Thanking The Doctor, Not The Chart

Part 4 of How to Thank A Doctor:

"How do I avoid my thank you note being scanned into my medical records?"

Doctor D recently got an email from a patient who was horrified to find that a thank you note she wrote her doctor had been filed in her chart. WTF? Why the heck would a doctor stick a personal display of gratitude in the chart with a bunch of lab results?

Yes, we doctors are kind of obsessive about our records. The record is supposed to log every interaction we have with our patients. Most docs don't count a thank you note as a medical encounter, but some docs are just going to err on the side of being anal and put anything in there. (It's not our fault that we are meticulous about records. We live in constant fear of lawyers who are out to use medical records to destroy us.)

One question you may want to ask yourself:
Is is so bad to have your thank you note on the medical chart?

It may be odd, but it usually isn't a real problem? Unless your note is creepy, having a note on the chart makes you look like an awesome person to anyone who sees the chart later.

But if you are a private person who doesn't like your feelings being preserved in a permanent record there are a few strategies you can use to keep that Hallmark card out of your chart:

• 1) Don't mention details of your treatment or symptoms: Just stick with your feelings of gratitude. If you say, "Thank you so much doctor, but I just wanted you to know that since my treatment I've had this funny tingling in my fingers..." then you have just asked about your medical symptoms and therefore an MD is legally bound to keep record of these symptoms—usually by scanning the entire note into the chart. Keeping off the medical stuff will avoid forcing your doctor's hand on this.

• 2) Ask to keep it off your chart: Most doctors want to respect your wishes. If you say "don't file it" then as long as it isn't very medical in nature we will try to leave it out of the chart. Of course, there are some anal doctors that just can't help but stick everything in the chart, and for those doctors there is always option #3.

• 3) Ask the doc, "If I send you a thank you card will it end up in my chart?" If doc says "Yes" and you feel strongly about your card not entering the record, then express your thanks verbally. Despite what the gift card industry would have you believe, you can sometimes say it just as well without a card.

• 4) Say "Thank You" with an interpretive dance. There is absolutely no way to enter dancing into the medical record! On second thought, don't do that—it might come across as creepy.

Have you ever been frustrated to find you doctor charting personal communications that you felt shouldn't be in the medical record? Have any of you health professionals felt like you had to file a thank you?

As always Doctor D loves to hear your thoughts and stories in the comments!

Delayed Gratitude

Lots of people thank their doctor, but if you are reading this series chances are you're aiming to up your game and make your gratitude stand out from the rest.

So Doctor D is going to let you in on a little secret for how to thank your way into a doctor's heart:

The biggest factor in gratitude magnitude has nothing to do with the thoughtfulness of a gift or the wording of a note.

The most important factor for impact of a "Thank You" is how much time has passed.

Everybody says thank you right after a doctor does something for them. It is the socially appropriate way to end an interaction. We even thank people that we really don't like just because it is a social norm. While there isn't anything wrong with ending a visit with a heartfelt "Thank You," it won't really stand out in a doctor's mind.

...but thanking a doc the next time you see them shows it mattered to you enough to bring it back up. When this happens Doctor D thinks "Wow, that is so nice of them to remember that from the last time I saw them!" This just makes doctors feel good.

But the real grand slam of gratitude is to express thanks many months or even years after a doc did something good for you. Most patients never do this, even if the doc totally saved their life. It's just human nature—we get caught up in the stresses of life and forget.

When out of the blue a patient writes a note or says at a visit, "Hey Doc, remember when you did this for me? I just wanted to thank you and let you know that it meant a lot to me," that patient instantly becomes Doctor D's favorite. (Extra points are awarded if the doc doesn't even recall the good thing they did for you! Your remembering guarantees your doctor will never forget you or anything about you again.)

It's just human nature, we all feel appreciated when people bring up our good qualities we've displayed in the past.

As an extra bonus Doctor D will point out that delayed gratitude works with everyone in your life—not just doctors. So go out and thank some people for things they did for you long ago! You'll suddenly become the most popular person around.

