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So Many Patient Complaints, Not Enough Time

Primary care physicians often have to see patients with a litany of issues — often within a span of a 15-minute office visit.

This places the doctor in the middle of a tension: Spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait. And in some cases, it’s simply impossible to adequately address every patient question during a given visit.

It’s a situation that internist Danielle Ofri wrote recently about in the New York Times. In her essay, she describes a patient, who she initially classified as the “worried well” type:

… a thin, 50-year-old educated woman with a long litany of nonspecific, unrelated complaints and tight worry lines carved into her face. She unfolded a sheet of paper on that Thursday morning in my office with a brisk snap, and my heart sank as I saw 30 lines of hand-printed concerns.

Ms. W. told me that she had recently started smoking again, after her elderly mother became ill, and she was up to a pack a day now. She had headaches, eye pain, pounding in her ears, shortness of breath and dizziness. Her throat felt dry when she swallowed, and she had needling sensations in her chest and tightness in her gut. She couldn’t fall asleep at night. And she really, really wanted a cigarette, she told me, nervously eying the door.

This is the kind of patient who makes me feel as though I’m drowning.

Dr. Ofri did as many doctors do: She listened appropriately, went over the patient’s history and physical, reviewed prior tests, and concluded that many of her symptoms were due to anxiety. Except, in this case, they weren’t. The patient eventually had a pulmonary embolus, and hospitalized. Read more »

*This blog post was originally published at*

How To Help Your Doctor Make A Good Diagnosis

When patients and doctors communicate effectively, the patient has the best result. Not every doctor asks the critical question that can cinch a diagnosis. Yet good communication, coupled with good diagnostic skill can be worth more than $10,000 in tests and referrals to consultants.

You can help your doctor figure out what is going on by thinking and communicating like a physician. Whether you have a new problem or something that has been bothering you for a long time, here are some things that the doctor will want to know:

1. What are the symptoms? Be specific. Don’t just say “Sometimes I have a pain in my stomach.” Since more than 80 percent of health problems can be diagnosed based on information that you provide, make sure you can verbalize what you are feeling. Is it crampy? Does the pain come and go? Where is it located? Is it sharp or more like an ache? These specifics are giving information that your doctor can use as she thinks of the anatomy, physiology and causes of pain.

2. How long has it been going on? Try to be specific. ”Awhile” doesn’t mean anything to a doctor. That could be two days or two years. Did it come on gradually or suddenly? There is a different cause for any symptom that is chronic (over several weeks) vs. sudden or acute. Did anything precede the symptoms? Travel, trauma, or life stress can point to different causes. Read more »

*This blog post was originally published at EverythingHealth*

Why Pain Can’t Be A Vital Sign

There’s been a movement afoot for several years now to quantify pain as the so-called “Fifth Vital Sign.” It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand. The problem is that the word “sign” has a specific meaning in medicine that, by definition, cannot be applied to pain.

When you hear us medicos talk about “signs and symptoms” of a disease, it turns out that they are not the same thing. “Symptoms” are things the patient experiences subjectively. “Signs” are things that can be observed objectively by another person.

Headache is a symptom; cough is a sign. Itching is a symptom; scratch marks over a blistery linear rash are a sign. Vertigo, the hallucination of movement, is a symptom; nystagmus, the eye twitching that goes with inner ear abnormalities that can cause vertigo, is a sign. If someone other than the patient can’t see, hear, palpate, percuss, or measure it, it’s a symptom. Anything that can be perceived by someone else is a sign. Read more »

*This blog post was originally published at Musings of a Dinosaur*

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