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Thursday, December 1, 2011

Stressful and Nonstressful Visits

I usually feel good when I finish caring for a patient, but driving to a hotel before a visit can be stressful. I talk to guests by phone beforehand, eliminating obvious emergencies and unreasonable requests, but plenty of worrisome possibilities remain.

Sick infants make some hotel doctors nervous. I see them but some don’t. If, over the phone, the doctor tells you to take your baby to an emergency room, ask politely if he prefers not to see infants. If he admits this is so, you might try to find another hotel doctor before going off (see the appendix).

Elderly patients can be challenging. They seem fragile, so a doctor may lean over backwards to treat illnesses that don’t require treatment or refer to a hospital more quickly than he would a younger person. I consider age eighty the beginning of fragility; other doctors begin at seventy, but this is clearly wrong because I am over seventy and not fragile at all.

If a patient has a bellyache, I’m never relaxed as I drive. Without tests or x-rays I have to decide whether or not it’s safe to wait. When I decide it’s safe, I’m almost always right, but I send guests to emergency rooms if some uncertainty remains. Many endure a long, tedious expensive experience only to learn that nothing abnormal has turned up. Some consider this good news, but others wonder why, having summoned me and paid my fee, I didn’t save them the trouble.

I’m always uneasy before seeing guests suffering a cold or other ordinary respiratory infection because a large percentage – perhaps a quarter – are obviously disappointed if I don’t prescribe an antibiotic. You don’t realize how bad we feel when a patient believes we haven’t helped. To avoid this, most doctors (yes, most) prescribe a useless antibiotic, but I don’t, so I approach these visits knowing I might leave feeling depressed.

On the bright side, I often drive off knowing the diagnosis, knowing I'll help, and certain the guest will deliver a satisfying dose of gratitude. Relaxing drives include those for simple urine infections, eye infections, ear infections, and rashes. I’m rarely concerned if a guest suffers vomiting or diarrhea, even in the presence of abdominal pain, because this usually indicates a short-lived stomach virus. Guests who want their blood pressure checked rarely worry me. High blood pressure doesn’t cause symptoms, so those who make this request have other problems, generally anxiety-related. This usually becomes clear during the phone call, but it’s risky to assume a complaint is purely emotional without an exam, and I do well reassuring anxious patients.

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