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.

Why See A Doctor If You Aren't Sick?

A reader question:

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?

When someone shows up in Doctor D's exam room with an advanced case of some truly nasty disease D will often ask them, “But why haven't you seen a doctor since the Clinton administration?” They always answer, “Because I haven't been sick, doc.”

Waiting till you get sick to see a doctor is like waiting till you're in the water to get a life jacket.

It is a common misconception that doctors save a lot of sick people. Only rarely do we “save” you after you are sick. Usually we hold off a disease which still gets you in the end, or your body heals itself (and we take the credit). The real lifesaving is in preventing diseases or catching them before you feel the first symptom:

First, we help you prevent or postpone serious illness:

• Your doctor can review your genetic and lifestyle risks. What diseases are you more likely to get in the future? What can we do to prevent them?
• We can help with healthy diet, exercise, weight management, and avoiding things that will kill you (like cigarettes). Of course, everyone knows this stuff from highschool health class, but how many of us are really doing it? Even Doctor D needs his doctor to regularly remind him to eat right and exercise. It just isn't as easy to do it as Happy Hospitalist says.
• Get your shots. Doctors have probably saved more lives with vaccines than any other treatment ever invented. Seriously, at least talk to a doctor about it, even if an Oprah guest told you not to.

Second, preventive visits can find serious problems before they cause trouble. Most people can't feel high sugar, high blood pressure, or high cholesterol until it is too late, but those things will kill ten times as many Americans as H1N1 this year. And some of the most common cancers can be caught with early screening—early enough to make a difference between surviving or not.

Remember these preventative things should still be done even if you already have a disease. People with chronic or frequent illnesses often understandably focus on what is giving them trouble. Don't be that guy that focuses so much on what is hurting, when the real thing that might kill you is hiding in plain sight!

So even if you aren't sick or you are seeing a specialist for something else, you really should see a Primary Care Doctor at least every year or two. We cover a lot in these visits.

Doctor D promises he is not trying to get you into get preventive care just to line his pockets. If he wanted to get rich Doctor D would have chosen just about any specialty other than primary care. He also wouldn't be spending all his off-time on this blog.

What is the longest you ever went without Primary Care? Do you think it affected your health? Doctor D would love to hear your experiences.

Doctor Shopping (Finding a Doctor: Part 3)

Okay, so you make an appointment and see your new primary doctor. Sometimes it is the perfect match. If so, excellent! But some relationships that looked great on paper just don't work out in real life and you need to keep moving. This is where things can get tricky. Physicians are very sensitive about "doctor shopping" patients, so you need to learn how to doctor shop with caution.

First, all doctors (including Doctor D) are arrogant narcissists who always think they are the best doc around. They can't understand why any patient would leave their brilliant care for a second-rate hack.

Second, if you are coming from another doctor or several previous doctors, your new doctor may look at you with suspicion. Doctors assume that those who have been promiscuous with their medical care must be unable to have meaningful relationships. The doctor might assume that you are a "difficult patient" (crazy, demanding, rude, etc.) or a "drug seeker" (addicted to prescription medicines). These are the two dirtiest names doctors call their patients. You don't want to get either label.

So you must approach first visits mindful that doctors are a sensitive, suspicious bunch. The best strategy is to let the doc know right up front you aren't committing to a serious doctor-patient relationship just yet. Say that you are playing the field and if you move on they shouldn't get their feelings hurt. If you do so in a polite way, pointing out that sometimes even the best of doctors won't work out, you should be able to leave the doctor' fragile ego intact. (Many of Doctor D's ex-girlfriends successfully implemented a similar "it's not you, it's me" exit strategy.) This way the doctor isn't upset if you leave and feels extra special if you stay.

Also on your first visit it is essential that you never tell your doctor about what jerks your previous doctors were. Your new doctor will likely assume that you did something to deserve the abuse. Never mention the name of a narcotic pain medicine you just can't live without. If you are a bit unstable try to not to show all the crazy on the first visit. Think about it like a first date. Be yourself, but be the nicest version of yourself.

Unfortunately, the primary care doctor who is stressed and overworked may not be the nicest version of him or herself at the first visit. This can be a good opportunity to see what your doctor is really like. Will the relationship work? Only you can answer that.

Even in today's depressing healthcare system there are lots of examples of really good doctor-patient relationships. So don't give up! The right primary doctor for you is out there.

Doctor D would love to hear patients' perspectives, advice, or horror stories on first doctor's visits.

Read the "How to find a Doctor" Series