:
Now, it may not be terribly important to your current condition that you had your appendix out when you were 16. But it makes me not trust that you’re a very accurate historian in other areas that might be very important.
Get rid of medical lawsuits, and I’d be more inclined to treat you like a grownup. It’s me I’m protecting, not just you.
Not saying this is what your providers are doing but I have used reproductive health questions as a quick gauge of a patient’s health literacy. It helps me know what level of understanding they’re coming from when answering my questions and how to answer their questions.
“Any chance you could be pregnant?”
“No.”
“Are you sexually active at all?”
“Yes.”
“Are your partners men, women, or both?”
“Men.”
“Do you use condoms always, sometimes or never?”
“Sometimes.”
“Are you using any other type of birth control?”
“No.”
That’s a very typical exchange. So how does this woman know she’s not pregnant? Because she doesn’t feel pregnant, or her mother had trouble getting pregnant, or she had 1 of her ovaries removed, or she hasn’t skipped a period yet, or she thought 40 was too old to get pregnant, etc. It’s also an opportunity to help someone avoid an unplanned pregnancy. The woman with the history having an ovary removed was shocked when I told her that she could still get pregnant with just 1 ovary and swore to start using condoms because she really didn’t want another baby.
Or because she got her period as normal last week, and hasn’t has sex since then? Because her husband is in Afganistan but she still considers herself sexually active because that means “gettin’ some, when I get the chance” to her? Because she has been previously sterilized and doersn’t consider nonreversible sterilization to be a form of “birth control”? because her only partner is sterile? Because a doctor has told her she “can’t get pregnant” for a specific medical reason?
Just a few examples that don’t involve being a total ignorant dumbass.
True. But those answers can still give me useful information. If she had a tubal ligation and came in with abdominal pain she still needs a pregnancy test because tubals can fail and when they do there’s an increased risk of ectopic pregnancy. If she can’t get pregnant, why not, and could that have any influence on what’s bringing her in to the ED today? If she got her period last week and then comes up positive on her pregnancy test then the bleeding she had last week wasn’t a regular menstrual period. It was breakthrough bleeding and/or a threatened abortion.
IANAD, but in June my mother was diagnosed with end-stage renal failure and began dialysis. I have her medical and legal powers of attorney, so as a result I know more about this stuff than I’d care to. However, I repeat that I am not a doctor or medical professional of any kind.
I’m not sure what you mean by “taps,” but as far as I know the access options for dialysis are the same whether you’re considering doing it at home or not, and they are all (more or less) permanent. My mom was given a cardiac catheter when she began dialysis (while hospitalized for something else), and the surgery for her to get a fistula has finally been scheduled.
Once you’ve been on dialysis for either 30 or 60 days (I don’t remember which) you become eligible for Medicare – regardless of your age. The wait is to make sure that your kidneys don’t start functioning again.
This is the crux of the Patient Honesty argument, IMO. It’s not that most patients are liars, it’s that they are dumb.
Or in pain or confused or trying to save time by leaving out what they think is irrelevant or…and this is our fault…they think that because they told one of us something, the rest of us know it.
I was guilty of this myself last weekend. Brought my 7 year old into the ER on day 9 of a fever, cough, malaise thing 'cause I was afraid she might need IV fluids (and while I was soooo tempted to just do it at home, I was a good girl and didn’t.) Of course, she did that thing kids do when you bring them to the ER: she immediately looked well the second I brought her through the door. Nonetheless, I told the triage nurse, “9 days temp over 102 when unmedicated, persistent dry cough, poor sleep, less than 500mL fluids by mouth times 2 days, no food times 4 days, 2 kilos weight loss in 5 days. Oh, and she threw up tonight when I tried to get her on the scale.”
Saw the ER nurse: “9 days temp over 102 when unmedicated, persistent dry cough, poor sleep, less than 500mL fluids by mouth times 2 days, no food times 4 days, 2 kilos weight loss in 5 days, that’s more than 10% body weight. Oh, and she threw up tonight when I tried to get her on the scale.”
Saw the Intern: “9 days temp over 102 when unmedicated, persistent dry cough, poor sleep, less than 500mL fluids by mouth times 2 days, no food times 4 days, 3 kilos weight loss in 5 days, that’s more than 10% body weight. Oh, and she threw up tonight when I tried to get her on the scale.”
Saw the Attending: “9 days temp over 102 when unmedicated, persistent dry cough, poor sleep, less than 500mL fluids by mouth times 2 days, no food times 4 days, 3 kilos weight loss in 5 days, that’s more than 10% body weight.”
Wasted another hour of dithering because I forgot to mention she threw up to the Attending. The Attending was all ready to send us home with a Z-Pack when that finally came out, and *then *she ordered Orthostatic BP’s to check to see if the child was merely compensating for dehydration well. :smack:
I mean, I should have known that, but I assumed that one of the two nurses or the Intern would have told her in report, or charted it. And it didn’t seem like the most worrisome of her symptoms, and it wasn’t what I was focused on, it was just another damn thing that capped off a crappy week for us both. But it was that one detail that (rightly) changed the doctor’s outlook and required another test.
This, but even worse for us merely mortal non-medical-professionals.
I’ve gone to doctors, on various occasions, prepared to give an arbitrary lengthy detailed description of every detail of my life’s story that I could possibly imagine might be relevant for the current complaint. Hey, I’m not a doctor. I really really don’t know which little obscure detail I might give that would really be relevant.
But doctors don’t have the time to listen to every patient’s whole life story. Almost always, they try to drill down quickly to just the details they think are relevant – but the patient still doesn’t know what he should tell the doc. (I noted earlier – not sure if in this thread or another similar thread – that the doctors have trained me to just give the simplest briefest answers to their question and volunteer nothing more.) As a medical lay-person, I never know what I should tell the doc, and I never know if he’s really getting the right information or if he’s even looking for the right horses.
Note that I get my health care from a major HMO, where the care has always seemed seriously perfunction one-size-fits-all assembly-line style to me.