Things I hate to hear patients say:

[VA Hopeful Dr]

I hate HTN patients. In my area they always have the expectation that I'm going to lower it in the ED to a "safe level" before sending them home. It takes a 10-15 minute discussion with these patients and family to reverse their expectations, which usually involves me repeating the evidence over and over until it sinks in. Even then about 50% of my (mostly Hispanic) patients leave disgruntled and upset that I didn't fix their blood pressure. In fact, non-treatment of asymptomatic hypertension is the #1 patient complaint I get, and involves a lot of my time responding to the hospital and my medical director.

So PCPs please get with the 21st century and stop sending these patients in!!!

That'll take awhile as noted previously.

Just give them some amlodipine and send them home.

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[bravotwozero]

I don't mind seeing asymptomatic hypertension. Easy patients. What I don't like is when the RN or MLP gets involved and starts ordering EKGs, trops, head CTs, etc.

This! Have had to stop MLPs, and RNs from freaking out, otherwise it's like a small dose of clonidine and bye bye - good if you work in a RVU based environment.

 

[Perrotfish]

Part of the issue here is that the AAFP does not, as far as I am aware, endorse the 2017 ACEP guideline. Also, for reference, here is their most recent review article (not a guideline) with a recommended algorithm. According to their algorithm:

1) Any symptoms, to include headache, anxiety, palpitations, nausea, or a nosebleed needs at least a BMP. Good luck finding a patient who is asymptomatic by that standard.
2) Any signs of end organ damage, including an elevated creatinine on BMP, qualifies as a hypertensive emergency and requires hospitalization (presumably for the goal of lowering BP by 20% and serial labs?). Also even the ACEP guidelines seem to be unclear about what to do with abnormal findings on a BMP if you happen to draw the lab.

Now none of that is an excuse for a military/academic/Kaiser physician to send a patient with a SBP of 200/130 to the ER rather than to the lab down the hall, but for a stand alone clinic that's two bus transfers away from the nearest LabCorp office? I could see why dealing with this in the office could be difficult

 

[DrMcCoyDO]

I hate HTN patients.

One of my favorite patients I ever had was a HTN patient I had as a student. I was working at an ED in a really shady part of town (lot of gangs and drugs in the area). Guy came in at 1 in the morning; because, his PCP had started him on BP medication a week before, and he wanted to know if it was working. Checked the BP, it was right around 120/80, and basically told him “Yup, it’s working” and showed him the door.

 

[Perrin]

Pt's spouse, "She doesn't need chemo. That's how all those docs get rich. Making people sick and taking their money."

Me: "What was the oncologist wanting to treat her for?"

Spouse: "He said she had colon cancer, but we found a world famous specialist in [nearby big city] who treats these things. He's been giving her supplements and special preparations he makes."

Back Story
Pt came to ED with and pain. CT noted appendicitis and a suspicious colon mass with mets to liver. GS removed appy and refered to Onc. They Rec'd chemo. Spouse declined as he'd read online about Doctor scams and how natural methods can work better. Pt went to naturopath/herbalist.

Present
I google this Naturopath's clinic and the first link is google street view that shows a dilapidated ranch style house with an overgrown carport. I'd more expect someone to offer me meth than life saving treatment at this house. I researched further and found this naturopath's alma mater. Googled that and the first link was to a site called 'quackwatch' which warned anyone to avoid someone who claimed credentials from that 'College'.

I returned to talk to the pt and spouse. I told them that the cancer had taken over most of the liver and spread to the lungs. This was likely causing her current symptoms. Spouse asked what else they could have done and choked back tears. Pt was only in her 60's. I mustered every ounce of professionalism and empathy I had and told him that he did everything he thought would help her. There was little I can do in the ED, but I would admit her to have Onc and palliative care evaluate her.

I spent the rest of the shift in a bad mood. No telling if Onc could have made a difference, but the charlatans deceived them and ensured a death sentence. The gallow's humor is that they called the naturopath that morning because she was hurting and he told them to go to the ED.

 

[BoardingDoc]

Pt's spouse, "She doesn't need chemo. That's how all those docs get rich. Making people sick and taking their money."

Me: "What was the oncologist wanting to treat her for?"

