The Doctor's Corner

Not infrequently, we have a request from a patient to do one of the following over the phone:

• - make a diagnosis
• - speculate about what caused some symptom
• - call in a prescription for symptoms

I often joke that if a patient could “just hold the phone up to her vagina” I could tell what is going on! This is my attempt at being humorous in the face of a serious subject, telephone medicine.  Periodically, such as when the office is closed, and the complaints are bothersome enough to need attention after hours but don’t seem serious enough to warrant an ER visit, my call partners and I must do our best to figure things out over the phone. We have to consider the diagnostic possibilities and even call in a prescription without the benefit of an in-person history and physical exam.  Sometimes the diagnosis seems obvious and we hang up with confidence; more often than not, we are still thinking about the call awhile later, wondering about the “what ifs” that can’t be answered with the phone between us and the patient.

Consider the following scenario.  A woman has one or more of the following symptoms: urinary burning, urgency or pressure.  She calls in saying “I have a bladder infection, please call something in”. The correct diagnosis for the patient is:

1. - Bladder infection
2. - Kidney infection
3. - Vaginal infection
4. - Primary outbreak of Herpes
5. - Laceration of the labia/vagina
6. - Ovarian Cancer

The answer is that ANY of the above could be the diagnosis, and “just calling in” an antibiotic for a presumed bladder infection is not without risk.  A proper evaluation requires an in-person history, a urinalysis, a physical exam and possibly other tests.   The result of that evaluation will dictate the appropriate treatment, which frequently does not require a bladder antibiotic.  Fully half the patients I see for the complaint of “I have a bladder infection” do not, in fact, have a bladder infection.  I have made every one of the diagnoses on the above list in patients who were certain they had a bladder infection.   I know everyone is busy and that bosses can be difficult. I know that kids have needs and schedules and I know that it sometimes seems inconvenient to come in for an appointment when the self-diagnosis seems simple and obvious. That said, I also know from experience that doing the right thing medically usually requires more than a phone encounter. Please bear with us when we ask you to come in. We really do have your best interest as our number one priority.

On a related note, did you know that 90% of communication is non-verbal?  That statistic surprised me, but made sense when I thought about the difference between trying to explain abnormal test results over the phone instead of in person.  While I used to have my medical assistant convey most abnormal results over the phone, I no longer do that.  We found that the person on the receiving end of the information wasn’t able to listen or process information well once the word “abnormal” was spoken.  A flurry of questions and repeat phone calls along with an incomplete understanding of what the results meant was the outcome.  Thus, I now have my medical assistant give only very basic information with her request that the patient make an appointment to discuss the results and what they mean.  Patients who do get flustered with even this type of phone call are visibly relieved once they get to discuss the issue in person with me.  When we do biopsies or other office-based tests, I usually have the patient make a return visit in a few days to go over results.  While this may seem like a nuisance, the improved communication and understanding are well worth the time and effort involved, for both the patient and myself.  This approach actually saves time and worry, since more detailed information can be given, questions can answered and non-verbal cues understood.  Peace of mind is powerful medicine, indeed! Even when the results are worrisome or dictate a need for treatment or referral, the way that those results are communicated makes a big difference in a patient’s ability to process the information and understand what it all means.

So, when we ask you to make an appointment, we do so in the interest of high quality medical care.   We are always happy to work with your schedule constraints and we try to be as accommodating as possible when finding a time for that appointment.

On another related note, our latest afternoon office appointment is now a bit earlier, since I am now picking up my high school freshman (time flies!) after school so I can keep my finger on the pulse of the high school scene. We have added some earlier appointment times around the lunch hour to compensate.  Thanks for reading, and here’s to your health!