Best doc to know?

[Merely]

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So I was wondering, do you guys think that FM docs would be the best docs to have as a friend if your a non medical person since you can ask them all kinds of questions? Like I feel like you can't ask a CT surgeon things about your skin or stomach and stuff like that. Do you guys feel like you can answer most questions asked by your family members/friends or do you have to say like "go see a GI or cards" for that? I just don't want to not know when family members ask a question but I feel like specialists def wont know the answer to most things outside their field so FM or IM is superior in that regard? Can someone shed light on this? sorry for rambling

 

[NurWollen]

I feel like this is an awkward subject for a lot of doctors, but I have to admit I'm curious. This is actually something that attracts me to FM. I like being useful and helpful for people and I like having knowledge that is widely applicable. I do wonder sometimes to what extent specialists forget general medical knowledge.

 

[JustPlainBill]

Sooo ---- I'll relate a case and you guys/gals draw your own conclusions --- a story from residency --- (how can you tell the difference between a fairy tale and a war story? One starts,"Once upon a time, in a land far, far away" and the other starts,"This is no $h!t" )

Seems that an ER doc was working a shift one time with a nurse he had worked with before. Said nurse commented that her husband (who was not the ER doc) was suffering from heartburn. She had given him Tums, Pepto, etc. and asked the doc, "What do you think about it?" -- to which he commented, "Ah, heck, just give him some Zantac" --- turns out the husband was having an MI and later died. Said nurse sued the ER doc -- when the case went to trial, the ER doc lost as the jury held he had rendered a professional opinion. No, I am not joking.

That about ended me advising anyone outside of a professional capacity, with them sitting in my office on the exam table having been appropriately checked in and vitalized, with the appropriate paperwork, allergies and med list sitting in front of me, period.

Your mileage may vary, no warranties expressed or implied, car driven by professional driver on a closed track.

Yes, I don't even treat my own mother without having a chart, med list and doing a full exam, period.

I find that most people don't ask me anything anyway, once we get beyond the ,"What do you do?" -- "I'm a physician" --"Oh, really! What's your specialty?" -- "Family Medicine" --- "Oh (quick change of topic of conversation)".

I was actually lecturing to a bunch of pre-meds last weekend regarding trials/challenges of medical school --- and one of them asked me what my specialty was and when I told them Family Medicine, they actually said,"Oh..." and gave me a rather disdainful look --- a freakin' pre-med!!! Rather than call them out and introduce them to Dr. SharkTank, I just let it go and moved on, there were others who really valued the chance to talk to an alumni who could advise them on the real deal.

 

[AMEHigh]

Sooo ---- I'll relate a case and you guys/gals draw your own conclusions --- a story from residency --- (how can you tell the difference between a fairy tale and a war story? One starts,"Once upon a time, in a land far, far away" and the other starts,"This is no $h!t" )

Seems that an ER doc was working a shift one time with a nurse he had worked with before. Said nurse commented that her husband (who was not the ER doc) was suffering from heartburn. She had given him Tums, Pepto, etc. and asked the doc, "What do you think about it?" -- to which he commented, "Ah, heck, just give him some Zantac" --- turns out the husband was having an MI and later died. Said nurse sued the ER doc -- when the case went to trial, the ER doc lost as the jury held he had rendered a professional opinion. No, I am not joking.

That about ended me advising anyone outside of a professional capacity, with them sitting in my office on the exam table having been appropriately checked in and vitalized, with the appropriate paperwork, allergies and med list sitting in front of me, period.

Your mileage may vary, no warranties expressed or implied, car driven by professional driver on a closed track.

Yes, I don't even treat my own mother without having a chart, med list and doing a full exam, period.

I find that most people don't ask me anything anyway, once we get beyond the ,"What do you do?" -- "I'm a physician" --"Oh, really! What's your specialty?" -- "Family Medicine" --- "Oh (quick change of topic of conversation)".

I was actually lecturing to a bunch of pre-meds last weekend regarding trials/challenges of medical school --- and one of them asked me what my specialty was and when I told them Family Medicine, they actually said,"Oh..." and gave me a rather disdainful look --- a freakin' pre-med!!! Rather than call them out and introduce them to Dr. SharkTank, I just let it go and moved on, there were others who really valued the chance to talk to an alumni who could advise them on the real deal.

