10 Things Doctors Hate to Hear
March 4th, 2005
Filed under: Medicine
- “I’m on that little white pill, you know which one I mean.”
There are hundreds of little white pills, and that’s not even counting all the generics out there. In our clinic, we ask patients to bring their prescriptions (and non-prescription medications) in with them at every visit. It’s amazing how often they’re taking meds we don’t know about, especially when they’re seeing specialists. - “I was running a fever of 99° last night.” Or its close cousin: “I know my daughter was running a fever because she felt warm.”
Please get a thermometer (there are many easy-to-read and inexpensive thermometers out there now), and let me know if the temperature is over 101°, or 99°-100° daily for several days. I don’t care how low you think your body temperature is normally, nothing else is a fever. - “Oh, by the way Doctor, I’ve been having some chest pain.”
This is always said as the patient is halfway out the door at the end of the appointment.
(As an aside, I’ve noticed that the patients coming in explicitly for chest pain rarely have a cardiac condition; it’s the patients that that are reluctant to admit they have chest pain who have the bad hearts.) - “I was taking some antibiotics I had left-over…”
This is wrong, wrong, wrong. First, taking antibiotics willy-nilly is never a good idea, and is a perfect way of causing antibiotic resistance. Second, there should never be “left-over” antibiotics. This shows that the patient didn’t follow the instructions last time they were put on antibiotics (which is another excellent cause of resistance). - “I need a note for work excusing me for the past week.”
The patient’s been sick and off work (or school) for a week and now needs a note to excuse all those days. How can I honestly say this patient was sick that whole time if I didn’t see them? I’ll sign a note saying they were in that day and cleared to go back to work, but that’s it unless I know them very well or there’s been some telephone communication.
(Bear in mind, I’m not asking patients to come in with every little cough or cold, but if it’s severe enough to need a note for school or work, then the person need to be seen) - “Can you fill out this paperwork right now?”
There are so many reasons patients need letters or forms filled out: disability, worker’s comp, insurance, and FMLA just to name a few. All of these take time. I need to get the chart, look through it for the pertinent information and then fill out the form/write the letter. It will take at least a day or two to find the time to do this; don’t expect it immediately. If it’s vitally important, bring it in several days early; don’t tell me, “I need this for court tomorrow.”
And please don’t bring in a letter you’ve written for me to sign. While I appreciate the fact that you’re trying to help, I am very particular about what my name is on. - “My son needs a sports physical, the doctor saw him last week for a cold, so he should just be able to fill out the form.”
In a word, no. When someone is in for a sick visit, the focus is on the acute illness. Physicals require an entirely different mind set. In addition, most of our sports and school physicals also require lab work, a visual acuity exam, and resting and post-exercise heart rates – tests we don’t perform on routine visits.
If a parent is real aggressive about this, I tell them that I’ll be happy to fill out the form, but it’ll reflect exactly what I saw on the exam and as a result the patient may not be cleared for sports. This usually solves the problem. - “I need the drug that I saw on TV.”
The only thing harder than trying to persuade someone they need a drug is trying to persuade them that they don’t need a drug. Unfortunately, drug ads are too effective and patients come in demanding drugs for a problem they don’t have (or a problem where cheaper drugs will work just as well). A long frank talk is the best way to correct this problem, but it is time consuming and very draining. Alternately, I find that telling the patients the actual cost for their “wonder drug” work pretty well much of the time too. - “But Doctor, I do exercise; I walk at work.”
While it’s true that every little bit of exercise helps, if someone is truly concerned about losing weight or increasing their cardiovascular health they need sustained exercise. That means 20-30 minutes in a row of aerobic exercise at least three days a week. - “I know the appointment is just for me, but my son is sick as well…”
I admit it; I’m a sucker for this one and fall for it almost every time. There are some patients that do this at every appointment, so I set aside extra “family” time when I see their name on my schedule.
March 4th, 2005 at 4:56 pm
10 things doctors hate to hear
Polite Dissent � 10 Things Doctors Hate to Hear…
March 5th, 2005 at 10:43 am
Good list! I always know my meds (at least the ones I take regularly, the fly by nights I don’t always remember). I even know what my meds do and how they work. What trips me up is when they want to know the dose– I never know if the pill is 30 or 40 mg and I always forget if I’m on the 44mcg or higher Flovent.
On the note, I actually side with the patients on that one. Some of us work in punitive environments and we didn’t know how sick we were going to be. So a week goes by and we realize we’ve got to go to the doc and now we’re going to need a note for HR. I would say you might be assisting the employer in targeting that employee for termination based simply on a run of bad health. I would be inclined to give people the beneift of the doubt, if they are abusing the system, they’ll get their comeuppance sooner or later, independent of any note you write. Although, I’m sure you have more experience than I do with this, I only know what I have observed in my own health care (I think I only asked for a note once simply to conform to company policy that illnesses with more than 3 days absence require a doctor’s note–and of course I saw the doctor after those 3 days as I held out hope of getting better).