Doctor D would love to hear your stories about how you surprised someone with a delayed thanks, but he's a bit bummed that his patients aren't half as cool in how they thank MDs as the readers of this blog.

Okay, enough of a pity party. Doctor D really needs to go out and thank all the people that did cool things for him years ago!

How NOT To Thank A Doctor!

Last post I said there's really no wrong way to thank a doctor. While that is usually the case there is one very wrong way to thank a doctor...

Doctor D's number one rule for thanking doctors:
Don't be creepy!

The only way that you can mess up a thank you is to make it creepy. And by creepy I mean very, very inappropriate. Most patients don't need to worry about coming across this way because they have no twisted ulterior motives. I don't think anyone could be this creepy by accident:

• Showing up at Doctor D's doorstep at 1:00 am to thank him.

Stalkerish and not cool.

• Saying, "Okay Doctor D, now that you've saved my life I am bound to be your personal slave for life!"

It might have been okay if the patient was joking, but when said seriously it's just a little too much gratitude for Doctor D to handle!

• Telling Doctor D how awesome he is right before you ask for a prescription for high-dose narcotics.

Maybe the gratitude was heart-felt, but when combined with a request for controlled substances Doctor D can't help but suspect he's being manipulated.

• Making a very obvious attempt to feel up Doctor D while thanking him.

Yeah that got her discharged from the practice, and it almost got her an ass-whoopin' from Lady D!

Now most of the patients that read this blog don't have that psycho-killer vibe and therefore expressing gratitude like this never occurred to you. But if you do happen to be a bit on the creepy side a good rule of thumb to remember: if an action has ever gotten you a restraining order it probably isn't a good way to thank your doctor.

So "No Creepiness" is the only absolute don't of Doctor-thanking that D can think of. Does anybody know anymore no-no's for thanking doctors? Anyone have great stories about creepy gratitude?

Doctor D will be back soon with some tips on the right way to thank an MD in your life!

How Should I Thank My Doctor?

Believe it or not, this is the most common question that Doctor D gets in his email!

I must admit I hadn't posted a response yet because the answer seemed kind of obvious: Your parents taught you how to say "thank you" when you were a baby. It should be fairly straightforward at this stage of your life. If you are grateful to your doctor tell him or her "thanks" and doc will have a better day because of you.

But as more "How do I thank my doctor?" emails poured in I had to rethink situation. I'd been thinking from the doctor side of the equation, but from the patient perspective expressing gratitude may be more daunting.

Doctors are intimidating. We hold life and death in our hands with a god-like power! Our lives are always exciting and sexy, as anyone who watches prime-time doctor dramas can tell you. MDs are so intelligent and knowledgeable that we cannot help but act like jerks to our inferiors! We are so universally admired and appreciated that your expression of thanks had better be impressive or we will scoff at you.

As a physician, Doctor D can personally assure you that all of that is BS! We only put up that ridiculous front because it helps us handle a stressful and scary job where people expect the world of us. Trust me, doctors are normal people: we always love it when people thank us for a job well done.

I had the son of a patient find me the other day, "Doctor D, I just wanted to thank you for saving mom's life." Did I save his mom? Maybe. I just did what any doctor would have done in the situation. But thanks to his gratitude Doctor D was had a spring in his step for the rest of the day. Everybody likes to be thanked.

So if you want to thank a doctor, go for it! Say it, write it in a card, bake cookies, whatever. Trust me, your doctor will be thrilled any way you say it.

Since everyone seems to want detailed strategies Doctor D will start a series of several posts on dos and don'ts of doctor-thanking so all my readers can tap into the intricacies of thanking MDs!

You're welcome!

Did you ever try to thank a doctor and have it just flop terribly or complicate your doctor-patient relationship? Doctor D always loves to hear your stories in the comments!

Part 2: How NOT To Thank A Doctor

Part 3: Delayed Gratitude

Part 4: Thank the Doctor, Not the Chart

Part 5: Why Are Cheap Gifts The Best?

