Sometimes, it order to avoid a costly and unnecessary work up, you have to have an intervention with a patient. Not a “stop drinking” or “stop cocaine” intervention, but a “you don’t need any more testing, you will get better on your own” one. I have a pretty good success rate with these but it comes at a price. You have to spend an inordinate amount of time doing it. The other day I convinced one family that mom did not need her second CT scan for her third visit in a month for benign positional vertigo. I had to spend 15 minutes explaining the disorder,the treatment, and most importantly, what her expectations for recovery should be (ie, it won’t get better instantly, even with antivert). I got backed up with other patients but felt good that I avoided another run of blood tests and head CT. Later the same shift I spent even more time telling a healthy young guy why he did not need another EKG, CT, and MRI, and or repeat blood work for his second episode of vasovagal syncope. Trying to explain the autonomic nervous system in a way that a lay person can understand can be challenging enough – but when they ask a hundred questions, before you know it, you are 5 more patients in the hole. Well, at least that was towards the end of my shift and the guy felt “educated” enough about the condition to use the term “micturition syncope” in dinner conversation. And, I saved his health plan a crap load of money!
Unless we want to go back to the days of “Yes, Doctor,” and the patient dazzled by the mysteries of medicine, I think patients needing their physician to spend a few minutes educating them about their condition is reasonable. What is not reasonable is insurance company policies and reimbursement rates that do not acknowledge that patients need their physician’s time as well as expertise, and that in the long run education is cost effective. We don’t need medical school, just a short course on whatever condition we happen to have.
Right. Define “few minutes”. I always give a few minutes of explanation but having to sit there for 15 -20 minutes is just unrealistic. Other people are backing up….
I get bppv. The last time it acted up, the PA fixed me by moving my head and body around and repositioned the crystals in my ear to the correct tube. I felt like I was going to fall off the table, and I had to sleep upright that night but it was much better. This has been over a year ago and it has not came back. I used to get it every couple of months. Are you aware of this procedure? No technology required and it works great!
Too bad there isn’t a ICD 9 code for “endless education of the worried well.
Appreciate you having the stones to do this rather than order that fifth MRI judt to SHUT. THEM. UP.
I agree that too many scans are performed; however, sometimes the patient is in a pinch. I get about once every few months,complex migraines, with ‘stroke’ symptoms. My HUGE HMO always sends me to E.R for a scan. I asked the PCP do I always have to go in for a scan (hate E.R’s not docs), he said yes. I find that this is not always wise. I now
will not say I am having those symptoms. But in the back of my mind I wonder if this is wise. How can I stay safe and
not have my HMO pay for the costly scans and visits? Sometimes a patient is in a catch 22.
And printing out some material on the condition in question does not help? Discharge instructions that are more in depth?
You and Nurse K should work together. I would want to work there too.
YES! A doctor who educates! I am impressed. It’s so frustrating to watch tests be reordered time and time again. I really appreciate a common sense doctor.
Good job. I try to do the same, with my “why you don’t need yet another MRI” talk.