Saturday, October 2, 2010

That IS a Medical Problem

There are about 6 questions I need to ask when I see a patient:

1- What brings you in?
2- What medical problems do you have?
3- Do you take any medicines daily?
4- Have you had any surgeries?
5- Do you smoke, drink, or do any drugs?
6- Are you allergic to anything?

The rest is just gravy. I am REALLY getting annoyed with question # 2 lately. I have tried phrasing it many different ways...but people for some reason don't think that high blood pressure, high cholesterol, or diabetes are medical problems anymore.

They will say NO they don't have any medical problems, but when I ask do you take any medicines daily, they will reply yes for my high blood pressure! Well genius that's a medical problem, not a gift from your grandmother.

Recently I had a patient say she had NO medical problems at all. No matter how I asked it she said no. I kept prodding b/c she looked like she had lots of problems. I found a previous discharge summary, and below were her actual medical problems listed:
  • High blood pressure
  • HIV
  • Diabetes
  • Gout
  • Anemia
  • Hypothyroidism
  • GERD
  • Schizophrenia
  • Cervical Cancer
Guess what....those count!

Now I just say "do you have any medical problems including high blood pressure, diabetes, high cholesterol, chronic stupidity, etc??" It's getting annoying

-ER Doc


Ladyk73 said...

I am sick of telling docs that I had tubes in my ears when I was a kid, and weird eye surgery when I was two... I figured they would see I had no tonsils. And I hate being asked about one seams to care that I have allergies to

Do I have to tell them I had a cavity filled? that's surgery...

Anonymous said...

Re smart ass: u know u don't have to tell them about ear tubes and tonsils. U might want to tell them about ur stupidity tho

SerenityNowHospital said...

Not nice whoever wrote above.

Ladyk you would be considered a good historian but I would probably start daydreaming when you start talking about minor procedures

-ER Doc

Sharp Incisions said...

I'm a medical student, so they often find patients with specific types of conditions for us to see. For example, in our musculoskeletal term, they'd take us to see patients with hip fractures etc.

In my respiratory block, I got taken to see a patient, and was taking his history. I wasn't getting much relevant out of him, so I ended up asking 'have you ever had any problems with your lungs?'. The patient said 'no', then the supervising doctor raised his eyebrows and said 'don't you have emphysema?'. Oh yeah. That.

Now I tend to ask quite specifically, at the end of my 'history taking', whether they've ever had problems with:
- diabetes
- blood pressure ('oh no, love, I don't have any blood pressure')
- cholesterol
- their heart
- their lungs / breathing
- their liver
and sometimes a few more for good measure.

As a first year student, I don't always recognise the names of the meds, so at least this way they can't complain I wasn't comprehensive enough!

MedicMatthew said...

I always find this frustrating. The patient denies any history, however, he takes Lipitor, Lisinopril & Glipizide and when asked will say that he doesn't have hyperlipidemia, hypertension or diabetes so long as he takes the pill.

I have found that a lot of people seem to think that "medical problems" are just that- problems that inconvenience them. They don't see their hypertension as a problem because they take a pill for it and to them it goes away.

I have found that asking "Are there any medical issues you're being treated for or take medications for?" often provides a better picture of the patient's health, but it is a pain in the ass to say.

type1medic said...

I just based medical history off of the drugs they take. I mean seriously I get so tired of having to figure them out so when they say I take this then I ask why saves me time and them from looking too stupid. I mean please tell me how diabetes is not important to mention??

Arzt4Empfaenger said...

MM - "I always find this frustrating. The patient denies any history, however, he takes Lipitor, Lisinopril & Glipizide and when asked will say that he doesn't have hyperlipidemia, hypertension or diabetes so long as he takes the pill."

Exactly that. I can't count the times I've heard that!

Once on bedside teaching rounds I asked an older guy if he had any problems/illnesses/etc.? He said no (of course). In one of the next minor side sentences he stated something about his bronchial cancer though. Not an illness at all, huh? Similar thing a couple of years ago on the cardio ward with a guy who'd had a basaliom on his forehead removed. Head, meet wall. :|

Anonymous said...

ROFLMAO! You people don't READ your own BS paperwork! When you check in they make you answer all that malarkey, then the nurse asks it all again, so the doctor gets upset b/c he doesn't glance at the chart before seeing the patient? Good grief.

Anonymous said...

Could you Swap question #2 with question #3? May make things go more quickly for you?

Anonymous said...

As a RN, there's nothing more frustrating than attempting to complete an inpatient admission. I run into the same problem with medical history as you MDs do.

Most of my patients can't tell me the names and doses of their medications. I can't tell you how many times I've heard, "Well, I take that little pink one in the morning and before bed, but I don't remember the name of it." Even worse, they can't remember why they're even taking the damned pill!

Last month, I had a patient with a medical history and medication list that was literally several pages in length. I know this because he actually handed me several typed pages detailing all of his medical diagnoses, medications (including drug name, route, dose, time, reason, and prescriber!), and all of the physicians (including their office numbers!) who were currently treating him for the aforementioned. I nearly burst into tears; it was beautiful.

tracy said...

Hee! No Doc is interested in hearing about the Crazies...i just tell them the meds i take...then they figure it out. Crazy somehow isn't considered a "Medical Problem". Heh.

