Why is that “reassurance” (one of the most important things we do while treating a patient with a non-serious, self-limited condition) either works like a MIRACLE or is completely useless? The other day I had a uppity woman in her 20’s with chronic constipation (defined as a BM every 2-3 days instead of her ideal once per day) who despite having had several workups which have revealed nothing wrong (outpatient CT’s, colonoscopies, blood work, etc), somehow cannot accept that her body only sh**’s every few days!!!! Reassurance was futile and she left unsatisfied with her visit and I am sure will give us a crap (no pun intended) Press Ganey report.
A few hours later I had a very anxious Hispanic man in his 40’s with completely obvious non-cardiac,musculoskeletal chest pain. I did a basic work up - CXR, EKG, and Troponin and told him everything was normal. Naprosyn was prescribed. He was so happy that I don’t think he even would have cared if I did zero work up and just told him he was fine.
Si, Doctore, gracias!!!!!! was what he kept saying. I am sure he won’t get a Press Ganey report or won’t fill it in because he doesn’t understand it. Sigh.
Can everyone say, “bowel fixated?” I don’t like to stereotype but they seem to be major pains in the butt! Every pun intended.
People who want to feel well will do if given a reason. People who want to feel lousy (either because of depression, secondary gain or to help them escape responsibilities) don’t need a reason; anything you do to help them feel better won’t work.
“that medicine didn’t help at all” = nothing will help
“that medicine helped but gave me a dry mouth/made me sleepy/bumped my LFTs/whatever” = someone who wants to get better but is having trouble pulling it off
Did you give a scrip for Fiber One yogurt chock full of probiotics?
oh and Toni I think the term here is ANAL RETENTIVE
There is no such thing as a positive Press Ganey report. This is just as harmful an addiction as cocaine or heroin. the positive feeling after using is not a good thing. It only encourages the addict that the behavior is not self-destructive. The same is true of a positive JCAHO (TJC) review.
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