“I’m a doctor, not a store clerk.” Dr. McCoy Star Trek.

 

I am sure he didn’t really say it, but I would be less than honest if I didn’t tell you I feel that way daily.  Many patients have the wrong approach to seeing primary care and it all comes down to the huge trend in hospitals to give customer services classes that started in the late ’90s.  Oh yeah, the customer is always right, addressing customer issues, making the customer welcome, blah blah blah.  Yeah, this is one provider that gives less than two shits about kissing a patient’s ass.  Don’t like it? Fight me.

First off, even if you are a provider when you walk in my exam room, you are not right.  We have beaten this dead horse over and over, but seriously stop looking up symptoms, stop telling me what you want, stop fucking provider shopping, and just go with your symptoms. That is what we want to know and to be honest you trying to defend your google search of symptoms is wasting yours and my time, I do have other patients that I need to share time with and just because you think you have beriberi is not as likely as it is something else (ok beriberi sounds cool and is not super common)

Beriberi a disease caused by a vitamin B-1 deficiency, also known as thiamine deficiency. There are two types of disease: wet beriberi and dry beriberi. Wet beriberi affects the heart and circulatory system. In extreme cases, wet beriberi can cause heart failure.

So, unless your diet sucks or you are a severe long-term alcoholic, this disease is very unlikely.  Let me hear your symptoms, not your opinions and let me examine and diagnose. Bada bing, bada boom and you are on your way, either for some more tests or with a pretty clear diagnosis.

Yes, the patient isn’t always right.  You come to me to be seen for health issues, not the muffler for a 73 Gremlin. We are not there to kiss your ass but to help save it.

Yes, I am a friendly person and I treat my patients and other staff with kindness and compassion, however, don’t be pissed when I discount your “diagnosis”, won’t order a blood test for a copper level (happened last week the patient saw some naturopath who said he should have it done…), I am not giving you every medication you think you need, and if you are new to me, I will evaluate that treatment regimen to give the best level of care that I can with the medications that work for you.  Just because it has always worked sometimes it needs to work better.

Along that line.  Just because I want to go in a different direction is not a reason for you to think that I am trying to take something away.  The best example is changing or adjusting opiate doses.  I am not crazy (ok a little) but I am not a fan of long-term opiates.  I am ok with short term, chronic pain, and end of life of course.  Chronic pain worries me because often we let folks get to that state by just throwing opiates at the problem.  Look if you expect me to provide, I am not just giving a free opiate script because you want one, and I am going to review what has been done to try and mitigate your pain to see if it can be improved upon….You dig in your heels and are allergic to any other drug regimen or you have “tried it and it didn’t work.”  Yeah, I get it you are nervous about being away from opiates because you do have a physical need for them. You do, however, owe it to yourself to be treated not drugged out.

I know some folks have literally done everything to overcome a need for opiates, and I realize that they end up being necessary.  Yes, I am a kind and caring person, however, I am not there to please you every day and honestly, hospital management and their customer service, make the customer happy is bullshit.  My license folks, I am tired of any pressure to “just treat the patient the way they want it.”

When I come up with a treatment plan, I do share this with the patient and ask them if they are willing to take medications and follow (or do their best following) lifestyle modifications to treat a disease process.  I also negotiate for some of the tougher changes, but in the end, there needs to be an effort to follow a treatment plan that we both know.

If the patient is unable or unwilling to do this and does not like my diagnosis, I should be free to transfer their care out. Yes, that is not customer service, it is not kissing the patient’s ass, JD power is going to be pissed when they see those numbers and all of that.  It’s my license and my education, not your fucking google search that matters here.  I understand allergies and bad side effects and will avoid those medications, but treatments should be relatively non-negotiable. I am liable once I diagnose and treat you for the care you receive.

Sorry if I hurt your feelings, but we are too damn “entitled” and every damn Karen wants to speak to a manager because they didn’t get their way. Have you ever stopped to think that maybe your way is wrong and that you need to put on the adult pants and do what needs to be done?