Tuesday, May 8, 2012

You Can't Make a Diagnosis Over the Phone

“Of course, you can’t make a diagnosis over the phone,” guests tell me.

But I can. Doctors do it all the time. I’d estimate my accuracy at ninety percent. It may be one hundred percent for some problems: respiratory infections, urine infections, backaches, many rashes, injuries, anxiety attacks. Driving to the hotel, it’s relaxing to know in advance that the guest has chicken pox, gout, herpes, a bladder infection, an acid stomach, or the flu. I can deliver my diagnosis, advice, and medication, collect my money and thanks, and drive home. What an easy job!

Jumping to conclusions is a major reason doctors get into trouble, but this is less of a problem when I make a housecall. A guest may announce that he’s having an allergic reaction and then describe symptoms that don’t quite fit. An examination will provide better information. 

Phone consultations require caution. If a fifty year-old describes chest pain that doesn’t sound like a heart attack, it’s unlikely I’ll tell him that it’s OK to wait. It’s also unlikely that I’ll make a housecall because an examination rarely helps, and I hate collecting a fee and then telling a guest to go somewhere else and pay another fee. On the other hand, chest pain in a twenty year-old is almost never a serious matter.

Abdominal pain is tricky at any age. Guests suggest gas, indigestion, and constipation. I worry about a dozen conditions that require a surgeon’s urgent attention. Oddly, it’s reassuring when vomiting or diarrhea accompanies the pain. Provided the guest is in good health, it’s usually a short-lived stomach virus, among my most frequent reasons for a housecall. Without vomiting or diarrhea, I’m likely to suggest a clinic visit where a doctor can get more information than a housecall provides.

"I know it's not broken because...." You don't know. Neither do I.

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