Sometimes you are just too exhausted to tell them off, knowing fully well it is going to create another angry-patient-shouting-at-me day if I decided to exercise my authority in chasing out that relo from my consult room, so I can proceed just with the patient alone.
Here goes, True Story from 23rd March, just one day after the fiasco with ‘the-patient-who-heard-the-name-wrong’
A patient I’ve never seen before, Y.
She came in with X, whom she verified as her step-sister. Funny that after all that concern & seemingly so authoritative to demand to drill and grill me in regards to Y’s issues, X claims that she’s Y’s friend.
Yes, after some high strung statements and questions from X, when Y appeared more calm and accepting of what I was trying to convey, I just had to ask “Sorry, you are X’s?? Friend? Relative?”
Okay okay, let me start from the beginning…
My colleague had ordered some imaging that morning.
Y has returned for her results. And I was seeing her for the first time.
After I explained the result to her regarding her CT cervical (neck) spine, and tying it up with her presenting complaint that morning, I asked if she suffers from a few other relevant symptoms?
Y was answering me when X butted in (Oh how I hate it when they do that) :”Are you sure she doesn’t have cancer? Because someone I know did have spine cancer, and no doctors picked it. All those tests they did didn’t pick it up. Her problem was back pain too”.
X : Why then, does Y have pain in her middle and lower back too?
Me : Do you, Y? (scanning through her previous records, I couldn’t see anything about those)
Y : Lower back is an ongoing problem since I was pregnant. Mid back just started this morning.
X: She is a single mom of 5, always puts herself last. I can’t stand to see mothers in pain. Even when my own mom suffered from pain, it made me so sick till I was vomiting.
Even now, thinking of driving Y home and leaving her in pain, I feel I could get a panic attack.
On the topic of cancer, upon further history taking (which refers to all those questions your doctors ask you), no constitutional symptoms identified.
X : You should send her for tests to make sure she has no spine cancer. I think she might. She is in so much of pain. You need to give her something that will take away her pain.
Like…send her for the most thorough & accurate test.
I had to stop myself form rolling my eyes.
For the records, I’ve already extablished that Y doesn’t take any painkillers, hardly even Panadol or Nurofen, even though in severe pain. Exception was today when she took panadol just before coming in to see me. I’d already discussed about optimizing analgesics earlier – a discussion which has a lot of interjections from Y’s well-meaning step-sister!
Me: Look. Firstly, she needs to be taking her painkillers.
By right, we should do an Xray, and if needed, CT scan later on for the lower backache that hasn’t been investigated before. The mid back pain just began, most likely it is referred pain or muscular origin.
If you want MRI for whole spine, it isn’t bulk billed. If you are happy to pay, I will refer you. Bone scans are not routine.
X: S0, someone might be dying, and you can’t bulk bill the tests?
Me: Everyone might think they are dying for one reason or another. Does that mean you do head to toe tests for everybody?
Look, I don’t determine if imagings are bulk billed. The government and imaging centres do. If you want any specific tests you are happy to pay for, I’ll give you the referral.
For now, since you are very anxious, I’ll give you the best tests under bulk billing – CT scans, which are more specific to look at cut section of the bones.
And while I could have thrown her out of the room, using my authority as a doctor, as I found X distruptive to my consult with Y by being patronizing, I didn’t.
Instead I ended up ordering CTs for both thoracic and lumbosacral spine. The later was probably justified by intermittent lower backache which began during her pregnancies…but my action in ordering CT T-spine with 1 day history of mid backache, sigh….I am guilty of over-investigating.
But honestly, it was either that or paving my way into another ugly night ahead if the relo turned angry and aggressive.
And I was too exhausted from yesterday’s drama, accompanying insomnia & the busy day that it already was and still was going to be for the rest of the night. I already had one colleague who stayed an extra hour to help out with walk ins, and I was going to be the only one left for the next 2 hours till closing time…
This is the trouble when we have a generation with entitlement mentality.
God be with us to handle these kind of characters day in day out _/_ I’m glad there were none in the same vein tonight…Tak larat dah!
P.S : X is a young lady probably in late 20s.