What patients think is not trivial

“Oh, by the way” are four simple words that cause most docs to shudder.  Yes, shudder.  Your patient signed in for a sore throat, congestion, and cough.  The nurse did her job.  She’s recorded the patient’s chief complaints.  She’s taken the patient’s vital signs and readied the patient to see me, the doc.

I take a history, asking questions about the problems that brought the patient to the office.  I ask pertinent questions about the patient’s health history, medications he takes, allergies he has.  I order appropriate tests, make a diagnosis, and discuss treatment options.  I write prescriptions and give the patient a print out summarizing the finds and plan as well as follow up instructions.  I ask the patient if he has any questions.  I say good bye and end with “be happy, be healthy,” my wish for all of my patients.

As I am reaching for the door, I hear “Oh, by the way …” and I shudder.  I was on my way to see the next person, the one that has been patiently waiting in the next room.  I did my job and did it well.  Now I have to start again.  I have to re-open the chart, start at the beginning, and do it all over again.  If I ignore the “Oh, by the way …” moment, I may miss something critical.  If I ask the patient to make another appointment to discuss the new complaint, I may injure the patient.  If I start the appointment process over again, I will delay the next patient’s care.  I shudder.

Recently, I saw a child for a sport’s physical.  On the way out of the room, her parent said, “Oh, by the way, I  just don’t feel right and I’ve been having shortness of breath off and on lately.”  The office is busy and wait time is around 30 minutes.  It’s late in the day and I am tired.   I shudder but not because I have to start all over.  I shudder from an adrenalin surge.  “I don’t feel right and I’ve been having shortness of breath” is potentially serious as in heart attack territory.

I start all over again.  My nurses notify my other patients that I am tied up and will be a while.  While vague, the history is troublesome.  The patient is too young to have serious disease, but he does.  The “Oh, by the way …” literally saves his life.

Prior to visiting your doc, make a list of everything you want to discuss with him.  Take the time to prioritize the list and put any “Oh, by the ways” on the list.  Share the list with your doc’s nurse.  Share it with your doc.  The nurse and your doc will then be able to set their own priorities and negotiate them with you.  In this case, I would have moved “not feeling right and short of breath” from last place to first place.  The child’s physical could have waited.

Had the father forgotten to discuss the “Oh, by the way” with me, he may well have died.  If I had ignored the complaint or postponed dealing with it, he may have died.  Partner with your doc.  Give him a list of your priorities and work with your doc.  What you think is trivial may not be.  Always remember, the life you save may be your own.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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  • http://briarcroft.wordpress.com/ Emily Gibson

    The “oh, by the way” IS the reason for the visit and our practice is looking at ways at getting at that primary concern ahead of time, through online symptom surveys filled out by the patient and reviewed in advance, and remembering to ask: “is there anything else that is concerning you today?”   There is no question it saves lives to focus on the symptom that most worries the patient but is the most difficult for them to bring up because it is scary.  As patients, we don’t want to admit our worst fears.  As physicians, we need to find more ways to elicit those fears.

    • http://pulse.yahoo.com/_3CY2U67646G7UIAHBQVTT2UP4Y Kristy S

      Miss Emily, the online symptom survey is an excellent idea.  It made me think of something that she and I came up with to try and help patients have the kind of discussions they need to have with their doctors.  Sometimes the things that they have to say may seem embarrassing to them but by having a place to write everything down that they can give to the doctor might help start this conversation.  We put it in to an e-book form.

  • http://twitter.com/Erin_Tolbert Erin Kadeg Tolbert

    Thank you for this reminder.  I am one who shudders at the “Oh, by the way” as it can make one patient visit seem like two.  I find that when I take more time to talk to the patient at the beginning of the visit and ask more open-ended questions rather than more direct questions the patient’s concerns usually come out initially saving me time and frustration. 

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