Spouse: "He said she had colon cancer, but we found a world famous specialist in [nearby big city] who treats these things. He's been giving her supplements and special preparations he makes."

Back Story
Pt came to ED with and pain. CT noted appendicitis and a suspicious colon mass with mets to liver. GS removed appy and refered to Onc. They Rec'd chemo. Spouse declined as he'd read online about Doctor scams and how natural methods can work better. Pt went to naturopath/herbalist.

Present
I google this Naturopath's clinic and the first link is google street view that shows a dilapidated ranch style house with an overgrown carport. I'd more expect someone to offer me meth than life saving treatment at this house. I researched further and found this naturopath's alma mater. Googled that and the first link was to a site called 'quackwatch' which warned anyone to avoid someone who claimed credentials from that 'College'.

I returned to talk to the pt and spouse. I told them that the cancer had taken over most of the liver and spread to the lungs. This was likely causing her current symptoms. Spouse asked what else they could have done and choked back tears. Pt was only in her 60's. I mustered every ounce of professionalism and empathy I had and told him that he did everything he thought would help her. There was little I can do in the ED, but I would admit her to have Onc and palliative care evaluate her.

I spent the rest of the shift in a bad mood. No telling if Onc could have made a difference, but the charlatans deceived them and ensured a death sentence. The gallow's humor is that they called the naturopath that morning because she was hurting and he told them to go to the ED.

I'm not sure that I would have sidestepped the question like that. I agree that it was the nice thing to do, but I think there is probably a way to work in what you said about onc and how it might not have cured her, but it certainly would have been a better shot than the quack they went to.

Also, serious question for anyone more legally minded than I am: is there any legal recourse that this family would have against the naturopath? Practicing medicine without a licence? Wrongful death suit?

 

[evilbooyaa]

Pt's spouse, "She doesn't need chemo. That's how all those docs get rich. Making people sick and taking their money."

Me: "What was the oncologist wanting to treat her for?"

Spouse: "He said she had colon cancer, but we found a world famous specialist in [nearby big city] who treats these things. He's been giving her supplements and special preparations he makes."

Back Story
Pt came to ED with and pain. CT noted appendicitis and a suspicious colon mass with mets to liver. GS removed appy and refered to Onc. They Rec'd chemo. Spouse declined as he'd read online about Doctor scams and how natural methods can work better. Pt went to naturopath/herbalist.

Present
I google this Naturopath's clinic and the first link is google street view that shows a dilapidated ranch style house with an overgrown carport. I'd more expect someone to offer me meth than life saving treatment at this house. I researched further and found this naturopath's alma mater. Googled that and the first link was to a site called 'quackwatch' which warned anyone to avoid someone who claimed credentials from that 'College'.

I returned to talk to the pt and spouse. I told them that the cancer had taken over most of the liver and spread to the lungs. This was likely causing her current symptoms. Spouse asked what else they could have done and choked back tears. Pt was only in her 60's. I mustered every ounce of professionalism and empathy I had and told him that he did everything he thought would help her. There was little I can do in the ED, but I would admit her to have Onc and palliative care evaluate her.

I spent the rest of the shift in a bad mood. No telling if Onc could have made a difference, but the charlatans deceived them and ensured a death sentence. The gallow's humor is that they called the naturopath that morning because she was hurting and he told them to go to the ED.

While chemotherapy alone is almost certainly not curative in that metastatic setting (depends on number of liver metastases at initial diagnosis), it would've likely lead to longer survival than what the patient decided on.

I would've told the spouse that they could have initiated chemo at initial diagnosis with a better chances of preventing this. But maybe I'm just bitter from seeing way too many neglected cancers go from curable to incurable.

 

[RoyBasch]

Also, serious question for anyone more legally minded than I am: is there any legal recourse that this family would have against the naturopath? Practicing medicine without a licence? Wrongful death suit?

I have always wondered this as well. Do these various bullshirt artists (Reiki spirit healers, chiropractors who "treat" systemic medical illnesses, homeopaths, etc.) face any legal liability for malpractice, failure to treat, missed or delayed diagnosis?

