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Related: Culture Forums, Support ForumsMan, do I hate it when patients second-guess my diagnosis.
A guy came in yesterday with an open and shut case of bleeding hemorrhoids. Classic risk factors, classic presentation.
Nah, he said, I dont think its hemorrhoids.
Well, I responded, it could be a case of rectal polyps. Ill need to do a digital rectal exam to know more.
Ugh! No! I dont want that again!
Youre bleeding down there. I need to figure out why.
I had a colonoscopy five years ago, and they gave me a clean bill of health.
That was five years ago. A lot may have changed since then.
No. I dont want the exam.
I gave up. I ordered an occult blood test for him. I prescribed standard treatment for bleeding hemorrhoids. Its up to him if he wants to adhere to the treatment plan.
If his occult blood test is positive, Im going to refer him for a flexible sigmoidoscopy. But, man! Coming in for medical advice and then dismissing that advice out of hand seems like such a waste of ones time. It was sure a waste of my time.
madaboutharry
(40,212 posts)Those graduates think they know everything!
Aristus
(66,387 posts)But a quick glance at his problem list is pretty convincing evidence that this guy is not too keen on a healthy lifestyle and taking care of himself.
erronis
(15,303 posts)I don't mind the prep and procedure of a full colonoscopy (had my 4th). Nice to know that I'm as clean as a whistle (for now.)
Since you're opening up this can o'worms: Should I continue getting 3 or 5 year checks (late 70s and last one clean)? My family does have some history of CRC.
Aristus
(66,387 posts)with the result of your scope. Usually three, five, or ten years. Whichever they recommend unless adverse symptoms develop in the meantime.
CincyDem
(6,363 posts)erronis
(15,303 posts)S: You'll know when you've understood when you hear that loud popping sound.
R: What do you mean?
S: You'll hear that popping sound when you finally pull your head out of your ass.
Marcus IM
(2,209 posts)Irish_Dem
(47,131 posts)He is rejecting your diagnosis right off the bat.
He doesn't think the bleeding is caused by hemorrhoids.
I would have asked him what he thinks is causing the bleeding.
He seems to have something else in mind.
Then when you suggest doing some diagnostic testing he rejects that too.
I wonder why he came in. Did a family member insist?
Is he worried about cancer? But doesn't want to face it?
Sometimes to go fast, you have to slow down with a patient.
It was not a waste of your time because you got this patient to do an occult blood test
and then can refer him to a specialist. It is going to be harder for him to argue
with a specialist who has a lab report in hand.
Humans are complicated creatures and sometimes you just have to meet them where
they are.
DJ Porkchop
(452 posts)multigraincracker
(32,688 posts)She has these nice long thin fingers.
getagrip_already
(14,764 posts)And is on a course of bleach and horse laxatives.
So the rw chat groups have already diagnosed him
3catwoman3
(24,007 posts)
history of asthma and allergies. As I recall, I got about as far as saying hello before his mother, a very stern looking woman with quite a sourpuss expression, said, quite emphatically, He wont use an inhaler, and he wont take any nasal sprays.
I replied, gently, Well, thats not going to leave me much to offer you, is it?
What I wished I could have said was, Then why the hell are you here?
Aristus
(66,387 posts)I wish you could have had the satisfaction of telling her what you really wanted to say.
Ive told my new employers that I dont see pediatric patients. It might affect my productivity numbers, but I dont care. Bitchy, self-important, anti-vaxx parents, I can do without.