Why I Can't Stop Being a Useless Doctor

So GPs are once again to blame for encouraging the spread of antibiotic resistant bacteria which will eventually annihilate all mankind. Well- mea culpa. However before you tar and feather me let me take you through a typical GP consultation and then you can draw your own conclusions.

"Come in"

"Oh hello Doctor. I thought I was seeing Dr Oldschool"

"Sorry - I'm afraid Dr Oldschool is away. I'm Dr Saintly. How can I help you?"

"Well, it's little Leah. I think she's got an ear infection. She's had it before."

I shall omit the details of the next four minutes during which I take further details of the episode of illness and examine an outwardly robust looking 4 year old finding nothing untoward apart from a slightly raised temperature on the way.

"Thank you Leah. You are a good little girl. Well, Mrs. Angst, apart from a slight temperature I am glad to say that I can't find anything untoward with Leah."

"You don't think she needs some antibiotics then Doctor?"

"No. This is likely to be a viral infection which will get better on its own. "

"But the last time she had this she was really poorly until Dr Oldschool gave her some amoxicillin."

"Well I don't think there's any need for that now."

"But she starts school next week and I don't want her to miss the first day. She's really looking forward to it."

"Well, as I said, I really cannot see any way that antibiotics will help here and if we prescribe some now then we might be encouraging resistant bugs and then she won't be helped in the future if she does need them. I hope that makes sense."

"So you won't give her any now then?"

"I don't think that it is necessary and we are really being encouraged to cut down on prescribing."

"So what should I do about her temperature then?"

"Er nothing really. NICE, our bible for good medical practice, advises that nothing should be done about childhood temperatures."

"What about some paracetamol then?"

"Well, as I said, we advise nothing- only drink plenty."

"So you aren't going to give her anything then?"

Me- blank face.

"OK then. Whilst I'm here can you give me some antibiotics for my sinusitis? I know what it is. I have had it before. I have left it two weeks but it is no better and I know antibiotics always clear it."

"Sorry, I'm afraid the practice policy is one appointment/one problem."

"But I tried getting an appointment and there are none available for 3 weeks."

"Oh all right then" and sensing a need for some diplomatic flexibility here, "but I'm afraid I still can't give you any antibiotics for it. NICE, the people I mentioned earlier have told us that we should not treat sinusitis. It always gets better in three weeks. So you've only got a week to go."

"Oh for f**** sake. I'm going to come back to see a proper doctor." Storms out

Now do I get a warm feeling of self-righteousness after such a consultation? Is Mrs Angst grateful for being 'educated'? Do I sit back basking in the knowledge that I have been a good clinician? No I do not. I feel useless, angry, frustrated and generally upset. And in that receptive frame of mind I then call in the next patient.

Politicians and academics may wish to consider how they would handle the above, I repeat typical, scenario before lecturing GPs who may have to deal with such cases daily amongst at least fifty others.

9 Things Your Doctor Wants You To Know

Don't worry -- we've seen it all before(01 of09)

Whatever your symptoms, no matter how crazy, unusual, or embarrassing, your doctor has seen it before, and probably at least once or twice this week. “I want my patients to know that they can bring up any topic with me,” says Barry Egener, M.D., a Portland, Oregon, internist and medical director of the Foundation for Medical Excellence.

“We see and hear everything, and it’s helpful for us to know what’s worrying you. If you’re feeling not sure whether or not you should say something, you probably should say it. If you’re feeling on the fence, bring it up. We accept that people come in with every potential history and past behavior,” he says (credit:Getty)

Give your symptoms context(02 of09)

Tell the doctor the story of your symptoms, and not just a list of them, urges Leana Wen, M.D., emergency room physician at George Washington University and co-author with Joshua Kosowsky, M.D. of "When Doctors Don’t Listen: How To Avoid Misdiagnoses and Unnecessary Tests." Instead of saying, "I have a headache," start from the beginning. “A good story has a beginning, middle, and an end, and usually an element of surprise," says Dr. Wen. "So if you say, ‘I’m someone who’s had migraines for 10 years, but for the last three days, I haven’t been able to get out of bed. I’m really worried that I have bleeding in my brain,’ you’re giving your doctor a lot of information in a context. It will help him or her diagnose you.”

Tip: Rehearse your story before you get to the doctor’s office so you can include all the information in the most concise form possible. (credit:Getty)

We know that weight is a touchy subject(03 of09)

If you are overweight, losing a relatively small amount of weight can make a big difference in your health. It can lower blood pressure, reduce pain and stress on joints, and reduce the risk of diabetes, cardiovascular disease, even, some studies suggest, cancer.

