There are a lot of issues being discussed in healthcare today. One point I don’t hear a lot about, but see everyday comes directly from our patients mouths. They come in to clinic with the mindset of “everything hurts and I’m dying”. What this means is that if they have a headache they think and know that they have a brain bleed and they need and MRI. If their child has a cough they definitely need an antibiotic. They woke up sick this morning or have an ache in their shoulder x1 day: everything hurts and I’m dying.
The undertone of this statement that they don’t directly say: And you BETTER do something– better yet– what I think you need to do.
Now, let me be clear it isn’t that I’m not empathic to patients who are feeling ill or in pain. However, there is this culture out there that extreme measures, investigations and treatments need to be taken if you have a headache. Are there the small percent of people who do need these measures? ABSOLUTELY. That is why we do history and physical exams to weed these people out and send them for these tests.
Why does this matter? What is this causing in medicine? Cost. Waiting room lines. The emergency department being used for non-emergencies (sorry people this was not created for you to get a pregnancy test free or score some morphine for back pain– it was meant for people with asthma exacerbation, CHF, PNA amongst so many others).
How does this effect providers? We also have to act like someone who thinks they are dying are dying. If we don’t they’re not satisfied. Re-assuring patients has become the most difficulty part of my job. We all know when we have this person in front of us. I always make sure to do a full physical exam. I talk them through it saying “your ears are clear–no infections, airway is patent– tonsils are not enlarged, no lymph node enlargement, lungs sound great, your neurological exam is completely normal, vital signs completely within normal limits—– etc etc”. But for some people they just aren’t satisfied.
What else are we to do? Patients who push for further intervention, I tell them I cannot treat an infection that is not there or worry about signs or symptoms that you do not have. I tell them this is good news.
My question is where are we going wrong? It seems like more and more people are lacking basic concepts about colds, headaches and belly aches. I do my best to educate my patients. Viral bronchitis is a BIG one. I tell them 98% of bronchitis is caused by a virus. The cough can last 3-4 weeks even after you begin feeling better. I state “Scary symptoms that you DO need to be concerned about are persistent fever or coughing up blood streaked sputum.” I ask them EVERY TIME “do you have any questions”. I usually ask this twice. Yet somehow there are still people who come back a week later cause they have a dry lingering cough?
Would love to hear thoughts from students on rotation and practicing providers with how you best handle these situations. As well as suggestions. May this serve as a reminder to always educate your patients as much as possible!