Oct 5, 2009

Getting To Know Your Body (First Visits)

Now back to a question I only halfway answered before:

One thing I would like to see answered on your blog is, what do you do on a first visit? Especially if you're not sick?
On your first visit with Doctor D:
  • First, you and Doctor D size each other up. A doctor-patient relationship can be a complicated thing. You gotta know who you're working with. What is the doctoring style of the physician? What are your wants and needs as a patient? How will the relationship work? It is a lot like a first date. We may not be discussing it directly, but Doctor D and his patients are carefully listening and watching to figure out if we are compatible. If you have strong opinions about your care, you should probably let me know, especially if your expectations are out of the norm: "Doctor D, I want you to take care of me without using any medicines" or "I refuse all preventive care." This helps prevent misunderstandings later.
  • Second, we go over your medical history. This is when you tell Doctor D all the stuff that has happened to your body in the past. We talk about surgeries, pregnancies, illnesses, drug reactions, as well as any current diseases, symptoms, and medicines. For some of you this will be a short discussion but for those who have been through the ringer in the medical system this could take a while.
  • Third, we evaluate your risks. We talk about what might happen with your body in the future. Doctor D will ask about diseases your family members had. He'll ask about your habits (diet, drugs, exercise, sex life, etc.) and do a review of systems to look for symptoms you may not have noticed. Then we talk about how to either prevent diseases or catch them early. Any Primary Care doc who only treats what you have now without preventing future illness isn't doing their job correctly.
  • Finally, Doctor D takes a look at your body. I might find some hidden disease on this exam, but I usually don't. The real purpose is so Doctor D knows how your body looks, sounds, and feels when it isn't sick. Diseases change the body; to properly recognize these changes it helps to know how the body looked when well. You may say, "Come on doc, I feel and look great!" Doctor D also suffers from a delusion of physical perfection he developed as a cocky 19 year old, but the fact is that even healthy bodies still have lots of little quirks or abnormalities. If I see you for the first time when ill I might mistake one of these physical quirks for a new problem and misdiagnose you. Similarly I might assume some small abnormality has always been there when it's really an important clue to your problem.
A while back Doctor D was in the ER and a dude comes in with a runny nose and headache--pretty standard viral cold, except that one eye was much bigger than the other. This gets Doctor D thinking about tumors in the eye socket and other scary stuff.

Doctor D asks about the eye and the guy says he's never noticed any between his eyes. Uh-oh! Then Doctor D shows the dude his own face in a mirror and the man is like, "Which eye doc?"

WTF? How does someone totally not notice one eye is fricking huge compared to the other? We doctors are trained to notice physical weirdness you stopped paying attention to when your mom taught you not to stare, so maybe this dude never noticed his funny eye? So Doctor D calls the family from the waiting room and they say he looks normal. Dr. D points out the eye and they are all like, "Well, what do you know? It is bigger!" Nobody knows how long it's been this way.

Luckily somebody had a childhood picture of this dude, and D discovered one eye has always been bigger. Apparently this guy has had a odd eye his whole life and nobody noticed! Stuff like this happens more often than you think. A lot of times this dude would have gotten his head pumped full of radiation in a big workup just because he was born funny looking.

It is really important that you have a doctor that knows you and your body well. First visits take a while even if you are healthy, but they are really important so don't skip out on them.
Incidentally Doctor D has his first visit with his new Primary Care doctor next month. What is the weirdest thing that ever happened to you on a first doctor's visit? Doctor D would love to hear your stories in the comments.


The Good Cook said...

Having moved back to my home town after living for a few years in Florida I was looking for a new Primary Care Physician for my son and I... found one not far from my home. Went, Met, Left.
Turns out the Doctor was a "boy" I had gone to high school with. He said "gee, at last I get to see you with your clothes off - what I wouldn't have done for this opportunity in High School!"...

Uh.. not so much.
Nice guy. Just not the patient / doctor relationship I was looking for... how about you? Do you ever run into old classmates that now have you as the physician in charge? How do you handle it?

Gretchen said...

What I want to know about is not so much a first visit but about finding a doctor to schedule it with. Especially since the wait for a first visit can be months long (I just tried to schedule one with a doctor that had been recommended to me and was told that the next available one was in March 2010!) - what's the best way to find a doctor who will be a good fit on the first try?

Doctor D said...

Wow Cook! I think you would find that doctor's comment under the definition of unprofessional in the dictionary.

I've never cared for any old classmates. I have had to examine some people I knew socially. I always tried to keep it very professional. I once did a prostate exam on this guy I knew. I ran into him one day and he said, "Hey D, last time we met you stuck your finger in my ass!"

He said it, not me, but was kind of funny.

Doctor D said...

Gretchen, it is difficult to find the right doc when you are in an area with a Primary Care shortage.

I actually wrote a series of posts on finding a new doctor a while back. You can read them here.

Anonymous said...

Best first doctors apt. ever. I was sent to a pulmonologist, by another pulmonologist. The medical student takes my history, I realize he doesn't know what I have when he forgets to repeat what I have to the fellow. Then the fellow was like...you could have this or that...or that other thing. And I was like well, I have X. And he was like....what? So I explained to him my weird anatomy. And he was like....pause (for which I read madly wracking brain trying to remember from some textbook what I had)....and then he was like...but I can't do anything about that! Now it makes me laugh. Poor guy. Now I know how rare what I have is. If I can find an internist who doesn't cringe when I tell them what I have, I know I'm off to a good start. I guess I know a bit more now too. Really like your blog.

Anonymous said...

In reading the post and comments, I guess one should choose a primary doctor and make an appointment even when one is feeling fine just to establish a relationship. I've never done that. I'm one of those folks that wait until something happens and then seek medical attention for that particular issue. I was at work and my insurance company called me and asked me to make an appointment. I guess they noticed I had never made use of my insurance. They told me they would waive the co-pay. I just couldn't think of a good reason to make an appointment. I couldn't figure what I would say -- "hey doc, my insurance company asked me to come in" so here I am. The last time I went was a number of years ago and it was because my parrot walked across my face while I was laying down and he his toe scratched my cornea (though I didn't know that was the problem until I was seen). I ended up at urgent care because I didn't have a PCP and it hurt too much to wait (I had already waited about a week thinking it would go away before finally going in).

I'm at the age where stuff is probably going to start happening so I will have to come up with some reason to make an appointment with someone at some point.

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