Hospital rounds: what is the point?

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MediRounds

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What is the the most important question that you ask yourself about a patient prior to presenting that patient on rounds? How does this help you direct your plan of care for that patient?
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MediRounds said:
What is the the most important question that you ask yourself about a patient prior to presenting that patient on rounds? How does this help you direct your plan of care for that patient?
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1) What do we know
2) What do we need to know
3) What are we doing next

and of course, why are they here and do they still need to be here.
 
I smell your market research. And I don't like it.
 
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Those are good questions. I would consolidate them into:

What is the overall goal for the patient (taking into account patient autonomy as well) and what do you, as the clinician, need to do to get the patient to that goal?

From there, you take into account the context of the patient: clinical condition, sociocultural variables, autonomy preferences, etc.

There is a lot that needs to be taken into account before a plan is made.

Any othe thoughts from anyone else?
 
That all sounds like something a social worker does on a daily basis.....i.e. clinical condition, sociocultural variables, patient autonomy, family contact, special needs, etc etc blah blah

When did medicine go from "treat patient X for condition Y" to "let's get to know this patient, talk about their personal, family, professional, financial, political, and cultural lives, consider these factors in a treatment goal, and....oh wait...we're still going to give them treatment Z but aren't we glad we got to know our patient so intimately that they reward us by yelling at us, cursing at us, and are now signing out AMA...job well done, folks!" ?
 
You're too young to be so jaded! Anyway, the importance of those questions has a lot to do with a patient's compliance, understanding, and trust. You have to think about these things. Are you going to treat the following patients exactly the same?

A. 50 year old Caucasian male with isolated dilated cardiomyopathy.
B. 50 year old Caucasian male with dilated cardiomyopathy and metastatic prostate cancer.
C. 50 year old Latino male with isolated dilated cardiomyopathy and limited English proficiency.
D. 90 year old Caucasian male with isolated dilated cardiomyopathy.
E. 50 year old, homeless, Caucaisan male with isolated dilated cardiomyopathy.

The question is not necessarily what you are going to treat them with, but how you are going to treat each of them. The way in which you manage each of these patients can not possibly be exactly the same...hence, clinical context.
 
In each of the scenarios, there is somebody I can consult. And that consultant is better trained at taking care of the particular co-morbidity/special need.

I'm not jaded by any means. Just being realistic.
 
Rollo said:
That all sounds like something a social worker does on a daily basis.....i.e. clinical condition, sociocultural variables, patient autonomy, family contact, special needs, etc etc blah blah

When did medicine go from "treat patient X for condition Y" to "let's get to know this patient, talk about their personal, family, professional, financial, political, and cultural lives, consider these factors in a treatment goal, and....oh wait...we're still going to give them treatment Z but aren't we glad we got to know our patient so intimately that they reward us by yelling at us, cursing at us, and are now signing out AMA...job well done, folks!" ?
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You're not there to be an *******. It serves well to know the patient and all the factors surrounding him or her.
 
Rollo said:
That all sounds like something a social worker does on a daily basis.....i.e. clinical condition, sociocultural variables, patient autonomy, family contact, special needs, etc etc blah blah

When did medicine go from "treat patient X for condition Y" to "let's get to know this patient, talk about their personal, family, professional, financial, political, and cultural lives, consider these factors in a treatment goal, and....oh wait...we're still going to give them treatment Z but aren't we glad we got to know our patient so intimately that they reward us by yelling at us, cursing at us, and are now signing out AMA...job well done, folks!" ?
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I agree that we shouldn't have to do it to the extent that we do but in the end it works in your favour. Knowing if patient lives alone or with somone, how well they get along with that someone etc helps YOU get the patient out to the appropriate place quicker (home vs rehab etc)
It doesn't add that much time to your pre-rounds, only needs to be done once and helps you keep your census down
 
Dr. Oz says that patients have better clinical outcomes when they know people care about them.

A good example is in NY Med: Episode 3 when doctor Oz makes sure his patient has a visitor post-op so they have a better recovery. He also takes a personal interest in him.

I'm not trying to appeal-to-authority; but... it's Oz.

Rollo said:
In each of the scenarios, there is somebody I can consult. And that consultant is better trained at taking care of the particular co-morbidity/special need.

