A Fool for a Patient

My Quora Answer to:
What was the most incorrect self-diagnosis you've encountered in your practice as a doctor?

My own. Any doctor who treats himself has a fool for a patient.

After my 5 muggings in Nicaragua over the Thanksgiving weekend in 2013, I developed a well-deserved diagnosis of PTSD. Which seemed to be fairly well-controlled until October 1, 2018. A few panic attacks here, occasional night terrors there, but I still maintained the ability to think and act rationally until then. And the next 6 weeks were pure Hell.

Mid November I finally came out of it. Here were my problems: hypersexuality, drinking, spending sprees, racing thoughts, weeks on end of “blacking out,” legal problems, and most distressful, loss of short term memory. I got on a bus 4 times to see my psychiatrist at the time, and 3 times I failed to get off the bus because I forgot where I was going. The 4th time was a disaster anyway because my psych couldn't see past the alcohol issue. I rarely, if ever, drink when I'm not psychotic, but her reply to my plea for help was, “go check into an ER.” That was the last time I saw her.

It wasn't until the first week in February that a more astute and compassionate doc diagnosed me with Bipolar Disorder. It was a bumpy road until then because I still believed (self-diagnosed) that the 6-week episode was PTSD. Once I got the correct diagnosis, everything fell into place. It was as if she shook a container of puzzle pieces and rolled out a finished masterpiece.

All is good now.

http://bit.ly/2Zv53uU

Scary Patients

My Quora Answer to:
As a doctor, have you ever been in danger from your patient?

Yes. Just one.

I was working in the ER at Waupun Hospital when the EMT's brought in a patient from a local prison. Waupun, Wisconsin is home to three prisons and close to a few others. The local economy thrives off of kidnapping and caging people.

Before I entered the bay, my nurse pulled me aside and warned me not to get close to the patient. He explained that the prisoner had permanently disabled a nurse at another hospital by attacking her physically during her intake exam. It was the only time in my career when I saw and treated a patient without doing a physical exam.

NB: I always did physical exams even with my psych patients. In addition, a physician can learn a lot just by observation. In medspeech, we document this with “A, A, Ox3, in NAD” which is shorthand for Awake, Alert, Oriented to person, place, and time, and in No Acute Distress. With ambulatory patients we also observe gait and lower body strength but the prisoner was shackled to a gurney and I was NOT going to unchain him just to observe his gait. That's how scared I was.

https://qr.ae/TWraSN

Bedside Manners

Answer to Why do doctors often have poor bedside manners, and what as a patient could I do to make their say better?

Because physicians are humans.

You will find the arrogant, rude, inconsiderate, and uncompassionate among us just as in society at large.

However, you will also find the sensitive, caring, loving, and compassionate among us, too. Just like society at large.

I'm not sure about others, but we learned about good bedside manners in med school. My teachers were professors in the Psychiatry Department at the then North Chicago VA. The training was excellent, and I internalized a lot of it. Among other components, we learned which words and phrases not to say, what body language puts patients at ease, and even to change the rate of speech under different conditions. Good stuff.

As for your second question, what can YOU do? Plenty, starting with just letting your doc know how you feel. Try not to make it confrontational. Just simple and honest. This may change how they interact with you, but I doubt you'll make much of a change in their character.

If that doesn't work, write a letter and mail it to the clinic manager/hospital CEO. Snail mail makes a bigger impact than email. That should make some difference. Especially if many others complain.

Then there's always Yelp, or Google Reviews, and so on. Permit me to give you a personal anecdote. I had to change family docs at the end of last year because my insurance changed. My first visit with my new one was February 2nd of this year. The encounter was humiliating.

Last Fall I fell into a manic episode that lasted 6 weeks. During that time I apparently drank. Which is not what I normally do. At one point I fell and kissed the concrete. I was taken by ambulance to an ER where, of course they obtained a blood alcohol level which was just above the legal intoxication level.

Anyway, the new doc walks into the room, introduces himself, then says, “so you are an alcoholic.” Then proceeds to grill me about drinking and abusing drugs, which I have never done. No physical exam, no history taking, nada. On the way out, he says, “see you in 6 months.”

I posted a negative review on Yelp. Someone in the hospital system must have read it and talked to him because at my follow-up visit August 2nd (just last Friday), he was as nice and attentive as can be!

If none of this helps, change docs. It's your right. Good luck.

http://bit.ly/2ML3mXI