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Doc office etiquette works both ways

September 10, 2013 Updated: September 10, 2013 at 12:46 pm

You don't have to be a doctor to diagnose a lie, but it can help.

The guy who can't stand still or follow what you're saying? Not sober, as he defiantly insists.

The little girl who keeps getting nose bleeds? Surprise - Mom's perfect little princess is probably a picker.

"One biggie is when kids come in and we ask the parent, 'Is he eating green vegetables?'" said Dr. Ian Tullberg, an urgent care physician with Memorial Hospital. "We're told by parents all the time that, 'Oh, we have balanced diets, they get all the food groups,' but if as many kids ate the kinds of foods parents say their kids eat, there would be no obesity epidemic."

Things used to be simple. When you felt sick, you made an appointment and explained your symptoms to your doctor, whose diagnosis was sacrosanct. You didn't fib, not about exercise or smoking, and if you had to wait an hour or two to be treated, you sucked it up and thumbed through an old issue of Redbook like everyone else.

The dynamics are a bit a more complicated today.

"People disagree with us all the time. My guess is five to 10 times a day we have to break people's expectations," Tullberg said.

Recently, a woman in her 60s became enraged and stormed out of Tullberg's office after the doctor refused to treat her common cold with antibiotics.

"It's almost like they think we don't want them to be better, which is of course not the case. We want to do whatever we can to get our patients to feel better, but we've got to do what's appropriate for the situation," he said.

Honesty can catch a doctor off-guard, too. Once, as Tullberg explained medication dosing instructions after an exam, a patient told him not to waste his time.

"The patient said 'You doctors know we patients never follow these instructions,'" Tullberg said. "I was pretty surprised by that one."

Lies and half-truths aren't the only things that can stymie a visit to the doctor. Sometimes, it's more about the timing of information.

"Some people hold their most serious complaint till last," said Dr. Sheldon Ravin, a family practitioner in Colorado Springs. "You think you're finishing a visit and they say, 'Oh, by the way, I've got chest pain.' That's something you should probably lead with."

It also can be tough for a doctor to convince a patient that their initial diagnosis-by-Google is flawed.

"When they do all this research and are convinced they have a sinus infection and then it's just a cold, they can get upset," said Dr. Kathryn Murray, a doctor of osteopathy at Penrose-St. Francis Primary Care. She encourages patients to speak up if they disagree with her diagnosis or treatment plan, though. "Let's have a conversation about it. I think patients should be as involved in their health care decisions as I am."

If one female patient hadn't shared her fear of mammograms, Murray wouldn't have had the opportunity to assuage her worries, she said.

Another thing that can be confusing for patients is the vast range in treatment approaches among doctors. While one doctor might treat a patient suffering from back pain with a muscle relaxer or pain killer, another might prescribe a steroid, and yet another might recommend icing, stretching and gentle exercise. Patients experiencing symptoms similar to those they've felt before often will seek treatment or medications that successfully have addressed the ailment in the past. If their current doctor suggests a different approach, there can be friction.

"All providers, even techs and nurses, practice medicine differently," Tullberg said. "That's why it's called the art of medicine."

A major contention point for doctors and patients is time - too much spent waiting, too little in the exam room.

Ravin knows physicians whose policy is to end the visit in 10 minutes and schedule a new appointment if more time is needed, regardless.

"I spend more time with a patient to address their needs, but you do that with three patients in a row and you're 30 to 40 minutes behind," said Ravin, who apprises waiting patients if there's a backlog and gives them the option to reschedule if they can't stick around.

A patient whose complaint turns out to be more serious than initially thought quickly can become a patient transfer to the emergency room, which can throw off an entire day's schedule of exams, Murray said.

"Sometimes, we do run behind. We try to respect patients' time as much as they respect our time," she said. "I'm the same way when I go to a doctor, too. Nothing's worse than sitting in a room for an hour with nobody telling you what's up."

At urgent care clinics such as Tullberg's, where patients are seen on a first-come, first-served basis, wait times depend entirely on the crowd.

"We try the best we can, but if we have 50 people come in, we have to see 50 people," Tullberg said. "There can be a two- to three-hour wait, and people get very irritated with that."

And about those cellphones: Most doctor's offices post signs asking patients to power down once they're in the exam room for a reason.

"It's frustrating to have a parent texting or on the Internet while I'm trying to explain what's wrong with their child," Tullberg said.

At Murray's practice, patients are usually polite - and smart - about cellphone usage.

"Most people will turn off their phones or they apologize," she said. "I did have one patient, I walked into the room to meet them and they put their finger up for me to wait and said 'I'm on an important business call.'"

Murray said she understood, and suggested they reschedule the appointment.


Contact Stephanie Earls: 636-0364

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