I'm not jaded by any means. Just being realistic.
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pseudosquam said:
Dr. Oz says that patients have better clinical outcomes when they know people care about them.

A good example is in NY Med: Episode 3 when doctor Oz makes sure his patient has a visitor post-op so they have a better recovery. He also takes a personal interest in him.

I'm not trying to appeal-to-authority; but... it's Oz.
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http://www.ncbi.nlm.nih.gov/pubmed/21664000
 
pseudosquam said:
Dr. Oz says that patients have better clinical outcomes when they know people care about them.

A good example is in NY Med: Episode 3 when doctor Oz makes sure his patient has a visitor post-op so they have a better recovery. He also takes a personal interest in him.

I'm not trying to appeal-to-authority; but... it's Oz.
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You lost me after you invoked Dr. Oz; is my sarcasm detector broken or are you actually appealing to "authority"?
 
Seriously what is the point of this thread? I'm just going to disregard the Dr oz thing, because I assume you must be kidding.

To the creator of the thread, we get enough of this crap in school. Ethics, behavioral science, etc. It's overkill really. Doctors who are people persons will be overly interested and doctors who aren't will be interested enough to get thru residency. Just the way it is. If I wanted to be a patients shoulder to cry on, I'd become a psychiatrist. I just need to know enough about the pt to help him, but I didn't study medicine so I can spend half my day on 4 pts because I needed to acquire a novel's worth of semipertinent info. While the new system of medicine med schools are trying to instill is more patient friendly, in the end you back up the whole system by literally wasting time on certain patients and making other more needy patients wait, while you ask every question under the sun so the pt can feel cared about.....isn't that part of the purpose of nurses anyways? Just saying...

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Well, this thread was meant to talk about hospital rounding and the right questions to ask oneself, but it evolved into something more interesting. I've been an attending in pediatric intensive care for 9 years. There isn't a day that goes by that an ethical, psychosocial, or other "non-medical" issue affects our decision-making as a medical team. The medicine is the easy part...intubations, central lines, CPR. The more difficult part of medicine is dealing with the "non-medical" issues. Anyone can diagnose and treat disease "X", but the way in which care is delivered is most important. You can take the path of a technician or become a physician. The choice is yours. But, if I knew then what I know now, I would have paid more attention to the ethics, behavioral sciences, etc in medical school. Those skills sure come in handy when your telling parents that their child is dying. In the end, we are just human beings treating and connecting with other human beings. When medical and surgical management fails and your patient gets sicker, what will you do?
 
MediRounds said:
Well, this thread was meant to talk about hospital rounding and the right questions to ask oneself, but it evolved into something more interesting. I've been an attending in pediatric intensive care for 9 years. There isn't a day that goes by that an ethical, psychosocial, or other "non-medical" issue affects our decision-making as a medical team. The medicine is the easy part...intubations, central lines, CPR. The more difficult part of medicine is dealing with the "non-medical" issues. Anyone can diagnose and treat disease "X", but the way in which care is delivered is most important. You can take the path of a technician or become a physician. The choice is yours. But, if I knew then what I know now, I would have paid more attention to the ethics, behavioral sciences, etc in medical school. Those skills sure come in handy when your telling parents that their child is dying. In the end, we are just human beings treating and connecting with other human beings. When medical and surgical management fails and your patient gets sicker, what will you do?
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It's inspiring to see someone 9 years into their attending career that isn't so jaded to stop caring about these things. Do you think that part of that has to do with being in pediatrics?
 
Now that I'm 16 years out of med school- I realize somehow this crazy system (medical education) works. When you are rounding you are being exposed to a myriad of patients and pathologies (and even a variety of personalities and social issues) It's sought of an osmotic or sponge type of learning- but it is still learning and after the process is over (including residency) believe it or not it will ALL come together. You'll remeber seeing a patient with rigors on amphotericin, you'll remeber that that rash looks like a fixed drug reaction- It's just not the conventional "book learning" we were all so used to.
 
