For The 20th Time, Dang It!

If you’ve ever been to the doctor then you probably know what it’s like to be asked the same question twenty times. 

-What brings you in today?

-How did that happen?

-What medications are you taking?

-What allergies do you have? 

-Do you drink?

-How much?

-Do you smoke?

-Do you take any illicit drugs?

-Are you sure? *looks down at urine test results*

-No, I’m not a cop or your pastor. That’s not my job, I just want to know what’s in your body so that I don’t give you something that will hurt you. 

-Riiiiiight. 🤨 Well, moving on…

Are you tired of answering these questions again and again? You’re not alone. But there’s a method to our madness. 

Here’s a scenario I experience more often than I’d like:

Me: Hi, Mr. Fiddlesticks, what brings you in today?

Mr. Fiddlesticks: I already told the nurse. 

Me: Correct, I understand your pinky toe is bothering you. What’s going on with it specifically? I’d like to help you with it.

Mr. Fiddlesticks: It’s all in the chart. Just do your job and read it.

Me: You’re right; however, I prefer to hear about it straight from you rather than hear someone else’s interpretation of your problem. 

Mr. Fiddlesticks: …

Me: … your toe?

Mr. Fiddlesticks: …BIG ANNOYED SIGH…

So this happens, and I get it. When you called to make the appointment, they asked you what was going on. Then, when you showed up at the front desk they asked you what you were here for and asked you to fill out some paperwork with similar questions. Once you were called back, the nurse asked you AGAIN about what was happening. Then, while you were waiting for the doctor perhaps a technician came in to run a test or gather bloodwork and asked those same questions again. And FINALLY, when the doctor comes in, they have the nerve to ask all those same questions again! Haven’t they been paying attention? Has no one been communicating behind the scenes? At this point you’re just tired of explaining things for the twentieth time. Surely there’s a better way than us asking you the same exact questions over and over again, right?

Well, you guessed it. Yes and no. Yes, if we’re simply trying to hear you tell a story. No, if we’re trying to diagnose a problem. Here are five reasons why this happens when you go to see your doctor. 

#1 Small Talk

I’d be lying if I didn’t admit that some of it is simply small talk. The staff simply wants to make you feel cared for and, if they can, to help bear your burdens. Sometimes simply asking about your day and the reason you’re there allows them to talk to you about it, sympathize with you, and hopefully cheer you on and encourage you through it while they go through boring or painful processes like taking your vitals or drawing blood.  

#2 Triage

Each person you talk to has a specific job and is looking for specific information. Therefore, they are asking specific questions to get that information from you. Even though they may sound like the same questions, there may be subtle differences in they way they ask the questions depending on the actual information they are attempting to gather from you.

For example, the person scheduling your appointment is trying to quickly decide whether to give you a 15, 20, 30, or 45 minute appointment. The person checking you in is making sure all of your information is up to date, well organized, and alerting the rest of the staff that you have arrived. Then the medical assistant or nurse is reviewing your entire case, preparing relevant information, taking vital signs and/or other relevant tests, and generally making sure everything is ready to go when the doctor comes around to see you in order to maximize efficiency. 

#3 The referral info is illegible, bloated, or just missing.

This could be an entire post in itself, but I’ll summarize. I work in a specialty, so I get this all the time: “It’s all in Dr. So-and-So’s (referring doctor) chart. Just read that.” There are many issues with that response but I’ll leave it alone for now. 🙂 But I will mention this…

This is often how referrals work, unfortunately: information gets filled out on a paper form, scanned into your electronic medical record, then printed from your chart, faxed to another office, then that fax is scanned into a new electronic medical record that is entirely separate. So effectively, your referral is filled out on paper, scanned in, printed out, scanned in, faxed, printed out, then scanned in again. By the time that’s all done, sometimes it’s so blurry we can’t read it. So I just have to ask you what’s going on. 

Also, as you can imagine, with all that scanning and printing sometimes things get lost to the shred box before they ever make it to me. 

And finally, sometimes that referral that consists of “relevant” information is bloated with a bunch of irrelevant information like insurance information, copies of driver’s license, etc. I don’t have time to sort through 67 pages to find the single page (true story) with relevant information, so I simply will ask you to tell me what brings you in. Sometimes it’s much more efficient to just talk to you, the patient. Because ultimately, I’m treating you and not the medical chart. 🙂

The world of medical records is surprisingly antiquated. Yes, it’s all electronic now (sort of) but that doesn’t mean it’s all connected. You should never assume your doctor/PA/NP has access to any of your past medical charts. Even though you have online access to things like “MyChart” that doesn’t mean we do. I know, it sounds ridiculous. Like I said, another blog for another day.

#4 Stories change over time.

Sometimes the more a person tells their story, the more pertinent information they remember. It’s not uncommon for me to hear things like “Oh, I forgot to tell the nurse earlier that….” Sometimes patients then go on to tell me about some specific detail that is actually very relevant and helpful. That “little detail” can even change the course of your care/treatment. If you hadn’t had to repeat yourself and if I failed to draw that information out from you, we might not be as close to a solution.

Also, if I’m frank, sometimes patients are just making things up as they go. Having patients retell their story multiple times can make this more obvious as significant details keep changing each time they tell it. This is only one of multiple ways we can generally tell if you’re not telling us the whole truth. Unfortunately, there are times when patients do this for bad reasons. To those patients, we see you. 😑 Your doctor may or may not let on that they know you’re being dishonest, but they know. And they’re disappointed in you….

However, I also try to extend grace to patients whenever possible. More than just trying to catch you in a lie, I want to try and figure out your motivation for doing so. Because, if I’m honest, there a few examples in which I can sympathize or be understanding of dishonesty. Perhaps you’re simply embarrassed to speak to anyone else but the actual doctor/PA/NP about a personal matter, so you lied to the staff about why you’re here, or at least you didn’t tell them the whole truth. I don’t recommend that approach, but ok, I get it. Also, is there something underlying that I can sniff out if I pay closer attention to your story? Maybe underlying depression or a case of abuse? If I can pick up on that, that’s more important to me than just calling you out on your dishonesty. 

#5 The Art of Medicine 

Your doctor/PA/NP is specifically trained and experienced in drawing out specific details from you and your story that will not only help reach a diagnosis but also increase the accuracy of that diagnosis. They very well may be able to pick up on small details that you do or say that will mean a lot to them in helping you figure out what’s happening. The team members helping you before may not have picked up on those subtle things and therefore could not have relayed that information to the clinician. Despite how it’s often portrayed, there really is an “artistic” side to medical practice. Part of that is in our social interaction with you, the patient. So sometimes that means we want to hear you tell your story to us directly, in person, and yes, for the fifth time already. 🙂

Learn More, Stay Humble