The more I go through this rotation, the more I realize that primary care is not for me. I am tired of being everyone’s mother. Half of this stuff is common sense. Low back pain? So sit up straight. Trying to lose weight? Take the stairs. If you want to show me the gross fungus on your toenail, don’t paint them before coming into clinic.
Sure, there are legit issues to sort out, like the kid with a history of hydrocephalus treated pharmacologically (??) who now has chronic headaches after Valsalva. We sent him for a head CT, and I want follow-up, but he won’t be back until after I leave. He’s the exception. Most headaches I’ve seen are due to eyestrain. Why are you reading in poor light? Do you want to go blind? (I told you, I’m turning into everybody’s mother.)
Today, there were a lot of doorknob questions. You know the type. History taken, physical done, assessment and plan formulated in your head, about to go present to the resident/attending. And when your hand is on the doorknob and the words “Voy a hablar con la doctora y regresamos pronto” on your lips, the patient goes,
“Doctora, una pregunta.”
It’s never una sola pregunta. It’s several. Once, I had a history of depression come out of nowhere. (I admit, I don’t generally ask psych symptoms on the review of systems, unless I suspect or there is known psych history — so that one was my fault.) Point is, the doorknob questions are the worst, because they are almost always serious. And they set you back ten, fifteen, twenty minutes. And then your next patient, having waited an hour to see the doctor, wants to take an hour themselves to discuss their chest pain, shortness of breath, and leg edema (oh, three cheers for heart failure!)
I don’t know what to do about these patients. I don’t want to blow them off, because often the doorknob issues warrant attention, sometimes even changing the differential, but at the same time, I cannot spend 45 minutes with each patient — it’s not fair to everyone else, and I’d never leave clinic. Tough call.