Don't Let Your Medical Provider Lie to You!
This week, I had a message from a person on the ENT board that exemplifies this problem. The person was simply informed that her dizziness was due to fluid in her ear. She was asking me what can be done to treat it. I hope she did not pay for this doctor's visit, because she sure didn't get her money's worth.
First, the doctor was vague. Exactly where is this fluid? Is it in the ear canal? The middle ear? Or, perhaps, is it in the inner ear? I am assuming if the doctor actually saw fluid, then it had to be in the middle ear. If so, why didn't the doctor explain it to the patient, and why didn't he provide some sort of treatment? The doctor just sent her out the door, still dizzy, and still confused as to what is going on. This is poor medical care, and people should not stand for it.
I think I have a highly-developed lie detector. I can smell it when it happens. As a clinical instructor for medical training, one of my past jobs involved clinical evaluations of PA students actively seeing patients at their clinical teaching sites. One student in particular comes to mind.
Tony (his real name) was a first year student that had logged a few hundred patient visits under the instruction of his preceptor in a large family practice office. I arrived at his office that morning to watch him examine and treat random patients. I would critique his mannerisms, his professionalism, his thoroughness in taking a medical history, his examination skills, and his ability to formulate a diagnosis and treatment plan - all essential components of any medical encounter. Although the presence of another clinician in the room while a student is seeing patients can be a bit intimidating, this is how a good clinician is trained. Basically, I introduce myself to the patient as an instructor and immediately melt back into the exam room, allowing the student to take charge.
The woman was sitting on chair wearing a paper gown. She was crying. Tony asked her why she was crying (a good move). She said that she has been having low back pain and is afraid it is her gallbladder. This caught my attention since the gallbladder is not in the low area.
"Do you think it's my gallbladder?" She cried.The patient just accepted this very, very incorrect explanation. I did not. If a gallbladder was posterior to your spine, it would be sitting in the chair! There was no way under the sun that her low back pain was due to a gallbladder problem.
"Yes, it could be", replied Tony.
"Really. Where exactly is my gallbladder?" She asked.
"Oh, your gallbladder is posterior to your spine", he said.
I allowed Tony to complete his cursory examination, develop an entirely incorrect diagnosis, and step out of the room so we could discuss the case.
"So, Tony, where is the gallbladder?" I asked.I watched Tony stumble through another four or five patients for the rest of the day, having to constantly correct his many errors in both judgment and management. It was obvious that Tony had chosen the wrong career path.
"It's posterior to your spine."
"No, it is not, Tony. It is in the abdomen."
"Oh, you mean LOCATION. Well, yes, of course, it is in the abdomen."
"Okay, with your finger, will you please point to the location of your gallbladder?"
"Well, it sort of varies, depending on the person, but it is somewhere in here." Tony moved his finger in a big circle indicating the entire abdomen.
"No, Tony, the gallbladder is right here." I purposely pointed to the left upper quadrant - the exact opposite location of the gallbladder.
"Oh, that's what you mean. Yes, of course, that is where the gallbladder is located."
"No, it is not. I was just testing you. The gallbladder is in the RIGHT upper quadrant of the abdomen. I cannot believe that you do not know where the gallbladder is located."
"Yes, I knew that, but since you were pointing to the left, I did not want to embarrass you by proving you wrong. You are my instructor, and I should not challenge you."
Needless to say, Tony did not get a passing grade for this clinical evaluation, nor did he continue with his training. I will try and keep this delicate, but Tony was stupid; pure and simple. There is really no other logical explanation. I was amazed that he was accepted into a medical program, and equally amazed that he had been caring for a hundred or so patients before I evaluated him. He had absolutely no business caring for patients. He did not have the basic knowledge base, and he did not know what he did not know. Up to this point, Tony had survived on his skill at telling lies. His philosophy was "If you don't know the answer, just make something up. Keep it vague. Maybe the patient will believe you."
Tony is probably working at Taco Bell, making wrong change, or maybe he went to a different medical program somewhere else and eventually graduated. There are a lot of "Tonys" out there who have jumped through the hoops, made it through the system, and are now licensed and seeing patients. Your own medical provider could be a Tony.
Here are the Warning Signs:
- If your medical provider does not take a sufficient medical history - cuts you off in mid-sentence and does not appear to listen (or care) what you have to say; then YOU MAY BE SEEING TONY.
- If your medical provider does a cursory examination, such as listen to your heart for one second in one spot, or examine you entirely with your clothes on (even though you are there for a rash), then YOU MAY BE SEEING TONY.
- If your medical provider fails to answer your questions in a professional and logical manner and attempts to BS you, YOU MAY BE SEEING TONY.
- If your medical provider does not tell you what you have (a diagnosis), but yet treats you, then you MAY BE SEEING TONY.
- If your medical providers gives you an unnamed and unexplained medication for a diagnosis that you do not understand, you are definitely SEEING TONY.
- If your medical provider is suspiciously wearing a surgical mask, solely so that he will not be recognized, then you MAY BE SEEING TONY.
- If you notice that your medical provider has a book entitled, Medicine for Dummies, on the books shelf, then you MAY BE SEEING TONY.