 

[bravotwozero]

I'm sure you can sue them, you can sue anyone for anything here. The question is what will you get if you win? These guys likely don't have deep pockets, or malpractice insurance, if you're lucky you may be able to force them to shut down their practice...

 

[Birdstrike]

“Spouse asked what else they could have done and choked back tears”

When patients ask me regret filled questions like this, I generally don’t indulge them. I don’t think it serves any useful purpose to re-litigate a patient (or physicians’) past bad decisions at a moment of crisis. Rather than start listing every poor decision they’ve made to lead to this point, I focus on what can help in the future. Typically something like this, “Rather than second guessing past decisions, let’s focus on what we can do right now, to make this better today, and in the future.” I think that’s honest and also useful.

 

[RustedFox]

I have always wondered this as well. Do these various bullshirt artists (Reiki spirit healers, chiropractors who "treat" systemic medical illnesses, homeopaths, etc.) face any legal liability for malpractice, failure to treat, missed or delayed diagnosis?

Of course not. People like white magic, because science is hard. And evil.

 

[gutonc]

While chemotherapy alone is almost certainly not curative in that metastatic setting (depends on number of liver metastases at initial diagnosis), it would've likely lead to longer survival than what the patient decided on.

I would've told the spouse that they could have initiated chemo at initial diagnosis with a better chances of preventing this. But maybe I'm just bitter from seeing way too many neglected cancers go from curable to incurable.

So much this right now. We had 13 cases in our GI tumor board this morning. Fully 7 of them began with "patient chose to pursue alternative therapy until terrible symptom X had their naturopath/chiropractor/witch doctor send them to the ER". 5 of those were my patients.

 

[Detective SnowBucket]

So much this right now. We had 13 cases in our GI tumor board this morning. Fully 7 of them began with "patient chose to pursue alternative therapy until terrible symptom X had their naturopath/chiropractor/witch doctor send them to the ER". 5 of those were my patients.

Aside the point, but is you profile pic from the oatmeal, I think I recognize it

 

[gutonc]

Aside the point, but is you profile pic from the oatmeal, I think I recognize it

'Tis

 

[GonnaBeADoc2222]

So much this right now. We had 13 cases in our GI tumor board this morning. Fully 7 of them began with "patient chose to pursue alternative therapy until terrible symptom X had their naturopath/chiropractor/witch doctor send them to the ER". 5 of those were my patients.

Seriously, did no one pay attention to what happened to Steve Jobs?

 

[RoyBasch]

What do these "Witch Doctors" think of themselves? If they have been practicing for time, they surely have had an accumulation of patients failing their bogus treatments that they bail on and send to the ER? Do they know the extent to which they've ****ed up? Or do you think the patient simply "disappears" from their practice once they resume care with actual physicians and the witch doctor assumes all is well? Do they realize these patients are suffering major (sometimes preventable) morbidity and mortality?

 

[gutonc]

What do these "Witch Doctors" think of themselves? If they have been practicing for time, they surely have had an accumulation of patients failing their bogus treatments that they bail on and send to the ER? Do they know the extent to which they've ****ed up? Or do you think the patient simply "disappears" from their practice once they resume care with actual physicians and the witch doctor assumes all is well? Do they realize these patients are suffering major (sometimes preventable) morbidity and mortality?

Dead people don't write bad Yelp reviews.

 

[hurtem&healem]

What do these "Witch Doctors" think of themselves? If they have been practicing for time, they surely have had an accumulation of patients failing their bogus treatments that they bail on and send to the ER? Do they know the extent to which they've ****ed up? Or do you think the patient simply "disappears" from their practice once they resume care with actual physicians and the witch doctor assumes all is well? Do they realize these patients are suffering major (sometimes preventable) morbidity and mortality?

They likely also have a list of patients who spontaneously healed. And they can easily ask the same question in reverse and get exactly the answer they want: How many patients have western medical doctors put through the horror of chemotherapy only for them to die a slower, more terrible death?

I'm not defending them, in fact I detest what they do, but you must recognise how poorly this argument holds up to the believers.

 

[Perrin]

I'm not sure that I would have sidestepped the question like that. I agree that it was the nice thing to do, but I think there is probably a way to work in what you said about onc and how it might not have cured her, but it certainly would have been a better shot than the quack they went to.