Anne2009 said:
It's inspiring to see someone 9 years into their attending career that isn't so jaded to stop caring about these things. Do you think that part of that has to do with being in pediatrics?
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Thank you Anne2009, but I'm not sure. I only know pediatrics. However, I do know jaded pediatricians and pediatric subspecialists. What has helped me as well, believe it or not, has been leadership training. At our hospital, trainees and attendings have gone through it. It makes the work environment more friendly and emphasizes mutual respect. I believe that this affects patient care and the interactions as well. A couple worthwhile books to read include:

The Servant: A Simple Story About the True Essence of Leadership by James C. Hunter

Leadership and Self-Deception: Getting out of the Box by the Arbinger Institute
 
nowanmd said:
Now that I'm 16 years out of med school- I realize somehow this crazy system (medical education) works. When you are rounding you are being exposed to a myriad of patients and pathologies (and even a variety of personalities and social issues) It's sought of an osmotic or sponge type of learning- but it is still learning and after the process is over (including residency) believe it or not it will ALL come together. You'll remeber seeing a patient with rigors on amphotericin, you'll remeber that that rash looks like a fixed drug reaction- It's just not the conventional "book learning" we were all so used to.
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Yes. The medicine is the ease stuff! :)
 
nowanmd said:
Now that I'm 16 years out of med school- I realize somehow this crazy system (medical education) works. When you are rounding you are being exposed to a myriad of patients and pathologies (and even a variety of personalities and social issues) It's sought of an osmotic or sponge type of learning- but it is still learning and after the process is over (including residency) believe it or not it will ALL come together. You'll remeber seeing a patient with rigors on amphotericin, you'll remeber that that rash looks like a fixed drug reaction- It's just not the conventional "book learning" we were all so used to.
Click to expand...
I'd have to agree and I'm not out of it. Between rounding yesterday and Morning report today and our educational case, I somehow programmed what I learned into my brain... just in time because we were asked about it today.
 
MediRounds said:
Well, this thread was meant to talk about hospital rounding and the right questions to ask oneself, but it evolved into something more interesting. I've been an attending in pediatric intensive care for 9 years. There isn't a day that goes by that an ethical, psychosocial, or other "non-medical" issue affects our decision-making as a medical team. The medicine is the easy part...intubations, central lines, CPR. The more difficult part of medicine is dealing with the "non-medical" issues. Anyone can diagnose and treat disease "X", but the way in which care is delivered is most important. You can take the path of a technician or become a physician. The choice is yours. But, if I knew then what I know now, I would have paid more attention to the ethics, behavioral sciences, etc in medical school. Those skills sure come in handy when your telling parents that their child is dying. In the end, we are just human beings treating and connecting with other human beings. When medical and surgical management fails and your patient gets sicker, what will you do?
Click to expand...

Your experiences as a PICU attending are very unique to you because you're dealing with a patient population that is very fragile and you are not only treating the child, you're also treating the parents because let's face it, nothing is more important to the parents of this world than the well-being of their children. Even the most hard-hearted of parents will come weeping through the doors of PICU if their child is in there.

Thus, I don't believe you are in any position to tell other physicians that they MUST consider non-medical quasi-pertinent information when they are treating ADULT patients. We've all seen adult patients who never have any family come visit them for whatever reason and these people do just fine. These are ADULTS. They don't need some stranger physician's help in sorting out their family or personal issues.

And I resent your implication that those of us who choose not to dive deep or take the extra mile with our patients aren't physicians but merely technicians.
 
Rollo said:
Thus, I don't believe you are in any position to tell other physicians that they MUST consider non-medical quasi-pertinent information when they are treating ADULT patients. We've all seen adult patients who never have any family come visit them for whatever reason and these people do just fine. These are ADULTS. They don't need some stranger physician's help in sorting out their family or personal issues.
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I respectfully disagree. People are people...no matter if they are children or adults. My perspective is different because I deal with parents quite often, but we do have infants and children who are wards of the state and have no family visiting them. Not every patient is going get an extensive evaluation for "non-medical" factors...I don't delve into every detail. But, I do think that a directed evaluation is important. "Non-medical" factors must be taken into account. Why else would you need to discuss end-of-life issues with end-stage cancer patients? It affects how you treat and manage those patients. Why else would you need to discuss psychosocial issues with a transplant team before a patient is given any organ? It may have compliance implications that may change whether or not a patient will receive one of the scarest medical resources. Why else would you need to question why an adult doesn't have any family visiting? It may affect placement of that patient after the hospitalization, if that patient does not have anyone at home to assist with more complicated care issues or if that patient can not find anyone to help him/her get to post-hospital follow-up vist at your office.