- If your medical provider is listening to your heart and failed to put the earpieces of the stethoscope IN his ears (I have seen this!), then YOU MAY BE SEEING TONY.
- If your medical provider fails to introduce themselves, doesn't wear a name badge you can read, or jumps if someone knocks on the door, then YOU MAY BE SEEING TONY.
- And finally, if your medical provider has no idea where your gallbladder is located, run as fast as you can, paper gown and all, and get the heck out of there. The person chasing you IS TONY.
Related Topics: Technorati Tags: medical care, medical training, health and wellness
18 Comments:
Perhaps the best entry you have ever written (and based on your past articles, yes, that's a compliment). I was literally laughing hysterically by the end of the article. Keep up the good work!
I agree this was a great article! I needed a good laugh and this definatly gave me a good laugh! Thanks!
Loved this article! Extremely funny, but all too true. I've had several "Tonys", as well as "Tony-ettes" in the past myself. Thanks for this - it made my day!
How incredibly refreshing to see a physician accurately critique another medical "professional" and to warn patients. There are many "stupid" Tonys and Tonis, just like every single profession and we've unfortunately, all had one examining us at one time or another. But we expect more from the medical profession because they can do serious harm to us and I have had more than my share of such terrible and life threatening treatment. Your article would have gotten a much bigger chuckle out of me if it weren't all so true! (with a smile and a snicker!)
My doctor's name is Tony and he hasn't given me a diagnosis. He is the best doctor I have seen and the only one I trust. The others have stuffed me into a box where I don't fit and have done more harm than gook.
I love your articles. This was great and oh so very true. I recently had 3 back to back drug reactions and finally diagnosed myself to the doctor the third time. Then he gave me an allergy pill when I really needed something much stronger. Since I have had diagnosed Lupus in the past I asked for a referral to a Rheumatologist. When I went to him I gave him my personal medical history and was willing to give him addresses, etc but he kept me waiting in a great deal of pain for over 2 months while he waited for a multitude of blood tests that must have been sent to China or somewhere Finally, a week ago I was "again" diagnosed with Lupus. I understand that he would want to be cautious but I told him right up front that I have the disease and I knew my symptoms and knew the drug reactions could have triggered a flare but, no, he had to do all the tests first. I am almost 66 and have had this thing for over half my life even if it is often in remission - why don't Doctors listen to their patients? I worked in health care many years ago and it always amazed me what some of our interns didn't know and how often the nurses (and techs like me) had to give them ia lesson is something or the other.
I have a cousin who has been suffering with migraine headaches for many many years...Her primary sent her for an MRI and told her everything was normal...I asked her to get a copy of the written report and just as I had guessed everything was not normal. She had had a brain infarct, a mild stroke..He never told her this and I of couse could not tell her. She then saw a neurologist and we brought the results of all of her previous tests. I questioned this new doctor about the findings and asked why my cousin was never told of the findings, and his response totally blew me away..."what would telling her accomplish"...So they just keep pumping her with meds, not telling her why and she still is suffering from migraines..
I had a very bad experience with an ENT. I went to him because of dizzyness...He came in and told me after looking in my ears, that it was not coming from my ears, but from my heart, my brain or my arteries, but he said I will send you for some testing anyway...So I went for a battery of tests and guess what? I had Benign Paroxymal Positional Vertigo...Gee ya think that has something to do with my heart, or my brain or my arteries? Never saw him again...Took care of the problem on my own.
Although I did not choose to go into the medical field, My mother was an RN(OLD SCHOOL) Father Lab/xray(old school) We were taught to stand when the dr. entered the room(if we could).Afer some personal serious health problems the last few years, I quickly came to the conclusion that the "old school" doesn't exist anymore. Daddy in his later years used to refer to some of the nurses as "new" just from their uniforms.The dedicated professional doctors/nurses are out there and God Bless them. Look out for that other bunch,though.
AMEN! To what you have said! I swear except for one GP MD who actually listened (had to wait 2 hours+ in the waiting room, then another 45minutes once you got into the exam room, but WELL worth it)and is now retired, I have seen nothing but "Tony".. The horror stories are multiple..
1) Went in for headaches/nausea that had lasted long after a head injury 6mo before to be told I had "popping in your left knee" (EHHH???)
2) Working in a job that I would be actively exercising 5-8 hours per day easily for 6-7 days/week, on a starvationesque diet (no time to stop and eat), not dropping an ounce or an inch, and the diagnosis of being overweight "because you don't exercise enough and you eat too much"..
3) "Take tylenol for the headache (again, after a head injury) and that it'll clear up in a few days".. While going to a walk-in clinic for vertigo/headache issues and a massive headache that 3-extra strength Tylenol weren't even touching.. Came to find out after an ER MD friend upon being told about Tony told me "go to the ER and this MD is going to be your MD" it was a massive sinus infection that even if Tony HAD looked in my nose wouldn't have diagnosed or treated because we all know, in Tony's world antibiotics are overperscribed, but if you're under 5 you get an antibiotic with every infection, if you're an adult it's suck it up and take a tylenol..