Agreed.

And for me personally I like to keep work and my personal life separate. Being a doctor doesn't define me and I really don't like having to think like a doctor outside of work if I can avoid it. I generally don't tell people what I do for a living. The job is already exhausting enough without having to take on the burden of friends and family's medical problems.

 

[styphon]

Sooo ---- I'll relate a case and you guys/gals draw your own conclusions --- a story from residency --- (how can you tell the difference between a fairy tale and a war story? One starts,"Once upon a time, in a land far, far away" and the other starts,"This is no $h!t" )

Seems that an ER doc was working a shift one time with a nurse he had worked with before. Said nurse commented that her husband (who was not the ER doc) was suffering from heartburn. She had given him Tums, Pepto, etc. and asked the doc, "What do you think about it?" -- to which he commented, "Ah, heck, just give him some Zantac" --- turns out the husband was having an MI and later died. Said nurse sued the ER doc -- when the case went to trial, the ER doc lost as the jury held he had rendered a professional opinion. No, I am not joking.

That about ended me advising anyone outside of a professional capacity, with them sitting in my office on the exam table having been appropriately checked in and vitalized, with the appropriate paperwork, allergies and med list sitting in front of me, period.

So I was wondering, do you guys think that FM docs would be the best docs to have as a friend if your a non medical person since you can ask them all kinds of questions? Like I feel like you can't ask a CT surgeon things about your skin or stomach and stuff like that. Do you guys feel like you can answer most questions asked by your family members/friends or do you have to say like "go see a GI or cards" for that? I just don't want to not know when family members ask a question but I feel like specialists def wont know the answer to most things outside their field so FM or IM is superior in that regard? Can someone shed light on this? sorry for rambling

There is a very similar case that was in "Clinical Reviews Journal" malpractice section.

A neighbor was having chest pain when he was mowing his lawn so he asked his fellow neighbor (a primary care doctor) what he should do. The doctor neighbor told him that he needs to be checked out by a cardiologist. The patient went, had an angiogram, and threw a clot causing a CVA. He successfully sued the doctor neighbor for "giving a professional opinion without a thorough history and exam"!!!

No matter how innocent and straightforward a question may be, as soon as you answer you open yourself up for liability, giving medical advice is NOT covered by the good Samaritan act!

 

[NurWollen]

There is a very similar case that was in "Clinical Reviews Journal" malpractice section.

A neighbor was having chest pain when he was mowing his lawn so he asked his fellow neighbor (a primary care doctor) what he should do. The doctor neighbor told him that he needs to be checked out by a cardiologist. The patient went, had an angiogram, and threw a clot causing a CVA. He successfully sued the doctor neighbor for "giving a professional opinion without a thorough history and exam"!!!

No matter how innocent and straightforward a question may be, as soon as you answer you open yourself up for liability, giving medical advice is NOT covered by the good Samaritan act!

That's unfortunate. Did he sue the Cardiologist too?

 

[styphon]

That's unfortunate. Did he sue the Cardiologist too?

The case summary only mentions the neighbor.

 

[Merely]

None of that makes any sense...there was no patient-physician relationship in any of those cases so how could the docs be sued? Couldn't they just say..."no I never said that.."

 

[VA Hopeful Dr]

None of that makes any sense...there was no patient-physician relationship in any of those cases so how could the docs be sued? Couldn't they just say..."no I never said that.."

Often lawyers will say that the patient thought a relationship was formed and that's good enough.

 

[JustPlainBill]

Often lawyers will say that the patient thought a relationship was formed and that's good enough.

Was also on the flipside of that one --- had a person try to tell me that HIPPA laws applied to a situation where they had confided in me about a condition of a family member who was along on a group trip --- I checked with my attorney and the phrase was "no expectation of a physician/patient relationship" as I had no interaction with said family member --- we were not in a clinical setting but were standing outside a hotel when this conversation took place and I never had anything to do with the family member in questions care. I avoided them the rest of the trip and ever since then. It was a struggle to resist the urge to tell them to urinate up a group of intertwined string ----

 

[cabinbuilder]

None of that makes any sense...there was no patient-physician relationship in any of those cases so how could the docs be sued? Couldn't they just say..."no I never said that.."