Crazed Nitwit said...

I'd LOVE to hear the answers on the chronic stupidity question. Too funny and also sad.

webhill said...

Same problem in vet med. Dog presents with PU/PD, weight loss, inappetance. I ask "is fluffy on any medication?" No. Then it turns out i see in the chart he's on enalapril, Heartgard (ivermectin), & famotidine for the past year. I ask about it & get "oh, I thought you meant OTHER medication." WTF?

C said...

Look, we just discussed this topic on my swearing Mom message board, only it was with children. Do.not ask questions you already know the answer to. They.will.lie! I'm sorry if it means you have to dig up their old records but it will save you tons of time.

You're welcome.

June Cleaver said...

LOL I'm looking at this from the other side of the coin; as the patient. I never know what all to include when being asked about medical history. Surely they don't need to know I had a wart surgically removed from the top of my foot when I was 4. I do have quite a nasty scar but that's the extent of it. I never know whether to thrown in the tonsilectomy, when I was 24, or not because it was surgery but it's done and over with so not really relevent when I'm in the ER for whatever unrelate issue. I tell them about the c-section but, again, doesn't seem very relevent since I'm not planning to use the involved organs ever again.

Allergies is another stumbling block. I definitely know they need to know about the codeine allergy (and I can never get the e and the i in the right order so I guess. sorry if it's spelled wrong). I tell them about the band-aid allergy but I know that puts me in the "possible whacko" category (I'm allergic to the adhesive. Not the latex). But then I can never decide if they need to know I'm allergic to bees and mosquitoes or, if I do mention it, if they're going to think "Well, you're in a feakin ER so you're not really likely to encounter those here".

At least now I understand why, when they ask if I have any medical problems and I say "No" they go on to ask "Do you have diabetes? high blod pressure? etc.". I always thought "Uh...wouldn't those be the medical problems you just asked me about" lol

SerenityNowHospital said...

-Replacing question 2 with 3 doesn't help produces the same response

-They know their medicines less than they know their medical problems

-In the ER I don't always have time to search for a past record. ALSO, a lot of times they dont have a past record. ALSO, a lot of times their medical history changes over time. ALSO, they don't always tell the triage nurse the truth or include everything so I have to ask that simple question

-Remember...if you are reading this blog you are probably MUCH smarter than most of my patients that I blog about

Anonymous said...

Maybe adding a question such as
"are you currently being treated or takking medication for any medical issues" might help prompt those who tend not to mention things if they are not causing "problems".

C said...

I asked a patient once if he had any surgeries. He said no. I examined him. Huge scar down the middle of his chest. I asked what happened. oh, i had coronary bypass surgery 5 years ago. yea, that's surgery!
RE your patient, maybe her schizophrenia precluded her from being aware of her problems?

Anonymous said...

This is the reason why I will always take the oppourtunity to ask family and friends about a patient's medical history...they usually add more to the story.

ERP said...

I almost never ask "Do you have any medical problems" unless the person has a very strange and complex sort of complaint. Otherwise I just ask about what I care about - like "Are you being treated for HTN, DM, or High Cholesterol" in someone with chest pain - because I really don't care if they have glaucoma. If they have an eye complaint, then I ask things differently.
Helps streamline things.

radioactive girl said...

I consider myself a pretty great patient. I have had a bunch of medical crap recently so I have a typed list of medications, surgeries, etc. I did say something that was stupid just recently though. (well, probably I have said lots of stupid things recently, just this one in particular that relates to the post)

At my preop checkup the doctor asked the regular questions and then said "so you are hypothyroid" as he wrote it in the chart. I said no, I'm not hypothyroid. I have no thyroid! Of course I am hypothyroid. I wasn't even thinking I guess because I take medicine that makes it not an issue. We both laughed about it after I realized what I said.

I'm sure that's not what you are talking about, but maybe sometimes that happens? That the person forgets/doesn't think that the problem is a problem because they are so used to the medicine they take to treat it that it seems like a nonissue.

hof said...

I'm going to side with both you and radioactive girl on this one. I don't even think of my insulin as a med, I honestly forget, even to my clinical trial doc. It's just such a part of my daily routine (8+ shots/day) that I don't even think about it anymore.

On the plus side for me mice and cells don't ever forget to tell me their history. Platinum refractory ovarian cancer cells, that's all I need to know.

CathiefromCanada said...

"Tell me what other doctors have treated you for"

R. May said...

I think Cathie may having the winning answer.....

Some people are stupid, nothing will fix that. But I think many people do not think conditions currently or previously being treated are 'problems'. They're either gone or under control.

Anon - people take random strangers on the internet much more seriously when there is an attempt at functional sentances and spelling. Based on what you wrote you are an angsty pre-teen with authority problems. I have one of those at home already - definately not to be taken seriously.

Keith said...

Its a big problem on the ambulance too. The way I usually ask is "Do you have any medical problems or anything you take medication for?" And they say no and then I say "How about any heart problems, breathing problems, diabetes, seizures, **insert body system they complain about** problems?"

If I still get a no I look at the med list and say something like "The don't usually give out Coumadin and metoprolol for no reason, do you know why your doctor wanted you to take it?"

~Ashley said...

i always love how NOBODY sees hep c or hep b as a medical problem.... thanks for warning us that you're a cesspool, dude.