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.
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.