Part 6: Spreading the Love

The Cure For Doctor Addiction!

Last week Doctor D told you about the dangers of doctor addiction. Today he's going to give you a twelve (actually 5) step program to save junkies!

Doctor Junkies feel an irresistible compulsion to see an MD every time they feel any physical discomfort form their bodies, resulting in risky tests and medicines as well as financial ruin for junkies and the healthcare system. While some responsibility for the problem rests with the junkies themselves, a lot of the blame for this can be laid on doctors who can be dealers and enablers for this deadly addiction.

Doctors are aware of the junkies in their lives. If you hang out with doctors (or read their blogs) you hear them complaining about junkies hitting them up for unnecessary care. "This patient of mine called an ambulance for a stubbed toe!" We gripe about our junkies, but we don't often propose solutions to improve the system that created this problem.

Well, today Doctor D is going to change that!

Doctors must take action to stop this madness before it gets out of control!

Here is Doctor D's plan to deliver our patients from the sad bondage of addiction to unnecessary medical care and lead them to the promised land of wellness!

1) Preach the Natural Healing Power of the Body.

Here's a big secret we don't often tell patients: the human body has an almost magical power to cure itself when infected and heal itself when injured! Who knew? In fact, before modern medicine this secret self-healing power of the body was the only thing that cured sick humans, and believe-it-or-not the human race survived. Modern patients and modern doctors often forget the human body has the ability to heal itself. Doctors are trained to intervene in the rare situations when body's own self-healing fails, but before long we find ourselves intervening when the body is doing a fine job on it's own because we only thing of medical cures not the body's own self-healing.

Doctors need to be spokespeople for the body's own immune system! We should spread the word about the body's abilities. We must acknowledge that even in our "medical miracles" the body does most of the healing on its own.

If MDs preach the amazing healing ability of the body, doctor-junkies will believe their body can handle that runny nose a few days without running to a doctor.

2) Grow a Pair and Don't Piss Your Scrubs at the Mention of Lawyers!

Most docs could easily educate patients on what symptoms usually aren't serious. Heck, we could give you a handout of all the symptoms that don't require a doctors visit if they are short lived: runny noses, coughs, joint aches, low-grade fevers, diarrhea, feeling yucky, etc. We could alleviate your anxiety with one therapeutic dose of knowledge.

Why don't we?

Doctors are terrified the information we give out will be used against us by blood-sucking lawyers.

We won't tell you to stay home with that runny nose because a nasal drainage could also be a symptom of a one in a million cerebrospinal fluid leak. We get terrified of missing zebras, so we kill a lot of horses. Fear of missing a rare diagnosis drives MDs to do irrational and dangerous things. We whip up doctor-junkies into a panic over their harmless symptoms and send them like lemmings over the cliff of over-doctoring.

Medicine is about taking risks. We risk your life every time we write a prescription or order a test. We should also be willing to take a risk by not doctoring conditions that are likely benign. There is risk either way, over-treatment protects us from lawyers, so physicians kill lots of doctor-junkies every year with big work-ups that are solely done to satisfy lawyers. Since we take risks either way, then we should practice with common sense and share our reassuring knowledge that most mild symptoms aren't dangerous with patients.

If blood-sucking lawyers want to sue me for using common sense, fine! Bring it on, bitches! Doctor D is ready!

3) Believe in prevention

Proper primary care can often prevent illness or catch it before it becomes serious. Fighting disease is only a secondary goal of medicine. Preventing serious illness is the real goal of primary care.

What does this have to do with doctor-junkies?

Doctor D has noticed a pattern that the MDs that give out the most unnecessary care to doctor-junkies are the same ones that suck at keeping their patients up to date on their preventive care. Coincidence? Nope.

Dangerous Doctorphilia is a need for the reassurance of receiving medical care. Preventative care fills this need in the safest possible way. Preventative care recommendations are constantly evaluated to insure their benefits far outweigh their risks. Appropriate preventative care and regular physicals can rehabilitate a former junkie. Their body has been checked for and vaccinated against most common problems. With prevention in their lives patients can have the confidence to weather minor symptoms without running to the ER.

