What kind of questions should the doctors be asking???

In My Humble Opinion
1

Or, did the parents’ doctors drop a whole lotta balls?
Background info (tl / dr):
My husband spent a week visiting his parents in their retirement home a thousand miles away, after FIL had a cardiac procedure while his wife was still in rehab from surgery.

FIL has numerous health problems, including imperfectly-controlled Type 2 diabetes (brought on by topology, as apparently a spherical shape is idea for everything except human bodies) and numerous sequelae from that.

The man is a poster child for obstructive sleep apnea, but no doctor ever asked him if he snored . No doctor had ever referred him to a dietitian to manage his eating. He has never had a colonoscopy (in fairness, we don’t know if it was suggested and refused, or never suggested).

He actually had a sleep study a few months ago (at our nagging) and no surprise, got a CPAP - but no practitioner sat him down and said “here’s why you need to use it”. So he tried it for 2 nights and was all set to send it back because he didn’t like it.

When the family mentioned the CPAP noncompliance his to the doctors, THEN they lectured him. When my husband went with him to the doctor, and suggested a dietician, the doc said “Oh yeah, that’s a great idea. Here’s a referral!”. When my husband asked the cardiologist about cardiac rehab, he said “Oh yeah, that’s a great idea, here’s a referral!”

(end tl/dr)

Long story short: What kinds of questions should a doctor routinely ask a patient (especially one who presents pretty obvious risk factors)? And what kinds of followup activities ought to be pro-forma after a procedure or diagnosis? Are we out of line in thinking that some of this stuff (apnea, rehab, diet) should have been raised at least once in the past couple of decades?

2

Why should a doctor care about this fellow’s health more than he does himself?

3

^ Because IT’S THEIR FUCKING JOB!

4

I don’t think you’re out of line at all and sometimes wonder what doctors are checking on. I had to push for cardio care after my husband’s second heart attack. I guess everybody needs a patient’s advocate and family is usually best if possible.

5

No it’s not. Doctor’s are not your parents nor are they your fairy god mothers. They are there to treat acute problems. Eating healthy, exercise, and general health maintenance are our own responsibility. If you ask for specific prohibitive treatments (like rehab or dietary counseling, etc.) most docs will oblige if they don’t disagree with you.

But if a patient comes in for a knee problem and they are morbidly obese which is likely the long term cause of the bad knee, the doctor is going to treat the knee. They are normally not going to counsel you on your weight and put you on a restrictive diet, because your behavior up until then indicates that it probably won’t be successful.

6

That’s bullshit. If the doctor doesn’t say anything about that situation he hasn’t done his job.

Making a lot of assumptions, aren’t you?

7

I don’t pretend to know what the right answer is here, but I will report that, several years ago, my now-ex husand, who chain-smoked, went to a new-to-him doctor to get help for IBS. The doctor said, in effect, “I’ll be happy to help you as soon as you stop smoking. But as long as you smoke, which tells me you don’t really care about your health, I’m not going waste time on you that could go to a patient that genuinely cares about being healthy.”

Right? Wrong? I don’t know, but I applauded it at the time because I so wanted him to quit smoking. (To my knowledge, he never did.)

Mama Zappa’s situation is different, and I think the doctors in her scenario were remiss in not at least trying to get her FIL into treatment and rehab that could help him.

8

That not how doctors work you have a problem you go to doctor he or she will fix that problem or treatment for it.They do not check other areas of you body for problems.You want that make a physical exam appointment that people get every 5 years or so when they get older.

9

IANAD, but I feel disappointed if a doctor does not ask me (at least on first visit) if I smoke or drink, or about my eating habits or my nutrition, or about how well or how long I sleep, or about my evacuatory characteristics, or how much I walk or exercise.

10

That not how the healthcare works :eek: if you go to doctor for cold it is not his or her responsibility to check for other health issues you may or may not have.You make a physical exam appointment.

