“You’re the doctor !!!”

[CoolDoc1729]

Nope. Been down that road trying to convince someone they had nothing when they know they have something. I think that’s the point of this thread where OP spent way too much time with unreasonable pts.


But you do you. I’m not here to debate who does it right or wrong. I’m just saying it’s the easiest path to sipping my coffee.

My time is valuable and better to deal with really sick pts than trying to convince the unreasonable.

I see lots of unreasonable people, I see lots of presentations that obviously are nonsense mixed with psych, and I have no trouble navigating these situations as I do it 50 times a month at least.

And the exchange in the OP still took less than a minute. I don’t feel I spent too much time with this person.

I just can’t make sense of the specific, much less common situation at the end of the OP.
I want more (usually tests)
Ok which one? What specifically are you worried about?
I DONT KNOW! YOURE THE DOCTOR

Implicit in this is both “I don’t trust you” and “you’re the only person I can trust.”

I think these are just anxious angry people and I am worrying too much about satisfying them because they are not able to be satisfied.

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[greatnt249]

I see lots of unreasonable people, I see lots of presentations that obviously are nonsense mixed with psych, and I have no trouble navigating these situations as I do it 50 times a month at least.

And the exchange in the OP still took less than a minute. I don’t feel I spent too much time with this person.

I just can’t make sense of the specific, much less common situation at the end of the OP.
I want more (usually tests)
Ok which one? What specifically are you worried about?
I DONT KNOW! YOURE THE DOCTOR

Implicit in this is both “I don’t trust you” and “you’re the only person I can trust.”

I think these are just anxious angry people and I am worrying too much about satisfying them because they are not able to be satisfied.

1: "Where do you want to go out for dinner tonight?"
2: "I don't know, you pick."
1: "How about [X]?"
2: "No, don't feel like going there."
1: "Okay, how about [Y]?"
2: "Not really in the mood for there, either."
1: "Okay, what are you in the mood for, then?"
2: "I don't know, I asked you to pick somewhere."
1: "..."

 

[JacobMcCandles]

I see lots of unreasonable people, I see lots of presentations that obviously are nonsense mixed with psych, and I have no trouble navigating these situations as I do it 50 times a month at least.

And the exchange in the OP still took less than a minute. I don’t feel I spent too much time with this person.

I just can’t make sense of the specific, much less common situation at the end of the OP.
I want more (usually tests)
Ok which one? What specifically are you worried about?
I DONT KNOW! YOURE THE DOCTOR

Implicit in this is both “I don’t trust you” and “you’re the only person I can trust.”

I think these are just anxious angry people and I am worrying too much about satisfying them because they are not able to be satisfied.

That’s a big crux of the issue. These patients are just meeting you for the first time (although not always) so it’s tough to build that trust. It’s even worse if they’re sent in by their PCP. You can’t tell them their PCP doesn’t know what they’re talking about because they’ll never trust/believe you. You just have to accept some patient encounters are a lost cause, you do what you can, you don’t argue or spend unnecessary time trying to reason with them, and you move on.

 

[gutonc]

1: "Where do you want to go out for dinner tonight?"
2: "I don't know, you pick."
1: "How about [X]?"
2: "No, don't feel like going there."
1: "Okay, how about [Y]?"
2: "Not really in the mood for there, either."
1: "Okay, what are you in the mood for, then?"
2: "I don't know, I asked you to pick somewhere."
1: "..."

You're doing it wrong....
1: "Guess where we're going for dinner tonight?"
2: "My favorite restaurant?!?"
1: "You got it!"
Profit.

 

[greatnt249]

You're doing it wrong....
1: "Guess where we're going for dinner tonight?"
2: "My favorite restaurant?!?"
1: "You got it!"
Profit.

If only it was that easy...

 

[emergentmd]

I guess if you think the only two options are to give them something unlikely to hang their hat on or tell them you don’t know but it’s not an emergency THEN spend unnecessary time in the room arguing with them.

Like you said, to each their own, but you strike me that you’re at the point where you just z-pack everyone because it’s easiest for you and not because it’s good medicine.

Well, if something is viral then I tell pts to go home and take Motrin. Many are super uneducated and get mad/complain then leave to another place wanting abx. Those who understand, I explain those who I know just want abx. Then go ahead w a zpak.

It’s life. I practice great medicine but I cant change the world.

I bet you are still young in your career and have medicine as a calling where you can change the world. You will learn in time.

When u get older, maybe you will look back and give me a mental shout out.

I will battle when it matters/changes something. When it doesn’t, then easiest path to go sup my coffee

 

[JacobMcCandles]

Well, if something is viral then I tell pts to go home and take Motrin. Many are super uneducated and get mad/complain then leave to another place wanting abx. Those who understand, I explain those who I know just want abx. Then go ahead w a zpak.

It’s life. I practice great medicine but I cant change the world.

