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.
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:
Saw a 10 year old kid today. Young fella has seen multiple doctors for “hiccups” (Urgent Care, Pediatrician, ER), has been prescribed antacids and antihistamines, has been referred to GI (no appointment for another 4 months) Mom and dad are frustrated: “It’s NOT hiccups, we keep trying to explain, his tummy muscles jerk and a sound come out of his mouth and his jaw flops opened and closed, but it’s just NOT hiccups.”
And I agreed with them. The kid (rather obviously) has a motor/vocal tic disorder, possibly Tourette’s (if the workup through neurology and psychiatry doesn’t turn up any organic causes for his tics). But if I had agreed with the previous doctors’ notes, agreed in my head before entering the exam room, I would have interpreted his mannerisms and vocalizations as a (kinda-weird and uncoordinated) hiccup.
Today, in my Urgent Care, the best thing I could do for this boy was to avoid automatically jumping to the same diagnosis everyone else has made. The only thing he and his parents needed (for now) was for someone to observe, keep the differential broad, ask questions from a different angle, think outside of the “box” created by his previous doctor visits.
I didn’t write him a prescription, I didn’t scope him or lab him or admit him. I just looked and listened and thought and recognized and recommended. And his mom left my Urgent Care so happy to have a name for it and a plan to pursue.
They left, and I started writing up his note with a trace of smug satisfaction… and I got the hiccups.