Doctors don’t care if you sleep or not or eat very little or too much .They get paid to fix you not chat with you.You want a sleep specialist or doctor that deals with eating problem or registered dietitian than make a appointment to see those specialist.

11

Oh for goodness sakes, if the doctor has referred him to a dietitian, everyone would be complaining about pushy doctors haranguing the overweight.

Different doctors have different styles. Which makes sense, because people have difference preferences.

But if your only plan for caring for your health is waiting around for doctors to tell you what to do, that is unlikely to work out very well.

12

I normally treat doctors has if my car broke down and looking for a mechanic.Some doctors know their work and other doctors forgot too much what they learn in medical school or too new out of medical school or just not smart.I know some doctors where person is on high blood pressure have high blood pressure go to a doctor for problem and doctor gives medication and person blood pressure gone very high.Other cases person almost OD.

Never treat a doctor has god.They make mistakes ,some are good and some are bad. Just like mechanic.

13

I work in healthcare management. Actually, it often IS the job of a doctor to notice that the patient has the symptoms of other health problems, even if those aren’t the reason the patient made the appointment. The specifics of this responsibility vary a lot depending on the circumstances.

But I will say to the OP–I have read most of the threads you have written about your in-laws…and they sound like the kind of people who get advice/referrals from doctors that they ignore/forget/deny they ever got when people ask. House was right–people lie.

I suspect that your father-in-law has probably had doctors at least mention most, if not all, of those issues to him over the years–but it is up to a patient to follow up on things like going for a sleep study, fitting a CPAP, scheduling a colonoscopy, etc. Healthcare is unfortunately very fragmented and disorganized. Certainly, helping patients understand WHY is frequently not a priority–mainly because providers historically haven’t gotten paid more for spending time on that.

It is true that if you want to receive optimal healthcare, you either need to act as your own advocate, or get someone to do it for you. It sounds like your in-laws don’t do this for themselves, so if you want it to happen–you are probably the person who will have to act in that role.

Best of luck to you. I have my own FIL who is a diabetic smoker, who is mostly non-compliant, and he lies about his medical care and recommendations from his doctors. My mother and father are even older than FIL, and both of them lie about what doctors say, do, and recommend, when it suits them. They’ve been caught in these lies, and still insisted on them. I think it’s pretty common, given what I hear from doctors.

14

It’s hard to tell what they’ve been told. My FIL tends to “do what the doctor says”, e.g. when he needed the cardiac procedure, he scheduled it when he didn’t even really know what it was. He’s rather self-righteous about “I’m not the doctor, I do what the doctor says” and gets angry when we ask him questions that most people would know about their own health.

Add to that the fact that when we nagged him to tell the doctor about his snoring, he was scheduled with a sleep specialist within 2 weeks and a study within a month. The doctor told him to do it, so he did.

even sven, Re the dietitian, “if the doctor has referred him to a dietitian, everyone would be complaining about pushy doctors haranguing the overweight.” I’d probably be annoyed but I’d also recognize that my weight was causing problems (or likely to). FIL has had poorly-controlled type 2 diabetes, now has stage 3 kidney disease, has hypertension, apnea, a pacemaker, has had a silent heart attack, has severe back pain related to the weight - and has deluded himself that he was eating properly (he was “down” to mid 200s and he is not a tall person). So in his case a dietitian would seem to be an obvious suggestion.

Yeah, people lie. MIL nearly died from hiding symptoms from herself, from her husband, and by forbidding him to tell us what was going on. We don’t think she lied to the doctors but they didn’t see her every day and she probably wasn’t as aggressive about seeking help. I could sympathize with that actually; I’m a good advocate for myself but when I get sick enough I get really, really stoopid.

Neither of the in-laws disobey doctors, so I would bet that if some of this had been suggested they’d have done it; on fact I’m likelier to argue with the doctors than they are. MIL usually goes with FIL (who is deaf as a post) to make sure information is understood.