My intention was not to offend anyone. My intention was to emphasize that being a physician means more than just prescribing medications, performing proceedures, or performing diagnostics. We are charged with a huge responsibility of maintaining people's health and well being. We just have to remember that we are people connecting with people. These people bring more than their medical issues to us and we just need to consider them because they do affect how patients respond to our treatments and managements.

Again, I do not claim perfection in this area myself. I, at times, find myself just looking at labs, treating symptoms, and adjusting medication doses. In my mind, this is technical stuff. When I address "non-medical" issues in my practice, I do feel that I extend myself beyond technical services for patients and their families. I just feel that as caregivers of our patients, we must be mindful of "non medical" issues and not refuse to believe that it is not pertinent information for us to obtain or address.
 
MediRounds said:
I respectfully disagree. People are people...no matter if they are children or adults. My perspective is different because I deal with parents quite often, but we do have infants and children who are wards of the state and have no family visiting them. Not every patient is going get an extensive evaluation for "non-medical" factors...I don't delve into every detail. But, I do think that a directed evaluation is important. "Non-medical" factors must be taken into account. Why else would you need to discuss end-of-life issues with end-stage cancer patients? It affects how you treat and manage those patients. Why else would you need to discuss psychosocial issues with a transplant team before a patient is given any organ? It may have compliance implications that may change whether or not a patient will receive one of the scarest medical resources. Why else would you need to question why an adult doesn't have any family visiting? It may affect placement of that patient after the hospitalization, if that patient does not have anyone at home to assist with more complicated care issues or if that patient can not find anyone to help him/her get to post-hospital follow-up vist at your office.

My intention was not to offend anyone. My intention was to emphasize that being a physician means more than just prescribing medications, performing proceedures, or performing diagnostics. We are charged with a huge responsibility of maintaining people's health and well being. We just have to remember that we are people connecting with people. These people bring more than their medical issues to us and we just need to consider them because they do affect how patients respond to our treatments and managements.

Again, I do not claim perfection in this area myself. I, at times, find myself just looking at labs, treating symptoms, and adjusting medication doses. In my mind, this is technical stuff. When I address "non-medical" issues in my practice, I do feel that I extend myself beyond technical services for patients and their families. I just feel that as caregivers of our patients, we must be mindful of "non medical" issues and not refuse to believe that it is not pertinent information for us to obtain or address.
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So we shouldn't discharge a bed-bound patient to an empty house? ;)

Great Post (serious).
 
Thank you. By no means were my comments a personal attack...they were just observations that I've made..
 
Rollo said:
Your experiences as a PICU attending are very unique to you because you're dealing with a patient population that is very fragile and you are not only treating the child, you're also treating the parents because let's face it, nothing is more important to the parents of this world than the well-being of their children. Even the most hard-hearted of parents will come weeping through the doors of PICU if their child is in there.

Thus, I don't believe you are in any position to tell other physicians that they MUST consider non-medical quasi-pertinent information when they are treating ADULT patients. We've all seen adult patients who never have any family come visit them for whatever reason and these people do just fine. These are ADULTS. They don't need some stranger physician's help in sorting out their family or personal issues.

And I resent your implication that those of us who choose not to dive deep or take the extra mile with our patients aren't physicians but merely technicians.
Click to expand...

you're pretty dang naive to think that non-medical factors don't have a role in an adult patient's health. As a doctor you can ask about some of this stuff and then refer to the appropriate person. This does not take much time. And seriously where have you been doing rotations? Assuming you're not like most of us seeing the downtrodden in society, even the wealthier patient population has psychosocial factors that should be considered in their care.

But hey you'll just be your below avg joe schmo doctor who gives antibiotics and sends the patient out no questions asked... good company man or some useless cosmetic specialty. But actually you wouldn't be a good company man because the patient will be back in the ED in 3 weeks and the hospital will have to eat the costs because medicare won't reimburse (private insurance soon to follow as well) and they'll determine you were the problem because you suck as a physician/technician. Yes, that's a run-on sentence.