Also, serious question for anyone more legally minded than I am: is there any legal recourse that this family would have against the naturopath? Practicing medicine without a licence? Wrongful death suit?

Doubtful. Every page on the naturopath's website had a huge disclaimer stating that he was not offering medical advice and to seek medical care for any medical condition. Now, what he told them behind closed doors was probably very misleading.

 

[Perrin]

They likely also have a list of patients who spontaneously healed. And they can easily ask the same question in reverse and get exactly the answer they want: How many patients have western medical doctors put through the horror of chemotherapy only for them to die a slower, more terrible death?

I'm not defending them, in fact I detest what they do, but you must recognise how poorly this argument holds up to the believers.

I think they also present to the patients the horrors of chemotherapy side effects and contrast it with their homeopathy and supplement side effects. Patient buys a few bottles of homeopathic water and returns in a few weeks. Naturopath tells them, "See, no terrible side effects like those chemo drugs. By the way, did you know those chemo drugs are just a scam by pharma and docs to get your money." Pt continues carefree as before, convinced that this is the right choice bc they aren't hurting or feeling terrible like their aunt, neighbor, or coworker did when they had chemo. Months later the symptoms of advanced stage cancer begin appearing, but he charlatan has already cashed all the checks. It is preying on human gullibility.

 

[Goro]

What do these "Witch Doctors" think of themselves? If they have been practicing for time, they surely have had an accumulation of patients failing their bogus treatments that they bail on and send to the ER? Do they know the extent to which they've ****ed up? Or do you think the patient simply "disappears" from their practice once they resume care with actual physicians and the witch doctor assumes all is well? Do they realize these patients are suffering major (sometimes preventable) morbidity and mortality?

Never underestimate the ability of people to engage in confirmation bias. I see this in my OMM True Believers.

And for some people "alternative" medicine is a belief system.

 

[Perrotfish]

What do these "Witch Doctors" think of themselves? If they have been practicing for time, they surely have had an accumulation of patients failing their bogus treatments that they bail on and send to the ER? Do they know the extent to which they've ****ed up? Or do you think the patient simply "disappears" from their practice once they resume care with actual physicians and the witch doctor assumes all is well? Do they realize these patients are suffering major (sometimes preventable) morbidity and mortality?

We have lots of patients who fail our treaents too. Anecdotally real medicine looks a lot like fake medicine. It's only when you do controlled studies that you realize that what we do works and that quackery doesn't. Quacks are just people who focus on the anecdotes.

 

[HomeSkool]

"My regular doctor (actually a family practice NP) told me not to let anyone give me general anesthesia because it would kill me."

I very professionally tried to explain that their NP is not a subject matter expert in anesthesiology but the patient remained resolute: if I wanted to do general anesthesia, I was going to need to call the family med clinic to get permission.

Yeah...I'll get right on that. Or not. Good luck with that thoracotomy.

 

[bravotwozero]

"Every other time I come the doctors give me dilaudid....."

A colleague of mine mentioned to me how a military doc he knew would deal with this, when drug seeking sicklers would show up in his ED. 'Due to a dilaudid shortage, the only form in which Dilaudid is available is a rectal suppository....' One by one, the more egregious frequent fliers started leaving, and would not come back if they knew he was there.

I am increasingly becoming more tempted to try this out....

 

[AlmostAnMD]

Correct

That said I don’t get upset with PCP’s for sending patients in. The data and recommendations aren’t old enough yet for universal knowledge. It takes something like 18 years for practice changes to disseminate to all fields and the research on this took place in our field. I’ve noticed major practice changes in EM and then Cards and now seeing it start in IM and FM.

I don't think this is correct, there has to be an upper limit for not doing a workup. For example, essential hypertension, even poorly managed, will max out. Someone can correct me if I'm wrong but I doubt anyone will see essential htn at 276/150, that's almost always a secondary cause

 

[Arcan57]

I don't think this is correct, there has to be an upper limit for not doing a workup. For example, essential hypertension, even poorly managed, will max out. Someone can correct me if I'm wrong but I doubt anyone will see essential htn at 276/150, that's almost always a secondary cause

Secondary cause? So you're advocating for getting renal artery US, maybe keep them in the ED for a 24 hr urine catecholamine collection? The emergent secondary causes for extremely high blood pressure are things like dissection, head bleed, etc. and they have symptoms.

