Just Drag Me Off to the Tar Pit
It's raining and dreary and miserable. My foot hurts (plantar fasciitis.) My head hurts; I've just taken two tylenol. And people are being really stupid today.
I go around and around and around with a guy who wants an antibiotic. I tell him it won't help because he has a virus. He says, "So you don't know what's wrong with me."
me: Yes I do; it's a virus.
Him: Then why can't you give me something for it?
me: Because it won't help.
Him: Oh, ok. But how about an antibiotic?
Then there's the lady with a TSH of 1.5 on 0.1 of Synthroid for 10 years, but has swollen feet, fatigue, dry skin, a pain under her ribs, and about six other general symptoms. How long has she had these problems? "A while." A week? A month? Since the Carter administration? "Oh, it's been quite a while." Extracting the history, one precious nugget of information at a time, wheedling, cajoling, repeating and re-phrasing every step of the way.
Another lady comes in, talking continuously, telling me about her terrible sinus infection for which she needs Biaxin. Nothing else will do. Just give her some of that Biaxin, please. I don't really need to take her temperature (98.5) or her blood pressure (168/96) or examine her (gorgeous pearly TMs, throat perfect; pinkest, clearest nose I've seen all day; bang on her cheeks with a sledgehammer and she's fine; never even stops talking.) She just needs that Biaxin. Ten minutes of careful explanations about bacteria, viruses, upper respiratory infections, antibiotic resistance -- not to mention side effects, though of course I do -- and she refuses to be swayed. Not only that; she literally won't leave without it. I strike a bargain: three days of Biaxin AND a blood pressure pill, and she has to promise to come back in a month so I can see how she's doing. She thanks me profusely on her way out. I won't see her for a year. I know this because every word of this visit is identical to her last visit -- a year ago. (And my office manager has to explain to her why there's yet another $110 Medicare deductible she has to pay.)
Next there's the 11 year-old girl who had a cold last week. She's fine now, but her dad wants me to "check her out." While there, he mentions a spot on his leg that was there a few months ago. It's gone now, but he wants to know what it was.
And finally there's an older gentleman whose blood pressure was decently controlled on moderate doses of once-daily generic meds. He said he wasn't feeling quite right, so he stopped taking them and switched to something over the counter called "Blood Pressure X". He's not sure what's in it (he forgot to bring in the bottle) and it's kind of expensive, so instead of taking it three times a day he's only taking it twice. But he feels great. Just great! His BP is 190/100, but he feels great. Just an illustration of the Second Law of the Dinosaur: It is impossible to make an asymptomatic patient feel better.