Wednesday, May 2, 2012

One Problem per Visit

Somebody posted a picture of a sign from a doctor's office advising patients they can only have one problem for each visit. This is something I have heard about recently, it was the first time I had seen a sign.

I was a general practitioner for 3 mostly unhappy years.  I was not very good at it.  I didn't realize I was not very good at it.  That of course was a bad combination.  Now I look back nostalgically on my three years on the front lines.  I am not sure why. At the same time I am now becoming more of a consumer of medicine than in the past so I have somewhat of a passing interest in what goes on in what we now call primary care.

The person with multiple complaints was always a frustration for a busy or even not a busy general practitioner.  There were several types.

The list maker brought in a long list of complaints or requests.  Many people feared or hated these people.  I actually never understood that.  You knew exactly at the beginning of the visit what you were up against, you could deal with the most severe or pressing complaints and try to get them to make another appointment to talk about the other ones.

The symptom shopper was another case all together.  These individuals would start out with a minor complaint which you could deal with fairly easily and just as you were wrapping up the visit hit you with the bomb-shell, "I've been having crushing chest pain", "I have a lump in my breast", "I missed my last two periods".  Quite often these came after you had individually dealt with 3-4 other minor complaints each presented one after the other.  Not infrequently you had already examined them and they had their clothes back on before the bombshell dropped.

Or the ones who brought family members without appointments or worse wanted to talk about family members' medical problems (at least if they actually brought the family member, you could bill for the visit).

And of course all these types of patients always came at the end of the day, when you were running late or quite frequently when they had arrived late for their own appointment.

This was all prompted by a visit to my family doctor last week.  I have had the same family doctor for 20 years now.  His office used to be a block away from my house, I've moved, he's moved and he is now a fair hike away from where I live.  I never used to go in much myself.  I am pretty healthy plus it is a lot quicker to just talk to one of my fellow specialists.  We had somebody from the Wellness program of our medical society talk to us a few years ago and we got a lecture about how we should all have a family doctor so I try to behave.

I take pregabalin for meralgia peresthetica which I self diagnosed a few years ago.  Like most doctors, I self treated myself with samples before I figured I had better come clean with my FP.  Unfortunately he only gives me 3 months supply and his office will not phone in refills.  Therefore every few months I have to fax him to bypass his desk-dragon and he refills my Rx.  The last time I was warned that he would do this but only if I agreed to come in for a history and physical.  I did and saw his locum who actually allowed me to have refills.

I have also developed gout over the last few years and it just happened that on the day I phoned to make an appointment to get more pregabalin, I had a crippling attack like I hadn't had in years.  Therefore when the receptionist asked me what my appointment was for, I say, "gout".

Come the day of the appointment I drive 20 minutes to his office arrive early and sit in the waiting room.  After a while somebody who could have been an MOA but could have also been a nurse practitioner summoned me into an examination room and hooked me up to the automatic blood pressure cuff.  "You're here for gout?", she said.  "Actually, " I confessed, "I was having an attack of gout when I phoned but I do need a new prescription."  A frown came over her face.  "You should have told us that, " she lectured, "we plan long long your appointment will be based on what you tell us."  She started to go on and I figured I had better interrupt her.  "You know", I said, "I am also a physician."

"Well I hope you run your practice differently!" she replied.

About 5 minutes later my FP arrived, refilled my pregabalin, as well as my colchicine and diclofenac.  And he didn't even complain.  Oh yes my blood pressure was normal and he is going to refer me to the dietician.


syeds said...

I hope "one problem per visit rule" is given for some special reason?

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Bleeding Heart said...

Probably because in order to make it as a family doc, you have to see one patient every 8 minutes.