As a physician, there are times when patients will say something that raises an eyebrow. Other times, they say something that makes my jaw drop. But I know my patients aren't crazy! What actually IS crazy is how their voices are becoming a reflection of how our health care system remains disjointed, with unnecessary burdens on patients and physicians.
1. "You don't need to fill out the form. You can just sign it."
I chuckled when the patient said it, because I don't affix my signature to blank forms. But I also don't think there was a nefarious intent on the part of the patient. He needed a form for work verifying he had been under medical care.
Perhaps the patient was just trying to save me time because I do recognize that many of my colleagues are being buried in paperwork, and some of them aren't always timely in filling out forms for patients. Others charge for every form they sign, or copies of records they make. This can quickly add up to a considerable sum of money. Even though much paperwork has been replaced with electronic data, there is much more documentation required today on the part of insurers and employers than there was just a few years ago. Both patients and physicians are tired of it. Sure, we do need to properly code and document care, but the sheer number of requirements beyond that are staggering.
2. "I wanted to make sure the numbness in my toe wasn't brain cancer."
This is the classic example of "Dr. Google." The patient had read that numbness was related to the nervous system, and she connected nerves to the brain, and therefore made the assumption that any numbness -- anywhere in the body -- may be related to brain disease.
Now, she neglected to recognize that the numbness was most likely a result of her poorly controlled diabetes, but this is a good example of what happens when you search for symptoms on the internet. You always get the worse case scenarios. As patients become more involved in their own care, it is critical we have useful, credible, and practical information on the internet. Sometimes a headache is just a simple headache.
The use of "Dr. Google" actually demonstrates the importance of having a physician. Medicine is an art as well as a science and computers -- even IBM's Watson -- are not going to replace doctors. And quite frankly, do you really feel confident typing your complaints on a computer screen and waiting for a result?
3. "Let me save you time. Only Percocet works for my pain."
We need to realize that we have a serious opioid abuse problem in this country. Too many people are addicted to opioids for pain management, just like this patient I saw in clinic. Most patients have legitimate pain -- and they need something for pain relief. Unfortunately, the medical community has not been doing a good job in treating pain.
We are too quick to give too many opioid medicines -- sometimes to avoid getting call-backs, and other times because it's simply what we were taught to do in medical school. Seriously, do we really need a 30-day supply of oxycontin after minor surgery, or a 10-day supply after a dental procedure? Unfortunately, this behavior tends to be the norm. We need to re-educate physicians about the role of opioids. We also need to offer effective strategies for managing pain, instead of simply resorting to opioids, especially as first-line agents. And we need to help patients recognize the signs of addiction, so they know when it is time to take some additional action.
4. "White guys don't get HIV anymore."
When a patient indicated to me that he had weight loss, night sweats, and fever, I suggested that we order an HIV test, as well as some other studies. He basically laughed when he heard HIV. Wow -- how things have changed over the last decade! There have been amazing advances in treatment of HIV but contrary to what this man thinks, Caucasian men still get HIV. And if people become less concerned about contracting HIV while engaging in behavior that puts them at risk, all the advances we have seen in recent years will quickly be lost. It still is a dangerous world out there when it comes to infectious diseases, and no one should be cavalier about their health.