Patient with self-admitted anxiety: While you’re feeling my stomach, can you please check if the lump on my left side is still there?
Cranquis: *palpates left flank, finds deep hard pointed well-defined mass with slight mobility* This?
Patient: Oh no, yeah, that’s it, oh I’m scared to ask… what is…?
Cranquis: Well, I have bad news and good news. The bad news is that you probably have another one on your right side just like it. The good news is, they’re your 12th ribs and they’ve been there all your life.
Husband of patient with glass fragment in foot [excerpts of his constant teasing throughout entire visit and procedure]: “HEH THAT’LL TEACH YOU TO WALK AROUND BAREFOOT. HEY DON’T BLAME ME I DIDN’T DROP THAT CUP ON THE FLOOR. OOH THAT LOOKS LIKE A BIG NEEDLE I BET THIS IS GONNA HURT. YEAH THAT’S GONNA LEAVE A SCAR FOR SURE, YOUR FOOT MODELING DAYS ARE OVER.”
Cranquis giving discharge instructions: “…now when you change the dressing, wash the wound carefully. Studies show that foot wounds heal faster if your husband kisses them regularly, but you could also apply bacitracin and…”
Patient: I got a headache and dizziness at 2 o’clock this morning, but I feel fine now.
Cranquis: Yesterday was the Fourth of July, and it was hot and sunny all afternoon. Plus you’ve got a mild sunburn happening on your neck and ears. So I’m guessing that you spent a long time outdoors and that you consumed more alcohol than water, right?
Patient: Well kinda. We were at the beach for 8 hours that day, but I didn’t drink any alcohol.
You’re the first doctor to actually touch me in 17 years. The rest of them just see a fat guy and write a prescription.
480-pound man with intertrigo.
WTF, my colleagues? Just because a person weighs more than another person doesn’t mean that you get some kind of Physical Exam Not Required modifier. Since when does “patient is obese” = “patient’s self-description of their medical concern is enough for me, wouldn’t want to actually use my skills to make a proper diagnosis”?!
This rage isn’t just targeted at “the rest of them” – I’m upset when I recall the times that I’ve convinced myself that a physical exam of an obese [or smelly or wheel-chair-bound or hyperactive or or or] patient isn’t worth the hassle. Sure, some of those times it probably wasn’t necessary in order to manage the presenting complaint – but what unknown overlooked conditions did I miss by being lazy, by stereotyping my patient and offering 2nd-class medicine? SMH.
So let’s make this our guiding slogan when faced with internal pulling-back from providing the usual standard of care, my colleagues:
Thanks for calling to check up on her, doc – and one more thing. Thanks for examining her stuffed animal during the visit yesterday. She keeps telling everyone, ‘The doctor checked out Winnie the Pooh and said he doesn’t have an ear infection, but I have an ear infection.’
Mother of a 3 year old kid with doctor-phobia – which eased up nicely after I gave poor long-suffering Winnie a full physical.
(Scene: Urgent Care exam room #3. Cranquis is performing vital medical activities requiring years of training and experience typing rapidly in the electronic medical record, while a teenaged patient and her mother wait to be discharged.)
Patient: Hey ma, can I have some money to buy bacon on the way home?
Mother: Ha! No.
Cranquis: I’ll be right back with your discharge papers.
Cranquis: Ok, here’s your note for school, here’s your instruction sheet, and here’s a small “Will Work for Bacon” sign I printed out for you, just in case.