4) Went in for kidney stones (have had them in the past, so KNEW what was going on).. MD looked at me, said "You pulled a muscle" (I'm a powerlifter now, I kinda pull a muscle every other day and I hadn't worked that muscle group to even pull anything there) followed by telling me to take an over-the-counter med that was CLEARLY listed on my chart as being ALLERGIC!.. Of course, the part that sucks is after the stones had passed I had the little baggie to get tested, guess who I ended up seeing at the walk-in clinic and got the jaw dropping "whoops! Missed that one!" look on Tony's face..
5) When I was a kid my parents took me to the doc because I couldn't run at school because my sides would hurt and I was breathing heavy... Diagnosis was I "was heavier than the other kids in my class".. 21 years later "You've got asthma!"
The problem is, now that everything is being computerized, if you go to a Tony and aren't satisfied with Tony, the next Tony MD you see considers you to be a difficult patient or seeking because you DON'T trust their judgement or their 30-second exam. There isn't any way of saying "I'm not paying for this" because the way the system is structured they still get paid for NOT doing their job. And, you're absolutely right on the lack of diagnosis/prognosis/treatment and the anxiety/annoyance/anger/frustration/etc. it causes the patient. Then, waiting forever to get in to the MD who will actually do the simple test that could have taken care of the problem YEARS ago when it was arguably cheaper to perform.
Tony consults in Australia too. He surely gets around :)
I have been to a Tony. when my regular Dr is not there they stick me with his sidekick. SHE, has made so many wrong diagnosis its not really funny. I won't go in to details because of 1 of the outcomes. BUT, she is a total IDIOT. She even caries a book around with her sometimes looking 4 what you maynot have. I made an appointment to see HIM and they told me I would get HER and I said noway jose, I'll wait for the real DR. even that I have to wait another month to see HIM. Very smart man, but apparently not smart enough to show HER the door.
I read with interest as I have had 3 kidney stones. One causing a great deaal of nlood when it passed later into the bladder. Next I had 2 and my family doctor sent me to a "specialest" and he took both hands and went down either side of my spine and said"This is your spinr" then did the same a little further out from the spine and said" These are your muscles" YOU HAVE MUSCLE PAIN!! Further test with my family doctor , a Ct scan with contrast showed 2 kidney stones. now I am still having the pain as one stone is ldged in my kidney. Right or wrong??
Thank you...I LOVE your stories and comments (including the kidneys stones. I had them myself). Thanks so much for joining in the Hunt for Tony. He is out there...in many disguises...and in many countries!
I KNOW WHAT A TONY IS. MY PRIMARY
DOCTOR WAS AGAINST AN URGENT SURGERY I WAS TO HAVE WITH MY
UROLOGIST. IT TOOK HIM 20 DAYS
TO GET ME A CLEARANCE TO FO INTO
THE HOSPITAL, HE WAS SO NEGATIVE,
HE EVEN AKED ME WHO ABOUT IF YOU
HAVE 400 IN SUGAR, HE EVEN SAID
LADY, DO YOU KNOW WHO MANY PEOPLE
ARE DEAD IN THE OPERATING ROOM?
HE WAS VERY NEGATIVE.
My family Doctor knew I was clinical depressive & had given me 2 different kind of meds. for this, then gave me a perscription for CHANTIX to quit smoking--NEARLY KILLED ME !!! What should I do ???
C.J.
Had to take my 17 year old daughter to the doctor for severe abdominal pain. we saw Tony who said she had a PID. He gave her antibiotics, but when they were done, She had the same pain. It got better for a few days and then got worse again.
I took her back in and he told her it was all in her head. REALLY!! A family doctor who told an 17 year old girl that her pain was all in her head. He told her to go home and use Ibuprofen. A couple more days of agony and I called them back that it wasn't in her head. The incompetent fool told me that there was nothing wrong with her but he would refer me to a gyne!! Thank goodness, I took her to them and they actually had a sensible diagnosis. SHe had adhesions from the PID. Two weeks after outpatient surgery she was fine. After that I refused to have him for any of my family.
I'm not sure why doctors keep these sorts in their practices, but I bet it has to do with a) the incompetent has bought into the practice.
and b) The owner of the practice might get sued if he tries to get the incompetent to leave. FWIW, Kitty
I have to say that the manner this was done in was great and made me laugh but I have to admit that I can identify with this poor woman. I was in a car accident in april (the beggining of April) and now here we are in august and still we know no more than we did at the start. I have had three MRI's done so there is a road map of my entire back and as of my last visit my Physiatrist (hope I spelled that right) still has no idea what is going on. To make things worse even though we have found two herniated disks she says that we still don't know if that is causing my pain. All of my treatment has been at my prompting based on what other doctors have recommended without having done an examination simply because she has yet to contribute to my diagnosis. I have Chiropractors and doctors alike take advantage of my condition and my insurance and continue treatments without having any idea what the problem is long after they should have referred me out. If not for my primary and an ER dr. telling me that these things were not normall I might still have been going to these people.It is sad to see that our health care system seems to be motivated not by the wellness of others but by the almighty dollar. Sad indeed.
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