I bet you are still young in your career and have medicine as a calling where you can change the world. You will learn in time.

When u get older, maybe you will look back and give me a mental shout out.

I will battle when it matters/changes something. When it doesn’t, then easiest path to go sup my coffee

Mid career. I never felt medicine was a calling but felt it’s an opportunity to help people and I still believe that even though many times it’s not what the patient wants to hear.

 

[GassYous]

1: "Where do you want to go out for dinner tonight?"
2: "I don't know, you pick."
1: "How about [X]?"
2: "No, don't feel like going there."
1: "Okay, how about [Y]?"
2: "Not really in the mood for there, either."
1: "Okay, what are you in the mood for, then?"
2: "I don't know, I asked you to pick somewhere."
1: "..."

You're doing it wrong. You ask "do you want x y or z?" If you give them two choices there's a supposedly right and a wrong answer. It's hard to choose because they don't want to be wrong. Similar problem with one choice because they are deciding yes or no. Give them three choices and that lets them make a decision. Don't leave it open ended.

 

[greatnt249]

You're doing it wrong. You ask "do you want x y or z?" If you give them two choices there's a supposedly right and a wrong answer. It's hard to choose because they don't want to be wrong. Similar problem with one choice because they are deciding yes or no. Give them three choices and that lets them make a decision. Don't leave it open ended.

Guy makes a joke as a parallel to OP's post and gets life advice...story of my life.

 

[The Knife & Gun Club]

This thread is the embodiment of why I start all of my encounters off with a “what were you hoping we could do for you today?”

The answer is almost always illuminating. If it’s a person that says they just want to feel better or confirm they’re not dying I’m happy to oblige and will tailor my “show” to making them feel like that desire was met.

And sometimes they say they want to be tested for “urea plasma because I saw it on tiktok and doctors never test for it because they’re racist” then I know up front there is no winning in this situation and just get on with my life.

 

[Rendar5]

This thread is the embodiment of why I start all of my encounters off with a “what were you hoping we could do for you today?”

The answer is almost always illuminating. If it’s a person that says they just want to feel better or confirm they’re not dying I’m happy to oblige and will tailor my “show” to making them feel like that desire was met.

And sometimes they say they want to be tested for “urea plasma because I saw it on tiktok and doctors never test for it because they’re racist” then I know up front there is no winning in this situation and just get on with my life.

^
|
This.

 

[thegenius]

That’s a big crux of the issue. These patients are just meeting you for the first time (although not always) so it’s tough to build that trust. It’s even worse if they’re sent in by their PCP. You can’t tell them their PCP doesn’t know what they’re talking about because they’ll never trust/believe you. You just have to accept some patient encounters are a lost cause, you do what you can, you don’t argue or spend unnecessary time trying to reason with them, and you move on.

There is general truth to this.
I also say though "Your PCP sent you in to make sure you are not dying. That's all I'm capable of doing."

As I said in the past, works like ~80% of the time.

 

[thegenius]

Well, if something is viral then I tell pts to go home and take Motrin. Many are super uneducated and get mad/complain then leave to another place wanting abx. Those who understand, I explain those who I know just want abx. Then go ahead w a zpak.

It’s life. I practice great medicine (customer service) but I cant change the world.

I bet you are still young in your career and have medicine as a calling where you can change the world. You will learn in time.

When u get older, maybe you will look back and give me a mental shout out.

I will battle when it matters/changes something. When it doesn’t, then easiest path to go sup my coffee

 

[thegenius]

This thread is the embodiment of why I start all of my encounters off with a “what were you hoping we could do for you today?”

The answer is almost always illuminating. If it’s a person that says they just want to feel better or confirm they’re not dying I’m happy to oblige and will tailor my “show” to making them feel like that desire was met.

And sometimes they say they want to be tested for “urea plasma because I saw it on tiktok and doctors never test for it because they’re racist” then I know up front there is no winning in this situation and just get on with my life.

I just spent 10 mins looking this up because I either never heard of it, or don't remember it.
It appears routine urine|blood cultures don't grow these (?)

 

[Apollyon]

I just spent 10 mins looking this up because I either never heard of it, or don't remember it.
It appears routine urine|blood cultures don't grow these (?)

I remember Ureaplasma urealyticum from med school. It's related to Mycoplasma. It doesn't have a cell wall.

 

[thegenius]

I remember Ureaplasma urealyticum from med school. It's related to Mycoplasma. It doesn't have a cell wall.

OK
...well then...
Then what do I do with ureaplasma? tickle it? wipe it away?
DOCTOR APOLLYON.....WHAT DO I DO WITH THIS INFORMATION

 

[Apollyon]

OK
...well then...
Then what do I do with ureaplasma? tickle it? wipe it away?
DOCTOR APOLLYON.....WHAT DO I DO WITH THIS INFORMATION

That is, literally, ALL I GOT!!!!