My advice: if you have that thought process you're best being in a technician like field such as derm, plastics, radiology, pathology, etc.
 
Rollo said:
Your experiences as a PICU attending are very unique to you because you're dealing with a patient population that is very fragile and you are not only treating the child, you're also treating the parents because let's face it, nothing is more important to the parents of this world than the well-being of their children. Even the most hard-hearted of parents will come weeping through the doors of PICU if their child is in there.

Thus, I don't believe you are in any position to tell other physicians that they MUST consider non-medical quasi-pertinent information when they are treating ADULT patients. We've all seen adult patients who never have any family come visit them for whatever reason and these people do just fine. These are ADULTS. They don't need some stranger physician's help in sorting out their family or personal issues.

And I resent your implication that those of us who choose not to dive deep or take the extra mile with our patients aren't physicians but merely technicians.
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I mean, the social issues are going to affect you one way or another, even if you don't want them to. If you're talking about an adult who can take care of themselves after they leave/ is easily agreeable to going wherever they need to in order to be taken care of, that's obviously not a big deal. But I feel like that only happens maybe 50-60% of the time. Perhaps you're not very touchy-feely, and I think that is totally acceptable, but that doesn't change the fact that you have to at least be aware of the living situation of each patient.
 
Agreed. If you don't look, you wont find anything. Just something to think about...
 
duckie99 said:
you're pretty dang naive to think that non-medical factors don't have a role in an adult patient's health. As a doctor you can ask about some of this stuff and then refer to the appropriate person. This does not take much time. And seriously where have you been doing rotations? Assuming you're not like most of us seeing the downtrodden in society, even the wealthier patient population has psychosocial factors that should be considered in their care.

But hey you'll just be your below avg joe schmo doctor who gives antibiotics and sends the patient out no questions asked... good company man or some useless cosmetic specialty. But actually you wouldn't be a good company man because the patient will be back in the ED in 3 weeks and the hospital will have to eat the costs because medicare won't reimburse (private insurance soon to follow as well) and they'll determine you were the problem because you suck as a physician/technician. Yes, that's a run-on sentence.

My advice: if you have that thought process you're best being in a technician like field such as derm, plastics, radiology, pathology, etc.
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This. Once the medical issues are fixed, we still have to figure out placement/insurance/compliance issues so often for patients who hadn't seen a doctor in years. If you treat a patient's acute condition without giving them education or determining whether they need to be transferred to a nursing facility or have home care, they'll end up back in the ED with the same CHF/COPD/Asthma exacerbation within a few days.
 
Can anyone share an actual experience that reflects the above conversation? No real names or details, of course... :)

An experience in which you discovered something "non-medical" that changed your management or treatment plan?
 
MediRounds said:
Can anyone share an actual experience that reflects the above conversation? No real names or details, of course... :)

An experience in which you discovered something "non-medical" that changed your management or treatment plan?
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Happens all the time. I mean you only have to ask patients if they can afford their medications or get to their PCP on their own to have endless stories of how just prescribing or saying to follow up fails.
 
MediRounds said:
Can anyone share an actual experience that reflects the above conversation? No real names or details, of course... :)

An experience in which you discovered something "non-medical" that changed your management or treatment plan?
Click to expand...

Had a patient that had RCC and was scheduled for a total nephrectomy approximately 5-7 days later. Standard protocol is to send the patient home and she would've come back for the procedure. We talked to her, turns out she has no siblings, kids, or parents alive (patient was decently elderly) and while she has a good support system of friends in the area, she had no one in the house with her 24/7. Now on top of this, she had some early dementia signs as well. With all these factors we recommended that she just stay in the hospital until the surgery. Patient was agreeable, so she just hung out and talked to the med students for 5-6 days until her surgery. Very pleasant lady and a pleasure to just go and talk to in the morning.

While it didn't change our actual plan (she was still getting a nephrectomy) it did influence our 'management' in the sense of discharge planning and possible re-admission.

Also, I've had 3 Jehovah's witness patients. 2 of them were having some sort of GI bleed and were severely anemic (<6 and symptomatic). One of the patients was transferred to hospice after a long talk with the patient, his friend, and his pastor because we couldn't transfuse them and GI wouldn't scope them with their anemia. The other patient, I was told, was made DNR/DNI and passed away over the weekend.

