Huge clinical pet peeve: Not adhering to your treatment, but coming back to the clinic anyway.

[Aristus]

Patient: "My back is still hurting."

Me: "At your last appointment, I wrote you a prescription for the pain, and referred you to physical therapy. Did you fill your prescription and make an appointment for a physical therapy consult?"

Patient: "Well, no..."

Me (in my head only) : "Did you think the pain would magically get better just by showing up to the clinic again?



It's a waste of clinic time...

This happens way more often that you would believe...

[Siwsan]

1. Went through that with my mom

After dad died, she just got angry. She needed counseling and probably some mood leveling medication but she refused. She actually told her doctor, right in front of my sister, "I know I'm making my kid's lives a living hell but I don't care." I wouldn't say she made our lives HELL but she sure as hell frustrated us to the edge of reason, at times.

[Emile]

2. Is there a way of checking if the patient had the prescription

filled? I recommend an inversion table for lower back pain. Hanging upside-down for a few minutes takes all the pressure off of swollen discs.

[Aristus]

3. Sure, that's easy to confirm or rule out.

But when the patient says he hasn't filled his prescription, I take him at his word. My thing is: why are you not doing the things I advised that would make you better?

[Emile]

4. No kidding! What's the point of even going to a doctor

if you are not going to follow advice on how to get well.

[CrispyQ]

7. Maybe just to find out what's wrong.

Some may, for whatever reason, try to get better on their own. Money is one HUGE factor I could see for that. I was stunned how little my "silver" insurance plan paid for medical tests. Sure the doctor's visits are practically free, but I only see the doctor occasionally, & of course she prescribes all these tests, which isn't surprising if that's the kind of markup they have. Who knows what the markup is on meds. Our "healthcare" system is so fucked up it's almost unbelievable.

Also, not everyone has a desire to get better.

[femmedem]

8. Maybe a good question would be a gentle, "What prevented you from filling the prescription

and consulting with a physical therapist?"

The person might have obstacles related to money, transportation, mental health, scheduling or just confusion or fear. It isn't a lack of trust in you or the patient wouldn't have returned to you.

Perhaps the patient needs to connect with social services?

[Aristus]

9. A lot of my patients are homeless, so I'm usually acquainted with barriers to care.

All the things you mentioned, money, transportation, etc. My team helps them overcome these barriers so they can get the help they need. The example patient in the OP was a mainstream patient with no such barriers. Although the reply above about not wanting to get better is certainly valid.

[Unca Jim]

13. AMEN!

Though I'm sure there is plenty of obstinate stupidity out there, it ca be hard to get the help you need.

[mitch96]

12. Just tell him he will be incontenent of urine and feces if he does not get the right treatment.

Then his penis will fall off... If that does not work, he's a lost cause...
m

[Phoenix61]

5. I worked as a mental health therapist for years.

Treatment almost always involved homework.

Me - So, how’d the homework go.
Them- well… I was busy, tired, work, job…
The homework might have been something as simple as taking 5 diaphragmatic breaths an hour. But nooooo and it’s not like they weren’t breathing anyway, right?
I feel your pain.

[AllaN01Bear]

6. medical pet peive . when back is fused and " nothing cant be done and drs wont listen.

ive had to force drs to listen to me over the years and it is a pain in the butt esp when they feel they know more than the patient who has been living with this condition for years .

[Aristus]

10. Sounds like you've had more than one provider say: "Well, you'll just have to live with it."

I've never told one of my patients that. There's always someplace to refer them, some kind of intervention we can try. It's just frustrating when the patient doesn't follow through.

[WhiteTara]

11. you can prescribe all day

and if the patient doesn't follow the script, it's misery for everyone. Have you thought of saying, when you have taken the medicine and done the work for one week, call me and we'll fit you in.?

[MyOwnPeace]

14. Aristus - you are to be commended......

You are showing the 'patience of Job' - and actually caring about those that you serve (and the obvious understanding that "you serve" is also commendable!) - venting your 'frustration' with a pack of progressive "Lib-tards" - you are on your way to Sainthood!
Looking over the responses posted so far you continue to show your progressive mindset - you're still fighting and not ready to throw up your hands and say - well, whatever one opts to say when they're "Mad as hell and not gonna' take it anymore!"
We need more people in government that have your commitment, compassion, and understanding.
Don't let the 'pet peeves' do you in - we're with you, friend!

[Aristus]

19. Thank you for your kind words.

I appreciate it.



Pet peeves exist in any profession, but the truth is, I love most of my patients, and am not shy about saying so.

[NNadir]

15. My physician prescribed physical therapy for my bursitis.

I went for it and the pain subsided. When the therapy sessions were done and I was feeling great, the therapist said, "keep up with the exercises you did here, and you won't be in pain."

My hip hurts.

I'm a lousy patient but I know it's my own fault.

[3catwoman3]

16. Many years ago, I walked into an exam room to see a teenage boy...

…who had his mom with him. The first thing I noticed was a very sour expression on her face.

I think I got about as far as saying ,”Hello,” when she immediately and sternly announced, “He won’t use an inhaler, and he won’t take any nasal sprays.”

I responded, “Well, that’s not going to leave me much to offer you, is it?”

My brain was saying, “So then why the hell are you here?”

[momta]

17. I've had the opposite problem.

In college I went to an ENT several times for what he kept diagnosing as a sinus infection. Every time (over one semester, about five times) he would prescribe antibiotics. The last time I told him, "I'm not going to fill this prescription. I think I need to have my tonsils removed."

He said, "Well, if you're not going to follow my advice..."

So I stopped going to him.

Over the summer I went to a doc in my hometown. The instant I opened my mouth he said, "Yeah, those need to come out."

Tonsils out. No more infection.

Patients can be stupid. So can doctors.

[Aristus]

18. There is almost no worse clinical practice than throwing antibiotics at every patient who

walks in the door. He sounds lazy and incurious. Two traits you definitely don't want in a medical provider. I'm glad your hometown doctor knew his stuff.

[Pepsidog]

20. My son just graduated Med school this week. Starts orthopedic surgery residency in June. His current

attitude is if the patient doesn’t listen and go to treatment or take meds then oh well I can’t be bothered with wasting my time. As an attorney, I deal with many people who don’t follow my advice whether it be showing up to probation or staying out of trouble. I tell my son when he has his own patients I hope he will have a little more empathy because many times other things, barriers as you said, that cause people to not do what you tell them. I stress that he can’t just give up on people. His gf is a social worker and agrees with me. At graduation my son was recognized by his peers for his “Humanism” and I joke he should give the award back. I’m sure as he gets his butt kicked the next 5 years in residency he will recognize that some people need more help to overcome obstacles that they perceive prevent them from getting better. I want him to become the best ortho surgeon he can be but I guess at some point if a patient refuses to comply with treatment there is only so much as a doctor you can do especially with Hippa looking over your shoulder.

[Aristus]

21. Congratulations to your son.

He's in for a hell of a ride in residency.

I did a rotation in orthopedic surgery when I was in PA School. My precepting physician was quite possibly the most intelligent person I have ever met. I mean, he was scary smart! Not the warmest person on the planet, but not a robot, either. He was able to establish good relationships with his patients. His hobby, believe it or not, was CAD design of custom surgical instruments. He was a little intimidating to be around. But I learned a lot from him. Including the fact that the first thing an orthopedist almost always does after visiting with a new patient is refer for physical therapy. That helps me out in my clinical practice.

[Pepsidog]

22. Thank you. We are very proud of him.