Word to the wise: Never treat without an office visit. “An ambush can happen almost anywhere. I’ve been ambushed at the gas station, at the local coffee house, and outside the supermarket while trying to get two fussy daughters into the car. I’ve even been ambushed in the parking lot of my clinic by a patient who had an appointment to see me 20 minutes later.

The common factor among all ambushes is that the doctor’s concentration regarding a patient’s care is overshadowed by something else. It is the perfect setup for bad decisions, since the human brain can only give its full attention to one matter at a time. Instead of concentrating solely on Mandy’s daughter, I was focusing on whether or not I should extricate Mrs. Hughes from the hospital setting.

I glance at my watch out of the corner of my eye. Do I argue? Or just take the path of least resistance and say Yes? I choose the latter and agree to call in a prescription. She tells me which pharmacy she uses and thanks me profusely.

As Mandy leaves, I think to myself that Brooklyn just received some rotten, ambush-related medical care. I had not seen the patient. I had not reviewed her chart. And I did not specifically recall ‘last time.’ I was guided by my desire to swiftly make both the daughter and mother feel better; unfortunately, I did not succeed on either count.”

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  • Elliott

    Kevin, the lesson is never treat without an office visit? How about don’t try to treat by guessing. The author admits that he didn’t remember what he gave last time and never checked the chart or asked his nurse to check the chart. How does that simple expediency which wasn’t followedjustify your maxim?

  • Anonymous

    As a physician, I understood completely what Kevin meant by “office visit”. It meant an evaluation that includes obtaining a thorough and pertinent history and performing a physical exam and giving advice and prescribing medications.It’s doctoring without distraction and doing it the way it’s been taught in medical school.
    Elliott, even if I knew what medication that was prescribed in the above case in the past, I would recommend that this patient be seen. It might be a case of Epiglottitis. God knows what would happen if I treat a case of epiglottitis without seeing the patient. Although, this condition is rare now, it’s still more common that Transverse myelitis and we know what can happen if you miss a case of TM.

  • Elliott

    But this doctor is being reasonable. I went back and read the article and he wasn’t advocating an office visit. He just wanted some uninterrupted time to review the chart and focus. He admits his mistake. (I did make a mistake in my first read where I assumed that Mandy was a nurse, but the doctor only says employee.)

    Given that the author is not suggesting that an office visit was required even though that was his initial request of Mandy, I don’t see why Kevin is putting words in his mouth.

    Finally, had the doctor prescribed the correct cough medicine, what are the chances that a visit would not have been necessary at all. Even not knowing the answer in this particular case, it seems to me that the try the previous drug before an office visit is a perfectly acceptable practice especially when the mother is suggesting implicitly that it appears to be a very similar problem.

    As a postscript, many doctors suggest CDHP or some other movement towards the decrease in 3rd party payors is the solution to the mediocre US healthcare system, but in this case, Mandy is acting like a perfectly reasonable consumer. She is reducing her costs (by getting a free “consult” even if it is deficient). If she actually had to pay full cost for an office visit then what do you think wouldbe more likely to happen? Brooklyn’s cough gets treated or not. Instead, more likely is that Brooklyn’s cough goes untreated or telephone prescriptions become more common.

  • Anonymous

    Elliott, Brooklyn could have asthma and could go into status asthmaticus and be intubated and placed on a ventilator. Or epiglottitis and has to have an emergency tracheostomy. Or she may have a bronchial foreign body requiring bronchoscopy to remove the FB. Or she could have a pneumothorax that requires a chest tube. Or pneumonia requiring hospitalization. Or she may have a viral URI that requires only OTC meds. Elliott, I’m glad you’re not a medical doctor, cause you’ll make my high malpractice premium go up higher.

  • Anonymous

    I am an ER doc. I try to be a nice guy and approachable and since I am sometimes the only doctor in the hospital, nurses and other hospital staff often want the “free consult” for themselves or family members.

    “Sorry to bother you doc, but could you just…….”

    I used to try to help people out. No more. Among our large physician group two of these “favors” turned into lawsuits. So now the answer is always a very kind “no”, no matter how trivial the request.

    Elliot, start your own telephone/internet medical practice to dispense advice since you are so smart. Quit chiding Kevin over stupid petty remarks.

  • Anonymous

    I’m also an ER doc who points people to the registration desk when they try to get free advice. Plenty of Lawsuits in the literature emanating from curbside advice. I have a bullseye on my back, i’m not just giving it away.

  • Anonymous

    A doctor should never ever give medical advice without properly examining the patient. Not even over the phone, except for well-known patients, with well-known chronic illnesses. Even if the patient is not paying for the advice, the doctor can be sued for malpractice.

    As a doctor, before “being nice” to patients, think about being nice to your family (by not losing your income). Always keep in mind the worst. Patients are humans, i.e. they will jump on an opportunity to make a lot of money, especially if they feel it was the doctor’s fault. Very few have the decency to not sue after asking for (the wrong) medical advice as a favor.

    Love your patients, but love yourself even more!

  • Anonymous

    I always considered it inpolite to start asking doctors medical questions in a social settings – unless this was a general discussion about generic issues of interest to everyone involved.
    I remember once during a singles weekend there was a plastic surgery resident at our table and some older woman just started showing him extra skin on her neck and bugging him about what she can do. The guy looked really uncomfortable and clearly wanted to get rid of her. The rest of us didn’t find this particular conversation stimulating either, and tried politely to change the subject of conversation to weather or politics or anything else, but there was no stopping her… I was wondering though, why this particular doctor hadn’t just put her in her place.
    I think it is perfectly fine for a doctor to say: “why don’t you call my office tomorrow and schedule an appointment” if he wants the patient or, if it is a social occasion to just change the subject of the conversation.

  • Anonymous

    “Patients are humans, i.e. they will jump on an opportunity to make a lot of money,”

    I heard a rumor physicians were humans, too. But I’m not sure I believe it.

    Kidding aside, no professional should ever give advice without a complete understanding of the facts involved. And considering your time and knowledge is what you sell, you shouldn’t give it away simply because someone asks you in a social setting.

    CJD

  • Anonymous

    CJD, this is the first time you made sense. You’re learning. Keep it up.

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