It doesn't have to make sense. This is the legal world we live in. You can be sued for any medial advice given in public. I don't give medical advice to anyone outside my husband and kids ever. I don't give the mom with 6 kids enough antibiotics for all if one tests positive for strep. I don't given medication over the phone. Patient's hate it. They want things to "be like the old days". In the here and now, you can be sued and expect to lose especially if a "relationship" can be proven and there was a death that occurred.

Do not ever do anything without a chart note and allergies listed. It will save your career.


I am very clear with my friends and family not to broadcast in public that I am a doctor. I hate how people vent on you about their fibromyalgia and bursitis. Makes me crazy to have to listen politely without commenting back.

 

[CantStop_WontStop]

So then on the flipside is it possible to be sued for refraining from giving advice, say your response is "I'm sorry but I can't give any medical advice outside of my office, feel free to make an appointment and I'm happy to help", but then something serious does occur before the person can make it to a doctor?

 

[cabinbuilder]

So then on the flipside is it possible to be sued for refraining from giving advice, say your response is "I'm sorry but I can't give any medical advice outside of my office, feel free to make an appointment and I'm happy to help", but then something serious does occur before the person can make it to a doctor?

That why you should always add that, "if you feel that poorly then you should go straight to the ER".

 

[Merely]

I appreciate everyone's insight but assuming a situation where you won't be sued (family) can someone offer any insight on my original question?

 

[deleted87716]

So then on the flipside is it possible to be sued for refraining from giving advice, say your response is "I'm sorry but I can't give any medical advice outside of my office, feel free to make an appointment and I'm happy to help", but then something serious does occur before the person can make it to a doctor?

Depends on the nature of the patient's complaint. If they were complaining of symptoms that were obviously potentially serious (e.g., left-sided chest pain radiating into the neck and left arm, etc.), maybe. The correct answer would be to call 911, not just say "Sorry, I can't give you any advice." If they were going on about their 6-month history of low-back pain, probably not, even if it later turned out to be caused by metastatic prostate cancer.

That being said, I offer the following disclaimer: "I am not a lawyer, and this is not legal advice." 😉

 

[AMEHigh]

There is a very similar case that was in "Clinical Reviews Journal" malpractice section.

A neighbor was having chest pain when he was mowing his lawn so he asked his fellow neighbor (a primary care doctor) what he should do. The doctor neighbor told him that he needs to be checked out by a cardiologist. The patient went, had an angiogram, and threw a clot causing a CVA. He successfully sued the doctor neighbor for "giving a professional opinion without a thorough history and exam"!!!

No matter how innocent and straightforward a question may be, as soon as you answer you open yourself up for liability, giving medical advice is NOT covered by the good Samaritan act!

So the patient went to the doctor as advised. So I assume if the doctor would have told him to go to the ER or his PCP and also had an adverse outcome he still would've been sued? So what are we supposed to say? Nothing, just run away with our fingers in our ears screaming la la la I can't hear you?

I always tell people they should go to their doctor but now that's not even the correct thing to say? Damn.

Or is there part of the story missing?

 

[AMEHigh]

I appreciate everyone's insight but assuming a situation where you won't be sued (family) can someone offer any insight on my original question?

There are pros and cons to every specialty.

I don't think you should pick a specialty based on "not knowing something when you're family members ask you a medical question."

Who knows if being a family doc will benefit you in that regards. Maybe they'll ask you surgical questions, maybe they'll ask you hiv treatment questions, maybe they'll ask you questions about a newborn.

The moral of the story is you shouldn't give your family members or friends medical advice unless you examine them and review their medical history. Not because they might sue you but because you can't give appropriate advice without working up the patient properly.

 

[JustPlainBill]

That why you should always add that, "if you feel that poorly then you should go straight to the ER".