Anyways, interesting list!
Michelle
March 6th, 2005 at 5:07 pm
I’ve got a pretty good filter that just ignores the 99 fever. The antibiotic one always gets a stern lecture from me.
Some answers that have been bugging me lately.
Question-Are your ears doing ok?
Response-I don’t know.
Maybe I’m asking for this by not being specific, but I’m trying to be open ended so that I don’t have to ask about hurting, popping, clicking, pressure, etc.
Question-Have you felt like you’ve had a fever?
Response-I don’t know, I don’t have a thermometer.
That’s not what I asked. I asked how you felt. You are answering the question, “have you taken your temperature?” which is different.
March 6th, 2005 at 6:06 pm
and for the patient – the doctor will be available shortly
ie his time is more valuable than yours, even though you scheduled the appointment in advance and you arrived on time!
March 8th, 2005 at 1:12 pm
You know, I’ll bet being a doctor would be pretty neat, if it wasn’t for those pesky, bothersome, patients.
March 8th, 2005 at 1:21 pm
Official Comment
99.9% of the patients are great, it’s that 0.1% that tends to cause problems. The same as any profession dealing with “customers”, I’m sure.
I’d rather deal with the worst patient than a bureaucrat-infested insurance company any day.
March 8th, 2005 at 6:54 pm
Nice list.
A common thread seems to be that these people have no idea about how a clinic is run or the 10th grade Health class basics of personal medicine. Of course, most of us couldn’t pass a 10th grade small-engine shop class final, either.
The alternative to ‘the doctor will be available shortly’ is ‘Sorry – I have another appointment now; stop at the front desk and we’ll talk about your heart pain some other time.’
On the flip side:
I used to go to an ‘empower the patient’ clinic, and at the end of the exam my FP physician always asked me “And what do you think we should do about this?” as if I had a clue.
March 9th, 2005 at 12:25 pm
While I understand that doctors are busy and can’t always predict how long appointments are, some doctors chronically overschedule and leave patients waiting for excessive amounts of time. I waited for 2 hours in a crowded waiting room for one doctor. Two sets of drug reps and a TV crew went in during that time. Given how busy and crowded the office was, she should have asked the drug reps to come back later. (A third drug rep arrived and offered to come back later and left, I wanted to thank him.) Even after I got into an exame room, I waited another hour before a PA saw me.
I now go to a different doctor.
Bolie IV
March 10th, 2005 at 12:10 pm
[...] most recent appointment. In honor of my own stupidity, I offer you today this link to the Ten Things Doctors Hate To Hear, brought to you by Polite Dissent. What’s number one on the list? [...]
March 12th, 2005 at 6:00 pm
Add to the list, bumping off “I DO exercise”
“I just can’t loose weight. I watch what I eat and I keep gaining weight. It Has to be my thyroid/my insulin resistance/my metabolism [etc]. Please do these tests/prescribe these medicines/recomend a surgeon [or fill out these forms for one] for a stomach stapling/banding/resection, etc.”
And then seeing these folks at the local Burger King or Hometown Buffet with a 3,000 kcal meal and a Diet Coke.
October 16th, 2006 at 12:54 pm
As a patient, I hate to hear “boiler plate” or “blanket” comments, like “get some exercise and watch your diet”. This kind of non-specific catch-all begs for a non-specific response.
If it is important enough to my care to address at all, perhaps it would be more productive to say, “What kind of aerobic exercise do you do 3 times a week for thirty minutes?” Or, “I want you to write down EVERYTHING that goes into your mouth for the next week and bring it in.” (Not that the doctor would have to spend a lot of time looking it over, but it could serve as a useful tool, even if it just made the patient more aware of their eating habits.) Then I MIGHT feel like the doctor was talking to ME, addressing MY health concerns, and not just covering his/her bases.
November 18th, 2006 at 4:13 pm
How about this one: “I want my shoulder, blood pressure, cholesterol, depression, or whatever to get better.” Then after discussing the treatments for the condition, “I don’t want to do physical therapy, take medication, go to counseling, or do any of the treatments you’re recommending.” Well, I forgot my magic wand today, so you’ll have to pick one of the options we just discussed!
February 6th, 2007 at 8:01 pm
I am sure being a doctor is tough work. Try being a parent of a patient with chronic, but difficult to figure out autoimmmune problems. I feel like we see 5 blind doctors and our daughter is the elephant they are all trying to describe (old joke about the 5 blind men and they all describe only one part of the elephant, but think they see a whole animal). The Neuro, says it is epilepsy, the Endo says it is Hashimoto’s, the Rhumo says she has hypermobility and hypotonia, the GI says she is lactose intolerant and has chronic constipation, the Dermo says she has psoriasis and our primary doctor is totally out of his element. While she has all of these, we still don’t get why.