Obviously with these 2 patients, their social beliefs and refusal to consent to blood products changed our management from curative (if only temporary with blood transfusions) to hospice/comfort measures. Now granted, both of these patients had very clear wishes about their situation.
 
Some people in this thread scare me. I know I'm not even in med school yet, but I just can't wait to become a doctor so I can be a good one...and not just one that will write a prescription and send the patient out the door.

Call me too naive, too ambitious, tell me "just wait until clinicals" or whatever, I don't care.
 
Bacchus said:
Happens all the time. I mean you only have to ask patients if they can afford their medications or get to their PCP on their own to have endless stories of how just prescribing or saying to follow up fails.
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I guess to give an actual story...

Had a pt with multiple admissions, 3 of which have been during the past month. On the surface, the patient seems to be a huge PITA and nothing else. Doesn't follow up with her PCP and runs to the hospital at the drop of a hat.

If we would just keep treating her acutely she'd just come back. Delving into her back story (and actually talking with her instead of just treating her symptoms) we learned her daughter works night shift, she relies on her daughter for transport, someone in her family was actively dying and another was suffering from leukemia. She was also realizing her own mortality and relying on the support system of the hospital because she would get lonely and freak herself out.

So, we could have just treated what she came in for, but instead we scheduled her a PCP followup (moreso so she'd go, but also out of convenience for her) at a time that was convenient for her daughter, set her up for outpatient group therapy, and recommended a psychiatrist for her.

Like I said above, if we just would have treated her acute complaint she'd be the "PITA lady" who was always coming back to the hospital. But, after getting her back story it made a lot more sense and we were able to appeal to her senses and explain to her the various changes in her treatment we were going to make.
 
In Emergency Medicine, the patient's social situation will sometimes determine whether or not I can send them home or have to admit them. Patients with no social support will sometimes require admission whereas if I can get family involved, it can be a discharge. Some people with questionable outpatient follow-up will be told to return in 2 days for a cellulitis recheck. The Closed Head Injury patient or the intoxicated patient can go home with a family member who can be instructed on how to observe them, but if they don't have that, we can observe them in the ED until we've ruled out the need for a head CT or until they're clinically sober.

Financial status will also determine what medication I use to treat them. Maybe I'll prescribe an H2 blocker instead of a PPI. The albuterol MDI can be prescribed with or without the spacer (Expensive!). The doxy script replaced with the less comfortable 1g Azithromycin that can be given one time in the ED.
 
Rollo,

I'm honestly dying to know how you answered questions during the interview process for medical school.

I'm not sure about the rest of you, but I can't imagine trying to practice medicine for the rest of my life with that kind of mentality. You are right when you said, "We've all seen adult patients who never have any family come visit them for whatever reason and these people do just fine." On the flip-side, we have all seen adult patients who don't do fine in that situation. In other words, and, correct me if I'm wrong, you'd rather refrain from finding out the non-medical information because the majority will do fine?

Please indulge me.

Scenario:
"Medical pertinent information"
An 82 year old woman is admitted to the 3rd floor due to recent onset of increasing fatigue. She was a very sweet but quiet lady and had no one visit her during her 2 day stay. You ask your routine medical questions and obtain only the "pertinent information," noting that she has a documented history of chronic IDA. You treat her medical problem and refrain from attaining any of that "non-medical quasi-pertinent information" because she got better according to her labs and will do just fine after discharge. Also, because you are inpatient only, there is no reason for you to follow up on her and thus you set her up with a FP in 1 week. Three days later she commits suicide, which you wouldn't have ever known had you not recognized her picture in an obituary. You never find out why.

"Non-medical quasi-pertinent information"
Turns out she had lost her husband of 60 years a month earlier. She had also written in her diary the week leading up to her hospital stay and her death that she was too sad to eat and had been having trouble sleeping since his death. She was an only child. Also, she wasn't able to have children. At the end of the day, she was an ADULT. And, her suicide might have been averted had someone "dove a little deeper" into WHY she was experiencing a sudden increase in fatigue with her chronic IDA. It's easy stamping a diagnosis based on the lab work and physical signs. In this scenario, her increasing fatigue was multifactorial and not just a result of her IDA. The combination of her grief, insomnia, loss of appetite and chronic IDA led to her complaint. This woman's life might have been saved by going that extra mile.
 