 

[Rendar5]

I don't think this is correct, there has to be an upper limit for not doing a workup. For example, essential hypertension, even poorly managed, will max out. Someone can correct me if I'm wrong but I doubt anyone will see essential htn at 276/150, that's almost always a secondary cause

In the asymptomatic patient anyworkup is outpatient, so again no role for testing in the ED

 

[thegenius]

In the asymptomatic patient anyworkup is outpatient, so again no role for testing in the ED

That is the point to this entire sub-conversation. Doesn't really matter what that BP is, if they don't have symptoms it's not an emergency.

And in this bucket I include patients who "feel a little dizzy", or have "a little headache" and are clearly comfortable and not actually having real symptomology. These patients are, for all intents and purposes, asymptomatic as well.

 

[CoolWhipp]

I know my body.

Including, any other similar phrase such as:

This is not normal to me.

I run cold so this is a fever for me.

I have a high pain tolerance.

/rant

 

[RustedFox]

I know my body.

Including, any other similar phrase such as:

This is not normal to me.

I run cold so this is a fever for me.

I have a high pain tolerance.

/rant

We did this once already it was a lot of fun. I think it was called "Things I hate to hear patients say".

Wanna merge the threads?

 

[DeadCactus]

I just don't take it literally. I take it as "I don't feel at my baseline and I'm concerned."

 

[Mount Asclepius]

That’s the problem. Some people don’t handle well the natural variation in baseline, and immediately run to the ED any time something feels off. The rest of us just fart and then move on with our day.

 

[NYEMMED]

"Well Doc let me start from the beginning, 5 years ago.......... (12 mins later), And that's why I'm here. I've been to everyone and everywhere and they can't figure it out, so I came to the ED tonight"

 

[southerndoc]

Don't forget... "Only Dilaudid works for my pain."

"Dr. X's office said he was on-call and would meet me in the ER."

 

[RustedFox]

S.u.p.e.r.b.u.m.p.

 

[brabbit2222]

"You only addressed my chest pain, but what about the numbness in my toes, this rash, why I feel so tired, and why my vision is blurry?"

"I'm very constipated and I don't feel comfortable leaving until I have a bowel movement"

"My cousin says I need an MRI to prove that my dizziness really isn't a stroke, my normal brain CT and Neuro exam don't matter."

 

[RustedFox]

"You only addressed my chest pain, but what about the numbness in my toes, this rash, why I feel so tired, and why my vision is blurry?"

"I'm very constipated and I don't feel comfortable leaving until I have a bowel movement"

"My cousin says I need an MRI to prove that my dizziness really isn't a stroke, my normal brain CT and Neuro exam don't matter."

I have said to a patient: "Sir, if we kept everyone who was constipated here in the ER until they had relief, we would have the hallways stacked with seniors who are simply waiting to have a poop."

Once he heard that, he reconsidered his position.

 

[The Knife & Gun Club]

"Why can't the ambulance take me home? They brought me here."

This one always kills me. Grandma is 65 on her 19th presentation this year for acute on chronic back pain, can’t use a smartphone or use Uber, has no friends, children, family, or even acquaintances around who can come pick her up. Maybe she has a son but the son is at home and doesn’t drive. She says she has no money, and doesn’t have a wallet or credit cards or cash.

I can not fathom how people survive.

 

[RustedFox]

The one that will forever make me snarl is the patient's complete inability to even know, let alone pronounce, the medications that they take.

I have said some pretty hilariously rude things in response to this deficiency... to the right patient.

 

[Apollyon]

As a diagnosed celiac (and not a medical professional) these attitudes make me very unhappy. I ask every medical/related professional about gluten in anything that's going into me - dentists, pharmacists and doctors/nurses. Yes, if I'm having a heart attack or a stroke and/or unconscious, then I won't be able to ask about gluten. Otherwise I do. Surely, if I'm septic, my doctor should be able to find me a gluten-free medicine even in an emergency. I went to a Gastroenterology specialist and had an endoscopy and had a diagnosis, by like a real doctor, (sarcasm) and I expect it to be taken seriously.