April 2nd, 2007 at 9:08 am
i have a quiz, pls advise
” Fishermen love me & doctors hate me, Kids want to eat me” it is 13 word letter
hint is “- H-T—Ior L–ME-”
Pls advise
January 25th, 2009 at 9:59 pm
I hate being a doctor more than you will ever know. Do you remember talking to your grandma about medical problems? How long could you hold conversation with her about her problems before being overwhelmed? high blood pressure, cholesterol, diabetes–oh even better how about fragility, can’t walk weak and dizzy and sudden pain all over? Now try to figuer her medical problem out but through 3 sets of lips of your relatives?How about doing that 24- 30 times per day? Not with same person but with 24-30 different person?
You get the picture.
February 12th, 2009 at 12:29 am
Joe, it sounds like you might want to change your profession. While I sympathize with your having to deal with “grandma’s aches and pains” type of patients, I don’t appreciate a doctor who is sick of treating the sick. Move on.
Oh wait, I forgot, you have all that time and money invested in your mishap. Sorry, what was I thinking!
May 15th, 2009 at 7:34 pm
Diana–if you’ve been a doctor for more than two years, you’re sick of treating the sick. We all are.
November 24th, 2009 at 7:26 pm
Oh oh oh, as a nurse here’s a favorite of mine “can I get that vicodin/ percocet/ oxycodone prescription refilled early? See I’m going out of town/ knocked them in the toilet/ the dog ate them and died and I just need a few”
March 12th, 2010 at 7:42 pm
What about doctors who instruct their students (who have a naturally great bedside manner) to become tactless and rude. my doctor always says, “so, what’s the matter this time?” and i don’t see him more than once a year. He’s instructed the student to state my mental condition loudly (OCD).
May 14th, 2010 at 3:37 pm
I know I am sick of treating the sick. It’s been three years of being a doc for me.
August 27th, 2010 at 9:20 pm
The most frustrating aspect of medical practice for me is that I feel I have been sold a very expensive bill of goods that has not lived up to its reputation. Becoming a doctor was an idealistic choice for many, myself included, based on the ideal of using what talents we had to improve health. In exchange, we would receive ample compensation (attractive) and the appreciation of society. For the most part, we came from scientific backgrounds and thought with logical minds to solve problems as they were presented. What I have found through my experience attempting to practice the science of medicine is that the business and politics of medicine has conspired to make that job very difficult. I leveraged several years, if not decades, of future earnings to afford my time in medical school and residency. Now I am out practicing general pediatrics and have found that I am still living paycheck to paycheck as I try to pay back all the loans. As I move from patient to patient, I find that, while parents tend to care deeply for their children, they do not seem to care that the doctor does so much more than simply give shots. I actually had the mother of a newborn say to me, “Why are you talking to me, I thought you were here to check the baby.” Add to this frustration issues with Medicaid reimbursement, disastrous social situations, and long days in clinic trying to do the best you can for each patient while seeing as many patients as possible so the clinic can remain open. i was not prepared to be a business person. I do not understand the influence insurance has on who can get what kind of healthcare. I am regularly frustrated by the lack of basic health literacy in my patients and parents. I am absolutely enraged by the fact that insurances reimburse more generously if I keep all of my chronically ill patients just a little bit sick so they have to come in more often than if I were to optimize their treatment so they could make fewer visits to the office. I stepped out of the ideal into a world of perverse financial incentives, parents who either don’t understand or don’t care, and an office that is run by people with business degrees and not by clinicians. I am bound to this scenario until I pay off my considerable educational debt. If i continue to pay my loans at the pace I am repaying now, that should happen not long after I turn 60.
January 4th, 2011 at 8:52 am
Joe, you sound like a very new doctor or not a very good one. Most experienced physicians intuitively know what’s wrong with someone within a few minutes of seeing them.
January 4th, 2011 at 9:46 pm
As a nurse for many years working with doctors, residents, med students I have seen a lot. Most med students go in scared but eager to learn, please their attendings and actually help the patient. Residents start to become jaded and some pretty full of themselves but still just as nervous or almost as nervous as the med student, most of the staff doctors who are attendings are actually still happy with their choices and interested in teaching. I have to admit also “I don’t hear too many doctors whine about hating to see sick people.” Those one’s are usually shown the door quickly. While working with patients can be rewarding and frustrating at the same time, burn out rate is high. Joe sounds like he needs to move on, maybe try research where you have very little patient contact.
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