“I’m on that little white pill, you know which one I mean.” There are hundreds of little white pills, and that’s not even counting all the generics out there. In our clinic, we ask patients to bring their prescriptions (and non-prescription medications) in with them at every visit. It’s amazing how often they’re taking meds we don’t know about, especially when they’re seeing specialists. “I was running a fever of 99° last night.” Or its close cousin: “I know my daughter was running a fever because she felt warm.” Please get a thermometer (there are many easy-to-read and inexpensive thermometers out there now), and let me know if the temperature is over 101°, or 99°-100° daily for several days. I don’t care how low you think your body temperature is normally, nothing else is a fever. “Oh, by the way Doctor, I’ve been having some chest pain.” This is always said as the patient is halfway out the door at the end of the appointment. (As an aside, I’ve noticed that the patients coming in explicitly for chest pain rarely have a cardiac condition; it’s the patients that that are reluctant to admit they have chest pain who have the bad hearts.) “I was taking some antibiotics I had left-over…” This is wrong, wrong, wrong. First, taking antibiotics willy-nilly is never a good idea, and is a perfect way of causing antibiotic resistance. Second, there should never be “left-over” antibiotics. This shows that the patient didn’t follow the instructions last time they were put on antibiotics (which is another excellent cause of resistance). “I need a note for work excusing me for the past week.” The patient’s been sick and off work (or school) for a week and now needs a note to excuse all those days. How can I honestly say this patient was sick that whole time if I didn’t see them? I’ll sign a note saying they were in that day and cleared to go back to work, but that’s it unless I know them very well or there’s been some telephone communication. (Bear in mind, I’m not asking patients to come in with every little cough or cold, but if it’s severe enough to need a note for school or work, then the person need to be seen) “Can you fill out this paperwork right now?” There are so many reasons patients need letters or forms filled out: disability, worker’s comp, insurance, and FMLA just to name a few. All of these take time. I need to get the chart, look through it for the pertinent information and then fill out the form/write the letter. It will take at least a day or two to find the time to do this; don’t expect it immediately. If it’s vitally important, bring it in several days early; don’t tell me, “I need this for court tomorrow.” And please don’t bring in a letter you’ve written for me to sign. While I appreciate the fact that you’re trying to help, I am very particular about what my name is on. “My son needs a sports physical, the doctor saw him last week for a cold, so he should just be able to fill out the form.” In a word, no. When someone is in for a sick visit, the focus is on the acute illness. Physicals require an entirely different mind set. In addition, most of our sports and school physicals also require lab work, a visual acuity exam, and resting and post-exercise heart rates – tests we don’t perform on routine visits. If a parent is real aggressive about this, I tell them that I’ll be happy to fill out the form, but it’ll reflect exactly what I saw on the exam and as a result the patient may not be cleared for sports. This usually solves the problem. “I need the drug that I saw on TV.” The only thing harder than trying to persuade someone they need a drug is trying to persuade them that they don’t need a drug. Unfortunately, drug ads are too effective and patients come in demanding drugs for a problem they don’t have (or a problem where cheaper drugs will work just as well). A long frank talk is the best way to correct this problem, but it is time consuming and very draining. Alternately, I find that telling the patients the actual cost for their “wonder drug” work pretty well much of the time too. “But Doctor, I do exercise; I walk at work.” While it’s true that every little bit of exercise helps, if someone is truly concerned about losing weight or increasing their cardiovascular health they need sustained exercise. That means 20-30 minutes in a row of aerobic exercise at least three days a week. “I know the appointment is just for me, but my son is sick as well…” I admit it; I’m a sucker for this one and fall for it almost every time. There are some patients that do this at every appointment, so I set aside extra “family” time when I see their name on my schedule. Source