This flippant attitude toward those diagnosed with celiac and subsequent exposure to gluten is unfortunate. Sure, the Gwyneth Paltrow "I go gluten-free to cleanse my body and lose weight" people make it harder for real celiacs on a day to day basis but they shouldn't affect my medical care. A reasonable question for the doc in the post that I quoted would be to ask "Are you a diagnosed celiac?" before deciding whether to check for gluten.

I'm a bit cranky now because I got exposed to gluten at a restaurant today and will have to spend the next few days running to the restroom - and that was accidental and a likely small amount. I can't imagine how unhappy I'd be in the ER, vomiting and sitting on the toilet while being septic or having a workup for chest pain or whatever. And the nurse was upset because she/he has probably dealt with sick celiacs before and likely the nurse would be the one helping/cleaning up after the celiac while the doctor wouldn't be. I doubt that the accidental exposure would kill me but some celiacs do have seizures and weird neurological symptoms on exposure and I'm not risking that if possible and neither should my doctor.

Late response, but, whatever. My wife is gluten sensitive, but, it's not GI symptoms. She gets a rash. And, a rash after getting a med is really concerning to many docs (wondering if anaphylaxis is imminent). So, GSE that gives someone the runs doesn't worry me.

 

[southerndoc]

"I'm very constipated and I don't feel comfortable leaving until I have a bowel movement"

A patient once told me that... I told them we have several clean toilets in the waiting room and none in his treatment room. We're discharging him and he's welcome to stay in the waiting room until he has a bowel movement. Surprisingly, he left immediately after being escorted to the waiting room.

 

[turkeyjerky]

Cannot fathom why anyone would want to take a dump in the ER. I sure as hell don't like to **** outside my house.

Once I got signed out a patient w/ constipation waiting to poo. This woman was sitting on a bedside commode for an hour, screaming and demanding pain medicine (no, ma'am, we're not going to give you more opioids. That's why you're constipated in the first place). After a little bit, the whole department smelt godawful b/c she had opened the door to her room. I had to walk over there to close the door and told her to behave herself.

 

[turkeyjerky]

The one that will forever make me snarl is the patient's complete inability to even know, let alone pronounce, the medications that they take.

I have said some pretty hilariously rude things in response to this deficiency... to the right patient.

I'll sometimes ask patients, or their families, if they even know the first letter of the name of a med, or what's it's prescribed for. Nada. Never works.

Me: "Do you have any other medical problems?"
Pt: "Medical....?"
Me: "You know, like anything you see a doctor for, take medication for, or have required treatment for in the past? You know, like anything you would consider a medical condition or problem?"
Pt: Lists off plethora of orthopedic pains and surgeries
Me: "Ok, so, just to be clear, you don't take any medicines every day?"
Pt: "Ohh...well I take medicines for my heart, thyroid, pressure, sugar..."

Every.Damn.Day

 

[RustedFox]

I'll sometimes ask patients, or their families, if they even know the first letter of the name of a med, or what's it's prescribed for. Nada. Never works.

Me: "Do you have any other medical problems?"
Pt: "Medical....?"
Me: "You know, like anything you see a doctor for, take medication for, or have required treatment for in the past? You know, like anything you would consider a medical condition or problem?"
Pt: Lists off plethora of orthopedic pains and surgeries
Me: "Ok, so, just to be clear, you don't take any medicines every day?"
Pt: "Ohh...well I take medicines for my heart, thyroid, pressure, sugar..."

Every.Damn.Day

I have said to OldMan who can't be bothered to list his medications:

"Who played 3B for the Yankees last year?"

"Josh Donaldson"

"Right-on. Okay. Who played 1B?"

"DJ LeMahieu"

Okay. If you can tell me the starting lineup of your favorite team (it was obvious that he was a Yankees fan), there is ZERO reason why you shouldn't be responsible enough to know the medications that you take to manage your life-threatening heart disease.

 

[RustedFox]

Cannot fathom why anyone would want to take a dump in the ER. I sure as hell don't like to **** outside my house.