And just to complete @cabinbuilder 's story -- and we've discussed this with each other ad nauseum --- then you get the obviously ketotic diabetic in your office that doesn't want to go to the ER because "You wait for hours".... or the ones that want you to fix them in the office and promise, promise, promise to go to the ER if anything changes, just please, please, please don't make me go to the ER for the nausea/vomiting, abdominal pain, no BM/flatus for 3 days doc --- yeah, it happens -- had one comminuted humeral fracture that refused EMS transport at the scene and then became very resistant when I sent them....and today was apparent acute onset aFib with a pulse pressure of 10mmHg who was resistant to going to the ER by ambulance and wound up being driven by personal auto --

 

[Bacchus]

And just to complete @cabinbuilder 's story -- and we've discussed this with each other ad nauseum --- then you get the obviously ketotic diabetic in your office that doesn't want to go to the ER because "You wait for hours".... or the ones that want you to fix them in the office and promise, promise, promise to go to the ER if anything changes, just please, please, please don't make me go to the ER for the nausea/vomiting, abdominal pain, no BM/flatus for 3 days doc --- yeah, it happens -- had one comminuted humeral fracture that refused EMS transport at the scene and then became very resistant when I sent them....and today was apparent acute onset aFib with a pulse pressure of 10mmHg who was resistant to going to the ER by ambulance and wound up being driven by personal auto --

And this is why everyone's end of visit summary is given to them, by me, and "warning signs including" is there.

 

[Doctor4Life1769]

Good read.
Scary thought but good to learn from others' experiences.

 

[cabinbuilder]

So back to the mom with a pack of kids with one positive strep test. She asks, "why can't you give enough antibiotics to cover all the kids?". My reply, "if I give antibiotics to one of your children who ends up being allergic to it and ultimately dies from a drug reaction, I don't have a chart note with stated allergies, that is negligence." You would sue me for practicing unsafe medicine, I would lose the suit, and my career would be over. I always get a quiet, "Oh" after that. Nips it every single time.

To add to @JustPlainBill. Patient's don't want to go to the ER. They don't like the wait, they don't want the cost. There is only so much one can do in urgent care or general clinic. I have been known to have patients sign out AMA if they won't go. I have been known to tell them that "you will die". I have also called EMS when that took the patient/family too long to make a decision or find a ride. I also have said that going to the ER is one day out of your life to be safe rather than being 6 feet under forever. Something to ponder. Death is forever.

 

[JustPlainBill]

So back to the mom with a pack of kids with one positive strep test. She asks, "why can't you give enough antibiotics to cover all the kids?". My reply, "if I give antibiotics to one of your children who ends up being allergic to it and ultimately dies from a drug reaction, I don't have a chart note with stated allergies, that is negligence." You would sue me for practicing unsafe medicine, I would lose the suit, and my career would be over. I always get a quiet, "Oh" after that. Nips it every single time.

To add to @JustPlainBill. Patient's don't want to go to the ER. They don't like the wait, they don't want the cost. There is only so much one can do in urgent care or general clinic. I have been known to have patients sign out AMA if they won't go. I have been known to tell them that "you will die". I have also called EMS when that took the patient/family too long to make a decision or find a ride. I also have said that going to the ER is one day out of your life to be safe rather than being 6 feet under forever. Something to ponder. Death is forever.

I've also recently started telling them that it's a violation of Federal law to give your medicine to someone else to take -- narcs, antibiotics, PPIs, doesn't matter --- they generally blow it off but sometimes I get a pause...

 

[VA Hopeful Dr]

I've also recently started telling them that it's a violation of Federal law to give your medicine to someone else to take -- narcs, antibiotics, PPIs, doesn't matter --- they generally blow it off but sometimes I get a pause...

Yeah, especially for controlled drugs I've had to start saying "The instructions on the bottle are not a suggestion"

 

[cabinbuilder]

So I was wondering, do you guys think that FM docs would be the best docs to have as a friend if your a non medical person since you can ask them all kinds of questions? Like I feel like you can't ask a CT surgeon things about your skin or stomach and stuff like that. Do you guys feel like you can answer most questions asked by your family members/friends or do you have to say like "go see a GI or cards" for that? I just don't want to not know when family members ask a question but I feel like specialists def wont know the answer to most things outside their field so FM or IM is superior in that regard? Can someone shed light on this? sorry for rambling

I guess to answer your first question is that, YES, family medicine is the broadest amount of knowledge base of the specialties. Now, to find one who is willing to answer questions in light of today's legal society is another matter.