Due to your preconceived notion that I must be a "bad physician", I won't entertain you by answering your hypothetical scenario because no matter how I answer it, you will find something in my answer that you will either disagree with and subsequently point out the perceived "absurd" nature of it or agree with and reinforce the concept in your head that your way of practicing medicine is, after all, the correct way.

Either way, I don't feel like getting my hands dirty by throwing mud at each other here.
 
Rollo said:
Due to your preconceived notion that I must be a "bad physician", I won't entertain you by answering your hypothetical scenario because no matter how I answer it, you will find something in my answer that you will either disagree with and subsequently point out the perceived "absurd" nature of it or agree with and reinforce the concept in your head that your way of practicing medicine is, after all, the correct way.

Either way, I don't feel like getting my hands dirty by throwing mud at each other here.
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I think you just need to realize that the non-medical side of patients is something very much worth considering when dealing with their care. That's all we've tried to say after your original post in this thread. If you had gone, "Oh yeah, those are some good examples, maybe I should try to incorporate that into my H&P", there probably wouldn't be so many posts about it. Continuing to be defensive isn't helping the mudslinging against you.
 
I mean, the social issues are going to affect you one way or another, even if you don't want them to.
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I totally agree, unfortunately. I'm not at all a fan of dealing with the social aspects of care, and that's part of the reason I chose a profession that minimizes their importance and my exposure to them. Technician, physician, call me what you want, but I don't see it as different than any other reason to choose a job.
 
duckie99 said:
you're pretty dang naive to think that non-medical factors don't have a role in an adult patient's health. As a doctor you can ask about some of this stuff and then refer to the appropriate person. This does not take much time. And seriously where have you been doing rotations? Assuming you're not like most of us seeing the downtrodden in society, even the wealthier patient population has psychosocial factors that should be considered in their care.

But hey you'll just be your below avg joe schmo doctor who gives antibiotics and sends the patient out no questions asked... good company man or some useless cosmetic specialty. But actually you wouldn't be a good company man because the patient will be back in the ED in 3 weeks and the hospital will have to eat the costs because medicare won't reimburse (private insurance soon to follow as well) and they'll determine you were the problem because you suck as a physician/technician. Yes, that's a run-on sentence.

My advice: if you have that thought process you're best being in a technician like field such as derm, plastics, radiology, pathology, etc.
Click to expand...

Completely agree. The medicine is very easy (the patients aren't even sick half time or would have gotten better on their own). Despite personally hating doing social work, I've found that's what sometimes has the biggest impact on the patients.
 
Rollo said:
In each of the scenarios, there is somebody I can consult. And that consultant is better trained at taking care of the particular co-morbidity/special need.

I'm not jaded by any means. Just being realistic.
Click to expand...

... then there's no reason to have you involved in the patient's care at all is there?
 
Doctor Bob said:
... then there's no reason to have you involved in the patient's care at all is there?
Click to expand...

...and you want me to tell you why I thought family medicine was boring?
 
SixStringPsych said:
Some people in this thread scare me. I know I'm not even in med school yet, but I just can't wait to become a doctor so I can be a good one...and not just one that will write a prescription and send the patient out the door.

Call me too naive, too ambitious, tell me "just wait until clinicals" or whatever, I don't care.
Click to expand...

I don't think doctors who don't care about social stuff are either bad or good. A lot of it is specialty specific and also specific to the culture of the hospital. Most doctors do have to deal with the social stuff at some sort of level, particularly when it comes to discharge planning. No one just kicks inpatients out on the street without finding out where they're going and if they will be able to take care of themselves when they get there.

And you will find a big difference between your sweet old lady who can't take care of herself at home and your manipulative drug seeker who's trying to game the system or your alcoholic who comes in for detox every month. Both types of people have tough social situations. Both might require an extra amount of social work on your part. But even the most caring doctor is going to be gung ho and happy about arranging things for the first whilst cursing and maybe even not doing everything they TECHNICALLY could do for the second. And I think you could argue this is not necessarily wrong. People should not be allowed to take advantage of physicians and use up resources when they have no intention of treating their disease. I see so many inappropriate admits it's not even funny.
 
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