Once I got signed out a patient w/ constipation waiting to poo. This woman was sitting on a bedside commode for an hour, screaming and demanding pain medicine (no, ma'am, we're not going to give you more opioids. That's why you're constipated in the first place). After a little bit, the whole department smelt godawful b/c she had opened the door to her room. I had to walk over there to close the door and told her to behave herself.

I give these people a battery of Rx and a discharge.

Mag citrate
Lactulose
Suprep
Whatever.

 

[The Knife & Gun Club]

I'll sometimes ask patients, or their families, if they even know the first letter of the name of a med, or what's it's prescribed for. Nada. Never works.

Me: "Do you have any other medical problems?"
Pt: "Medical....?"
Me: "You know, like anything you see a doctor for, take medication for, or have required treatment for in the past? You know, like anything you would consider a medical condition or problem?"
Pt: Lists off plethora of orthopedic pains and surgeries
Me: "Ok, so, just to be clear, you don't take any medicines every day?"
Pt: "Ohh...well I take medicines for my heart, thyroid, pressure, sugar..."

Every.Damn.Day

I have said to OldMan who can't be bothered to list his medications:

"Who played 3B for the Yankees last year?"

"Josh Donaldson"

"Right-on. Okay. Who played 1B?"

"DJ LeMahieu"

Okay. If you can tell me the starting lineup of your favorite team (it was obvious that he was a Yankees fan), there is ZERO reason why you shouldn't be responsible enough to know the medications that you take to manage your life-threatening heart disease.

I’ll honestly even take it if they can get close.

“Metro pro lol” and “my Formin’” is good enough.

The psychotic meth patient in my jail clinic can tell me he takes PTU for his thyroid and doesn’t like haldol. If you’re 50 with a stable job and a mortgage you should be able to tell me if you’re on anti-hypertensives.

 

[PianoMedic]

I'll sometimes ask patients, or their families, if they even know the first letter of the name of a med, or what's it's prescribed for. Nada. Never works.

Me: "Do you have any other medical problems?"
Pt: "Medical....?"
Me: "You know, like anything you see a doctor for, take medication for, or have required treatment for in the past? You know, like anything you would consider a medical condition or problem?"
Pt: Lists off plethora of orthopedic pains and surgeries
Me: "Ok, so, just to be clear, you don't take any medicines every day?"
Pt: "Ohh...well I take medicines for my heart, thyroid, pressure, sugar..."

Every.Damn.Day

My patient population is also medically ignorant, so I’ve just stopped asking about medical problems.

Instead: “Do you take any pills every day?”

This seems to work out better. I get some that tell me they like their Xanax bars this way, and others who laugh and tell me “just what my doctor prescribes!”. “Wonderful, what medications has your doctor prescribed?” Sometimes they can stutter out some of them. I give people a pass on levetiracetam. Took me probably 300 times of butchering it to where I can say it now, but I usually still say keppra.

Our primaries are getting better about having patients write down a med list. And some of our frequent fliers will bring in their last discharge summary. Just knowing someone has diabetes isn’t always helpful. Seeing they’re on massive doses of insulin with obvious metabolic syndrome tells me my normal 10 units and a liter bolus for their non dka/non hhs sugar of 600 isn’t going to work (record from icu in residency was a home regimen of 250 units of lantus at night and 230 units in the morning, can’t remember their mealtime doses).

 

[MechEDoc]

Okay. If you can tell me the starting lineup of your favorite team (it was obvious that he was a Yankees fan), there is ZERO reason why you shouldn't be responsible enough to know the medications that you take to manage your life-threatening heart disease.

But it's in the computer!

Yes, it may be in the computer - at the VA and it's a weekend.

 

[RustedFox]

But it's in the computer!

Yes, it may be in the computer - at the VA and it's a weekend.

My dad says that, too. He genuinely thinks that all his medical records are immediately accessible worldwide because "they're in the computer".

He's also been the victim of identity theft once or twice, and never stops complaining about it.

"But dad... its all in the computer."

 

[Rekt]

I know my body.

Including, any other similar phrase such as:

This is not normal to me.

I run cold so this is a fever for me.

I have a high pain tolerance.

/rant

This is all immediately translated in my mind to "I'm very pathetic and I have no coping skills and my life force is essentially zero"