 

[Sea_Bass]

One of the reasons I chose to do FM was because I think it's the purest form of what a doctor should be. Someone with knowledge of all medical conditions.

As for the other stuff mentioned in this thread, I don't disagree that we should be cautious in giving medical advice to people with whom we have not established a patient-physician relationship. However, some of the logic used to justify never answering a medical question from a friend/acquaintance is odd to me. Doctors give casual medical advice to random people everyday. If you add up all the doctors in the country, it probably happens tens of thousands of times per day. In total, it's millions of times per year. And how many times does this result in a lawsuit? Probably like a few times a year, if that. So seriously, the odds of someone suing you for casual medical advice is literally a million to one. Maybe more like a billion to one.

Not saying you should go play doctor to everyone you meet, but try to have perspective. We are told that "common things are common." The flip side of that is "rare things are rare." For me, personally, when I finish residency, I will not go around freely dispensing medical advice to people (you should pay me for that!) but I also won't spend one iota of my time worrying that I'm gonna get sued for it either. If I went around every day worried about some billion to one event striking me down, I'd never drive a car, get in an airplane, ride an elevator, walk in a rainstorm, etc. etc.

If it were so easy to get sued for discussing a medical topic with someone, how does a show like Dr. Oz exist? He gives crappy medical advice all the time, and his show is still on the air. There's been other doctors like Dr. Drew Pinsky and Dr. Dean Edell who've had radio call-in shows where random people call in, they are given advice, and that's the end of it. By the logic in this thread, these doctors would have been sued into the stone age a long time ago, yet they weren't.

Again, I think establishing a doctor-patient relationship before any medical advice is given is the responsible thing to do, I just don't think someone needs to have a panic attack if they said something in passing and it's taken as medical advice.

 

[JustPlainBill]

One of the reasons I chose to do FM was because I think it's the purest form of what a doctor should be. Someone with knowledge of all medical conditions.

As for the other stuff mentioned in this thread, I don't disagree that we should be cautious in giving medical advice to people with whom we have not established a patient-physician relationship. However, some of the logic used to justify never answering a medical question from a friend/acquaintance is odd to me. Doctors give casual medical advice to random people everyday. If you add up all the doctors in the country, it probably happens tens of thousands of times per day. In total, it's millions of times per year. And how many times does this result in a lawsuit? Probably like a few times a year, if that. So seriously, the odds of someone suing you for casual medical advice is literally a million to one. Maybe more like a billion to one.

Not saying you should go play doctor to everyone you meet, but try to have perspective. We are told that "common things are common." The flip side of that is "rare things are rare." For me, personally, when I finish residency, I will not go around freely dispensing medical advice to people (you should pay me for that!) but I also won't spend one iota of my time worrying that I'm gonna get sued for it either. If I went around every day worried about some billion to one event striking me down, I'd never drive a car, get in an airplane, ride an elevator, walk in a rainstorm, etc. etc.

If it were so easy to get sued for discussing a medical topic with someone, how does a show like Dr. Oz exist? He gives crappy medical advice all the time, and his show is still on the air. There's been other doctors like Dr. Drew Pinsky and Dr. Dead Edell who've had radio call-in shows where random people call in, they are given advice, and that's the end of it. By the logic in this thread, these doctors would have been sued into the stone age a long time ago, yet they weren't.

Again, I think establishing a doctor-patient relationship before any medical advice is given is the responsible thing to do, I just don't think someone needs to have a panic attack if they said something in passing and it's taken as medical advice.

While not meaning to rain on your parade or be offensive -- I recall a similar feeling/sense of "what I would do when I got out of residency" -- all that changed when I became the solely responsible and didn't have the nice, insulative cocoon of system/attendings/senior residents to backstop my nasty behind. May not be your situation, may not happen to you, each person is different.

 

[Sea_Bass]

While not meaning to rain on your parade or be offensive -- I recall a similar feeling/sense of "what I would do when I got out of residency" -- all that changed when I became the solely responsible and didn't have the nice, insulative cocoon of system/attendings/senior residents to backstop my nasty behind. May not be your situation, may not happen to you, each person is different.

