Every patient is unique, but it’s amazing how many repeat phrases that I’ve heard hundreds of times. These are invariably hints which painful experience teaches me not to ignore. Here are some.
Guest: “You’re the doctor.”
Like “You’re the boss,” this means “You’re wrong.” Other hints that I’m off base include:
“I wonder if I need something stronger…”
“My regular doctor always gives me...”
“My husband had the same thing, and the doctor said it was...”
Hearing these, I go back to square one and explain my thoughts.
Guest: “If I don’t get something it turns into (...bronchitis, strep, walking pneumonia, a sinus infection...).”
This guest is saying: “I want an antibiotic.”
Patients often work hard to convince me that their cough, congestion, or sore throat has a special feature that requires an antibiotic. They tell me that -
“I have an important meeting, and I can’t afford to be sick.”
“I have a tendency to strep.”
“It’s not a cold. It’s bronchitis!”
“If I don’t catch it quick, it goes to my chest.”
Plus the old favorite: “My regular doctor always gives me...”
This is one hint doctors rarely ignore. Prescribing useless antibiotics is almost the standard of practice; even good doctors do it.
Guest: “I try not to.”
This means “Yes” in answer to questions like: “Do you cheat on your diet, stick Q-tips in your ears, consume large amounts of alcohol, tranquilizers, salt, laxatives, or high cholesterol food?”
Guest: “I try.”
This means “No” when I ask if someone has obeyed instructions that are almost impossible to obey (take a pill every four hours, stick to an exercise program, ignore a crying baby)...
Guest: “Are you sure I need this?”
This means zero compliance unless I work hard to convince him to go along. Similar hints include:
“I don’t like to take medicine unless it’s absolutely necessary.”
“I’m sure it’s not broken.”
“My mother is allergic to this.”
“I have a sensitive stomach.”
Guest: “Everyone tells me what a great doctor you are, so I know you can help.”
This guest is preparing to ask for something I don’t want to give.