 

[TooMuchResearch]

There is a skill in rapidly figuring out what personality traits/disorder someone potentially has, what fear they have, or what their primary objective is for the visit.

Some really want a diagnosis. If unknown, all documentation must still reflect caution and ambiguity for medicolegal protection, but verbally some of these patients benefit from giving a firm answer with authority even if still quasi-ambiguous. Throwing out one or two unknown medical terms helps.

“It’s likely an inflamed and pinched nerve from the brachial plexus.”

“You have viral pharyngitis. A lot of Adenovirus has been going around. I think it’s very likely that.”

“Your pain is likely intestinal spasm and dysmotility from increased stool burden also leading to gastritis.”

You don’t straight lie and patients should clearly understand return precautions. Unfortunately the only way for both yourself and people with certain personality disorders to leave an encounter satisfied is to convey expertise that a physician can provide when the testing is ambiguous. Uncertainty even if absolutely right leads to distrust on the part of some patients with everyone ending up unhappy.

You are trying to do the right thing every time. Unfortunately, the right thing has to fluctuate for reach patient depending multiple factors including but not limited to their age, intellect, and actual symptoms or disease process.

Don't do this.
The patient inevitably returns and tells me some other doctor told them it's (insert some explanation that doesn't make sense) and I have to figure out how to tell them the other doctor made it up without actually saying it.

 

[Mount Asclepius]

Don't do this.
The patient inevitably returns and tells me some other doctor told them it's (insert some explanation that doesn't make sense) and I have to figure out how to tell them the other doctor made it up without actually saying it.

I don’t tell them some explanation that doesn’t make sense.

This is just something you have to use for some patients, definitely a diagnosis on the very top of the differential, and essentially impossible to ever know for sure.

I disagree with telling someone it’s probably lupus or equivalent. I don’t do that.

 

[emergentmd]

Some of you guys have reading comprehension issues. If pt comes in with gauge stuff like unexplained multiple joint pain, I tell them it’s nothing serious, take Motrin and if it continues a few week, They need to follow up bc it could be some autoimmune disorder like Lupus. This clearly is medically sound advice bc it could be, I have seen it.

I don’t jus go tell every joe bow joint pain that it’s lupus.

 

[The Knife & Gun Club]

I just spent 10 mins looking this up because I either never heard of it, or don't remember it.
It appears routine urine|blood cultures don't grow these (?)

In my mind I filed under why we should be treating uncomplicated cystitis based on symptoms rather than urine studies.

This particular bug responds to doxy and quinolones which are non-insane options to give someone for a GU complaint

 

[thegenius]

I don't think I've ever given doxy for a UTI unless the culture indicated so. I'm still confused by this ureaplasma.

 

[TooMuchResearch]

Some of you guys have reading comprehension issues. If pt comes in with gauge stuff like unexplained multiple joint pain, I tell them it’s nothing serious, take Motrin and if it continues a few week, They need to follow up bc it could be some autoimmune disorder like Lupus. This clearly is medically sound advice bc it could be, I have seen it.

I don’t jus go tell every joe bow joint pain that it’s lupus.

I just tell them if it doesn't go away, they might need additional work up and to follow up with primary care.

 

[Splenda88]

You can't reason with these people.

I admitted a patient 3 days ago for stroke rule out (slurred speech, drooling for 24 hrs per daughter), which were not present when I saw patient. CT head w/ no acute CVA. Repeat CT head in 48 hrs negative as patient could not tolerate MRI. Everything else ok. Neurologist signed off.

I proceed to discharge patient. Daughter said "Mom is not ready to go home" and she would like to speak with the physician. I asked her when do you think your mom will be ready? Her answer was "I dont know; I am not a doctor." She caught herself saying that, and then got mad by telling me "you shouldn't ask me question like that.

In my mind, I said continue talking to her will be pointless. "Discharge". She can appeal if she wants.

 

[RustedFox]

You can't reason with these people.

I admitted a patient 3 days ago for stroke rule out (slurred speech, drooling for 24 hrs per daughter), which were not present when I saw patient. CT head w/ no acute CVA. Repeat CT head in 48 hrs negative as patient could not tolerate MRI. Everything else ok. Neurologist signed off.

I proceed to discharge patient. Daughter said "Mom is not ready to go home" and she would like to speak with the physician. I asked her when do you think your mom will be ready? Her answer was "I dont know; I am not a doctor." She caught herself saying that, and then got mad by telling me "you shouldn't ask me question like that.

In my mind, I said continue talking to her will be pointless. "Discharge". She can appeal if she wants.

Reason #788 why it's okay to hate the muggles.

 

[Angry Birds]

The loudest complainers and the ones telling you they’re going to sue are typically not the ones who actually sue.

But they all have lawyers on retainer

 

[WhatJobDoIPick]

But they all have lawyers on retainer

Always fascinating when a Medicaid patient says "my lawyer."