You're right--I do feel that since I'm just beginning my training I may have a rosier picture of what the "real world" will be like. It's quite possible I'll end up the most jaded person on SDN. And maybe I'll have a good reason for it. I just wanted to throw this line of thinking out here as sort of a counterpoint. I hope the fear of a lawsuit--while always a possibility no matter how slim--will not consume me. Maybe it will, maybe it won't.

 

[Ericslv]

None of that makes any sense...there was no patient-physician relationship in any of those cases so how could the docs be sued? Couldn't they just say..."no I never said that.."

You make a good point. The neighbor could just say that and then they have to prove he didn't. If its not written it never happened. So most likely there was more to it than that.

 

[Ericslv]

You're right--I do feel that since I'm just beginning my training I may have a rosier picture of what the "real world" will be like. It's quite possible I'll end up the most jaded person on SDN. And maybe I'll have a good reason for it. I just wanted to throw this line of thinking out here as sort of a counterpoint. I hope the fear of a lawsuit--while always a possibility no matter how slim--will not consume me. Maybe it will, maybe it won't.

NO. I hold the most jaded title on SDN. 🙂

 

[Merely]

One of the reasons I chose to do FM was because I think it's the purest form of what a doctor should be. Someone with knowledge of all medical conditions.

As for the other stuff mentioned in this thread, I don't disagree that we should be cautious in giving medical advice to people with whom we have not established a patient-physician relationship. However, some of the logic used to justify never answering a medical question from a friend/acquaintance is odd to me. Doctors give casual medical advice to random people everyday. If you add up all the doctors in the country, it probably happens tens of thousands of times per day. In total, it's millions of times per year. And how many times does this result in a lawsuit? Probably like a few times a year, if that. So seriously, the odds of someone suing you for casual medical advice is literally a million to one. Maybe more like a billion to one.

Not saying you should go play doctor to everyone you meet, but try to have perspective. We are told that "common things are common." The flip side of that is "rare things are rare." For me, personally, when I finish residency, I will not go around freely dispensing medical advice to people (you should pay me for that!) but I also won't spend one iota of my time worrying that I'm gonna get sued for it either. If I went around every day worried about some billion to one event striking me down, I'd never drive a car, get in an airplane, ride an elevator, walk in a rainstorm, etc. etc.

If it were so easy to get sued for discussing a medical topic with someone, how does a show like Dr. Oz exist? He gives crappy medical advice all the time, and his show is still on the air. There's been other doctors like Dr. Drew Pinsky and Dr. Dead Edell who've had radio call-in shows where random people call in, they are given advice, and that's the end of it. By the logic in this thread, these doctors would have been sued into the stone age a long time ago, yet they weren't.

Again, I think establishing a doctor-patient relationship before any medical advice is given is the responsible thing to do, I just don't think someone needs to have a panic attack if they said something in passing and it's taken as medical advice.

Thank you for this perspective, I have to say the attendings on this particular subforum seem very chill and helpful, hope all FM attendings are like you guys!

 

[JustPlainBill]

Thank you for this perspective, I have to say the attendings on this particular subforum seem very chill and helpful, hope all FM attendings are like you guys!

**Sigh*** I really wish you wouldn't have said that --- now we *HAVE* to crush and humiliate you -- doggone it, just when I thought I was going to be able to start liking puppies and kittens again and starting to look forward to General Foods International Coffee moments in the early morning sunshine.....Oh, well, the Dr. SharkTank costume hasn't even been hung up.....;->

 

[Ericslv]

**Sigh*** I really wish you wouldn't have said that --- now we *HAVE* to crush and humiliate you -- doggone it, just when I thought I was going to be able to start liking puppies and kittens again and starting to look forward to General Foods International Coffee moments in the early morning sunshine.....Oh, well, the Dr. SharkTank costume hasn't even been hung up.....;->

I always carry my "humiliate a resident/med-student hotline card" in my wallet just in case. I'm getting way too soft. 🙂

 

[surrender903]

NO. I hold the most jaded title on SDN. 🙂

i believe i said "grumpasaurus rex."

 

[Ericslv]

i believe i said "grumpasaurus rex."

I can be both. 🙂