15 10 2011

As family medicine deals with mostly preventative medicine, there’s usually a fair amount of dialogue that occurs between doctors and patients about how to protect their health.  Of course, as I have rather quickly learned, this means having many of the same conversations (with different patients) over and over and over and over again.  This is probably why the resident-du-jour usually sends me in to have those “talks” with patients.  It’s not so bad, mostly you tell them something, they smile and nod, perhaps ask a few more basic questions which I can answer without trouble, you wrap up with some kind of 10-second pep talk, and then leave without a problem.

Each “talk” has, if you will, its own trigger phrase.  For example, if I’m looking into a kid’s ears and mom or dad says something like “yeah, his ears are really waxy, and I don’t know what else to do because I clean them out every day.”  This is when the transcript begins.  Every time, it goes something like this:

“What are you cleaning them with?”


“Well, Q-Tips are great for the outer ear, but you should never stick them into anyone’s ears, even your own.”

“Isn’t that what Q-Tips are for?”

“Most people think so, but because of the way they are shaped, they tend to pack the wax down into the ear more.  [Insert shpiel about curettes/peroxide/follow-up].”

Usually parents are really receptive to these sorts of talks, which surprised me at first.  Coming into this rotation, I had the idea that parents would be worse than normal adult patients, but they aren’t.  I think this is partly because no matter how long you’re a parent, there’s always that tiny seed of insecurity looking for better ways to take care of their kids.  Adult patients, though, are used to taking care of themselves and have done so for decades, so they feel that they know best all the time and will not take other suggestions (in the setting of anxiety or back pain, when “my vicodins” or “my xanaxes” are involved, they are stubborn as all get-out).

I have had lots of these “talks” with patients.  The most common ones are as follows:

The “it doesn’t matter how clean he says he is, use condoms unless you’re monogamous” talk.

The “quit smoking” talk

The “seriously, we aren’t giving you this blood pressure/cholesterol/diabetes/heart/psych med for shiggles” talk

The “Be a parent” talk

The “No, we are NOT upping your dosage of klonipin/xanax/ativan/fioricet/flexaril/vicodin/ Percocet/oxycodone/hydrocodone no matter what you threaten me with” talk.

The “Your kid is normal.  Really” talk

And my personal favorite:

The “I don’t care how much you/your friends/your relatives/TV/newspaper/the internet says it, you CANNOT GET THE FLU FROM THE FLU SHOT!”

This post is not to say that patients are dumb.  They aren’t.  What they are is hard-headed and stubborn, stubborn, stubborn to the point that it interferes with how well the docs can care for them.  Don’t get the idea that patients should be passive and docile; my favorite patients are the ones who have done their research, can ask intelligent questions, and actually participate in their own care.




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