4) Talk About the Risks of Medical Care.

Most patients don't realize that even appropriate medical care can be dangerous. Doctor-junkies love pills, and tests, and X-rays. The more the better! I've had junkies accuse me of trying to deny them the good stuff they are due when I'm just trying to protect them. "Order more, doc. I've got insurance!" WTF?

The best time to educate patients is when we are do appropriate interventions.

Many people at some point in their lives get a serious illness that requires aggressive care. If the power modern medicine helped their serious illness, they assume the same weapon should be used on their minor symptoms.

So, Doctor D actually educates people about the risks of care when he is giving it appropriately, "Antibiotic have some very real risks and I wouldn't give them if I didn't think your infection was serious." A word like this can save a patient from the frustrating and dangerous life of a doctor-addict who will beg for antibiotics every time they get a cold.

5) Educate Fearlessly!

Ultimately the cure for doctor-addiction is education. Instead of laughing at doctor-junkies' errors MDs should show them the light. Most doctor-junkies aren't stupid or irrational, they are just misguided about the proper use of medical care. It will take time and a bit of risk for doctors to show junkies a better way, but it is worth it.

After all, they are our junkies. Who is going to help them if not for doctors?

What do you think? Do you think this plan could will stem the tide of doctor-addiction? Have you ever had a doctor educate you on the power of your immune system or the risks of medical care? Did it help you avoid unnecessary medical care later?

As always Doctor D loves to hear your thoughts in the comments!

Doctored to Death?

What is a Doctor Junkie?

A commenter on the Medical Mafia post brought up the subject of doctor-junkies, and readers seemed fascinated by the idea.

Yes, doctor-junkies are real and they are everywhere!

Just as Doctorphobia is hazardous to your health, Doctorphilia can be equally disastrous.

Any regular reader of AskAnMD is aware that while MDs are useful, we can also be dangerous. An addiction to doctor-visiting will lead to lots of risky tests and medicines you don't need. Too much doctoring can take you to an early grave and make you miserable on your way there.

Who are these Doctor-Junkies?

Doctor-Junkie: (n) -a person who believes that every uncomfortable or unusual physical sensation must be evaluated by a doctor.

While most hypochondriacs are doctor-junkies, not all junkies are hypochondriacs. Some doctor-junkies aren't paranoid they have a horrible illness, but just feel every little thing must be "checked out."

Dangerous Doctorphilia is often an inherited condition. Doctor-junkies start out as those kids whose parents rush them to a doctor every time they sneeze or scrape their knee:

Once a mother brought her child to Doctor D's ER because the toddler had made an especially loud sigh. "A sigh?" I asked. "Yes, like this" and she made a sighing sound "so I just wanted you to check his lungs." Doctor D assured mom that we all sigh on a regular basis, but perhaps this sigh was louder because of her child's frustration that he had a mother with nothing better to do than gauge the volume of his sighs. She demanded a Chest X-ray just to make sure. Then Doctor D let out a loud sigh of his own.

You would think after a childhood spent in ER and clinic waiting rooms that someone would want to escape the world of needles and medicines, but the junkie is hooked by the time they reach adulthood. Any runny nose or sore muscle and the doctor-junkie gets that overpowering urge to visit somebody in a white coat quick. The doctor-junkie isn't satisfied with just an exam and reassurance, "No doc, I've been waiting a long time to see you so give me the good stuff—lab tests, X-rays, and lots of pills!"

To the doctor-junkie no symptom is too mild or too brief: every physical discomfort needs blood work and prescription medicine ASAP. If you doctor's office is on lunch break then junkies call an ambulance for that mild sense of nausea!

In addition to wasting billions of dollars, all those visits likely shorten the lives of the junkies. Radiation from imaging studies leads to cancers. Lab studies eventually uncover benign abnormalities that junkies need fixed. Junkies get some really nasty side effects from meds, because they've often been prescribed every medicine in the pharmacy.