But doctors know that losing weight isn't easy. We know that food can bring pleasure, draw families together, and be a highlight of any trip, celebration, or even any given day. “We also know that there are health consequences to being overweight,” Dr. Egener says. “We know that you cannot abstain from food the way you can abstain from drugs or alcohol. You need it to survive.” So when we ask you to lose weight, we're not ignorant of how difficult it can be, but rather aware of the health benefits that you'll gain if you can drop even a few pounds. (credit:Getty)

Don't use the internet to diagnose yourself(04 of09)

If you search your symptoms on the Internet, you can come to some wild—and wrong—conclusions, says Dr. Wen. Have nausea and fatigue? Frequent headaches? That could be anything!

However, the World Wide Web can be very helpful if you’ve already got a condition and you are having new or odd symptoms, Dr. Wen says. But users beware. “All web information is not created equal. You have to understand what’s a testimonial versus a research site,” Egener says. In general, stick with government sites such as cdc.gov or medscape.com, where you can find the latest research and legitimate medical studies. (credit:Getty)

Not everyone should take an aspirin a day(05 of09)

There is much research to support an aspirin-a-day therapy to prevent heart attacks and strokes, but the prescription is not for everyone, Dr. Egener says. “It’s a decision that must be made on an individual basis,” he says. “For some people, the risk of GI bleeding can outweigh the benefits.”

Some studies have shown that even very low doses of aspirin can cause bleeding in the intestinal tract. That's understandable since the way that aspirin prevents heart attacks is by thinning the blood and affecting its platelets (the materials that make it clot.) If the blood is thinner, it may be more likely to cause bleeding in the gut. DO NOT start an aspirin a day regimen without consulting your doctor. (credit:Getty)

We like it when you bring a friend to your appointment(06 of09)

“It’s one of the most critical things that patients can do to help themselves,” says Dr. Wen. “I know that [adults] want to seem self-sufficient and feel that perhaps it’s embarrassing to need to bring someone along, but it can really help you understand what the doctor is telling you.”

If you're at the doctor because you don’t feel well, it’s hard to advocate for yourself. A friend or relative can be a real ally in the office. Be sure to remind your companion that you do want to speak on your own behalf as much as possible (because, says Dr. Egener, it’s important for the doctor to connect with you as a patient and to assess by your questions and answers what your condition is.) (credit:Getty)

Find out if we have a conflict of interest(07 of09)

Ask your doctor if he or she is on the payroll of any drug or medical equipment companies. It may make no difference to you as a patient, but if tests are ordered or prescriptions are written for conditions that seem borderline, it may be an issue. Many doctors get monetary compensation for prescribing certain medications or by enrolling patients in a trial, says Dr. Egener. And although most say their decision making is not influenced by these connections, a new law called The Physicians Payment Sunshine Act (part of the Affordable Care Act) will take effect September 30, 2014 that will require pharmaceutical and medical device companies to list all physicians to whom payments are made. You’ll be able to look up your doctor (once the resource is available to patients, the American Medical Association will post a link) and find out whose payroll he or she is on (if any at all.) (credit:Getty)

Use the front office to your advantage(08 of09)

“We have appointments of different lengths for different purposes,” Dr. Egener says. “It takes longer to do a physical, but we have a shorter appointment if you come in for a rash.” So, make sure to communicate effectively when calling for your appointment—say, “I have three things I want to talk to the doctor about.” If you hate waiting, ask for the first appointment of the morning or the first one after lunch.

Also important: You should have a clear list of things you want to discuss, and be aware that you may not get to all of them.

Lastly, the office staff will ask about insurance. If you don’t have any, say so, and then ask if there is a sliding fee scale. You may be able to negotiate a fee, Egener says. (credit:Getty)

We don't always know what medication costs(09 of09)

If your insurance won't cover a particular medication—or it's still expensive even with what your insurance pays—let your physician know. "If you cannot afford a medication, usually there is another alternative," Dr. Wen says.

Doctors are also willing to discuss the medicines they've prescribed to their patients. "I don't expect that patients are going to agree with me on everything," Egener says. "I'm the expert in medicine, but you're the expert on your body." Doctors may prescribe a medicine that you would rather not take, so discuss your decision carefully with your physician to determine the risks and benefits of not filling a prescription. (credit:Getty)

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