The CPAP / dietitian / cardiac rehab are all things we’ve pushed for, because they aren’t being their own advocates. Frustrating as hell, as we’re not right there, and we shouldn’t have to treat them like children, and it’s uncomprehensible to me that someone wouldn’t want to know at least the basics of their health issues.

OK., that was pretty rambling, and more of a vent than anything else; their stubbornness and cluelessness is indeed something all us adult “kids” have to work on with them. The original issue of doctors not suggesting basic stuff (cardiac rehab should be fairly standard care after his procedure, a suggestion to see a dietitian on diagnosis with diabetes, etc.) is still a real concern.

15

If they aren’t getting paid for it, doctors aren’t going to do it.

16

I’m seeing a lot of people saying, “If you go to a doctor for a specific reason, the doctor has no reason to treat you for other health factors.” That may be true if you open the Yellow Pages at “Physicians”, close your eyes, and point randomly, each and every time you need to visit one.

But if it is YOUR doctor, and the Dr. is NOT asking about issues that may affect the treatment that will be prescribed, it is time to find another doctor.

MY doctor once tested me for respiratory issues when I went in for another ailment, and another time noticed a sebaceous cyst on my neck. Perhaps she was just looking for more things for my insurance to pay for, but it at least felt, to me, that she was genuinely concerned about my health.

17

OK, say you go in with a really bad cough. Probably bronchitis or an asthma flareup. Now, as it happens, you work in an asbestos mine, live in a tumbledown shack in a swamp near a sewage plant, and you smoke. As do about half your doctor’s other patients.

Does the doctor give you an inhaler and/or antibiotics and/or cough suppressant to deal with the cold? or does the doctor ask a couple of questions to find out the circumstances, and send you to a pulmonologist to get underlying problems helped out?

If you’re seeing a doctor to manage hypertension and diabetes, should the conversation be “BP is 140/100, blood sugar is 140, here have some BP and diabetes meds”. or should it be all that and “you are quite overweight. I think you should consult with…”.

Our impression is that the doctors have each addressed their own individual areas, but not made that second recommendation to seek other help. If the patient doesn’t know that smoking/asbestos/swamp habitation is bad, or likes smoking/asbestos/sewage gas, they won’t know to ask, or won’t WANT to ask.

THAT is my frustration. Yes, the parents need to be better advocates, but also some basic, relevant questions / referrals seem to be skipped.

18

Many doctors (IME) are cynical about the prospect of people changing their behavior. They all say things like “Stop smoking” and “Lose weight”. Very few people do it, and when they do, it is usually in response to something other than their doctor telling them to. Older patients are especially difficult. It’s a crap shoot just getting them to take their medication in a timely manner. Furthermore, they are generally under Medicare, so the doctor is likely getting less to treat them. If you think that doesn’t affect the amount of time the doctor is willing to spend sternly lecturing them, you are mistaken.

Basically, they are at a time in their life when they need to be more educated and proactive about their health care. In fact, for most of them just the opposite applies. The only real solution is for their children to advocate for them. You need to continue what you are doing, and its not going to get any better.

IANAD

19

I found with my parents that they didn’t ever see a single doctor who was in charge of their over all health. It was always specialists. They saw so many doctors that they couldn’t even keep straight which was doing what but they just assumed someone was keeping track of everything. Same with their perscriptions - they, and the docs, seemed to lean heavily on the pharmacy to worry about drug interactions.

One doctor treated my Dad’s cancer and he would refer Dad to other doctors for that problem. But he saw another for his heart problems and still another for his diabeties. Maybe he saw his GP every six months but I suspect he thought he was seeing enough doctors already and didn’t think he needed a guy who wasn’t actively working on one of his problems.

20

I’ve seen some recent articles on the subject, with no conclusion though. Some docs find that too many questions annoy the patients, they are saying that subtle prompting for further information is more effective than direct questions. However, other doctors disagree, so it doesn’t really reveal much. It’s become clear to me recently that you have to find your own specialists and not expect much from any old PCP. That’s not some sweeping criticism of physicians, you just need to find the right one for you and your condition.