Rather than forcing the junkie at rock bottom to change his ways, being harmed by healthcare has the opposite effect: a doctor-junkie who is sick from over-doctoring feels the compulsive need for more and more and more.

Who is to blame for this epidemic of Doctorphilia?

Doctors!

Yup, it's us. We have the stuff that junkies crave, and docs give out unnecessary care like candy till we get everybody hooked.

Why shouldn't we? Docs get paid to see people whether they are really sick or not. A proper exam followed by educating a concerned patient is difficult and time-consuming, while ordering tests and writing prescriptions is just so quick and easy. Doing unnecessary care and writing unnecessary prescriptions keeps patients happy with us because they feel they are getting something done.

Plus, it's nice to feel needed.

I know a doctor who shall remain nameless that gives antibiotics to every single person with a runny nose. Now almost all runny noses are caused by mild viruses that cannot be cured by any medicine. Dr. Zpack gives everybody a useless antibiotic and they all assume that the medicine worked when the symptoms resolve on their own. His patients are apparently unaware that human beings have immune systems. Dr. Zpack's junkie patients love him because he always "cures" their infection, and it's good business for him because half his visits are simple colds he can easily "fix" with one prescription. When Dr. Zpack's office is closed his patients panic and rush to the ER at the first cough. He's a nice old doc, but who knows how many superbugs and dangerous reactions have originated with Dr. Zpack's prescription pad?

The fact that doctors give out unnecessary care immediately legitimizes it. Patients accept that it must be safe and necessary if doctors order it. Some patients casually dabble in being over-doctored, but some susceptible patients fall over the edge into full-fledged addiction.

The Addiction Gets Ugly:

It's a win-win situation for the dealer and the junkie until something goes wrong: The junkie gets too demanding or overdoses on unnecessary care resulting in an iatrogenic injury. Then Dr. Dealer freaks out and cuts off the junkie cold turkey.

Doctor D has seen it too many times: panicked patients in withdrawal from over-doctoring pitching fits in the ER that they have to wait an hour to be seen for their runny nose.

Recovery:

Coming to Doctor D's office (or his blog) is like detox for doctor-junkies. Appropriate medical care is often a shock to the doctor-junkie's system. Doctor D has to explain to recovering junkies that the human body is actually capable of healing itself. Who knew?

Fortunately Doctor D has a 12 step program for the Doctor-Junkie epidemic. Tune in next week for my prescription for curing the over-doctored!

What do you think? Have you or loved one ever suffered from Dangerous Doctorphilia? How did you recover? Do you blame MDs for this problem?

Did you miss Doctor D? Where were you when you first heard the word iatrogenic? What other irreverent medical topics should this blog tackle?

As always, Doctor D loves to hear your thoughts and stories in the comments!

Happy Doctors Day, Fools!

Yes Doctor D is back, making an early emergence from his peaceful Lent respite:

Happy Fools Day! Which also happens to be Doctor's Day.

Actually the official Doctor's Day is on March 30th, but such an obscure holiday usually gets forgotten, so it's about April 1st by the time the nurses or hospital administrators get around to handing me a card.

"Um, yeah so it's like Doctor's Day so here's a card and stuff," they say as Doctor D suspiciously takes the generic thank-you card expecting to be ridiculed for some sort of foolishness momentarily.

The ironic serendipity of Doctor's being honored on April Fools Day is just the sort of thing that makes me miss this blog, where I may freely ridicule the health profession.

A day for doctors, seriously? That makes about as much sense as National Goat Cheese Month! Apparently the date was chosen based on the first date an MD knocked a patient unconscious. If that isn't a day to celebrate, what is?

While doctors love thankful patients and adoring nurses, we would rather not celebrate doctor's day. We seriously don't need a holiday. A day off maybe, but not a holiday.

Of course, a holiday can serve to increase awareness—in case anybody is unaware of doctors.

I pity the fool who is unaware that Doctor D is back!

I shall return on Monday with an answer to an interesting question!

Until then discuss amongst yourselves: What is the best way to celebrate National Goat Cheese Month?