10 Things Your Primary Care Doctor Does That Should Make You Run for the Hills by Dr. Sharon Orrange/Primary Care Physician: at DailyStrength Doctors and Advisors

Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…

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LOCATION: Santa Monica, CA, USA

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Assistant Professor of Clinical Medicine, Division of Geriatric, Hospital and General Internal Medicine, Keck School of Medicine, University of Southern California

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10 Things Your Primary Care Doctor Does That Should Make You Run for the Hills

158

Posted in Alcoholism by Dr. Sharon Orrange on Oct 03, 2008

In the last year I've had the opportunity to be a patient and a Doctor. I have frustrations like you do so I came up with my list.

1) Dr X leaves you waiting more than 45 minutes in the room on more than one occasion without an explanation or a quick apology when entering the room "I'm sorry to keep you waiting." Another way to handle it is to have the nurse let you know "Dr X is running 30 minutes late today so you can grab a coffee or a magazine"

2) Dr X's office provides no way for you to reach a HUMAN VOICE afterhours or on the weekends if you have a medical issue that requires attention THAT NIGHT.

3) Dr X smells like cigarette smoke. I get it...it's a hard habit to kick....but you can't smell like cigarettes when you are going to counsel your patients about modifying their risk factors for stroke and heart disease. You should cut it out during your clinic day.

4) Dr X doesn't touch you. You have a specific complaint (shortness of breath, knee pain, sore throat) and your primary care doctor doesn't look or listen to the affected area....maybe I'm old school but the answer so often lies in the physical exam

5) You are having severe pain (i.e. back pain after you lifted a couch), not relieved with over the counter meds, and Dr X is unwilling to prescribe pain meds for breakthrough pain because "they are addictive". We are dismal at treating pain in the primary care setting for unfounded fears of this. Short term use of Vicodin, Tylenol with codeine, etc for treatment of acute pain is completely fine for most patients.

6) You are talking about feeling depressed, sad or discussing a painful life event (the recent loss of a parent, etc) and you start to cry.... and you notice Dr X appears uncomfortable and tries to change the subject. Bad news.

7) A recent study showed that during 30% of primary care visits the doctor spent more time talking about themselves than they did the patient. Ok my patients often ask me how my kids are. 30 seconds...that's the amount of time I spend talking about myself. This visit is about YOU and we are already limited in what we can do in 15 minutes.

8) Dr X says "that's just part of getting old" when you have a complaint. Its true: arthritis, visual changes, decreased hearing, sun damaged skin are among the fun things that go along with getting old but WE CAN STILL HAVE A PLAN to deal with them and alter their course.

9) Dr X delivers bad news (loss of a pregnancy, a positive STD test, a new cancer diagnosis) with language that is short, sharp, rushed and without emotion. Some news will change a person's life forever and they will always remember that moment.....to add to it with a cold delivery is just painful.

10) Dr X can't say "I don't know what that is....but let's make sure it's not something worrisome". Often a patient has a pain, skin lesion, weird symptom that occurs only when they are doing such and such activity and I don't know WHAT it is. But it's your doc's job to admit that...and say they will do their best to monitor it and rule out worrisome things.

Am I missing anything?

Dr O.

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CONDITIONS AND COMMUNITIES: Alcoholism • Anger Management • Angina • Anxiety • Arthritis • Bipolar Disorder • Breakups & Divorce • Celiac Disease • Chronic Fatigue Syndrome • Chronic Pain • Cirrhosis • COPD & Emphysema • Coronary Heart Disease • Deep Vein Thrombosis (DVT) • Degenerative Disc Disease • Degenerative Joint Disease • Depression • Depression Supporters • Diabetes Type 1 • Diabetes Type 2 • Diets & Weight Maintenance • Epilepsy & Seizures • Fibromyalgia • GERD & Heartburn • Gout • Graves' Disease • Hepatitis C • HPV • Hypothyroidism • Irritable Bowel Syndrome (IBS) • Menopause • Migraine Headaches • Miscarriage • MRSA • Obesity • Polycystic Ovarian Syndrome (PCOS) • Post Partum Depression • Pregnancy • Rheumatoid Arthritis • Seasonal Affective Disorder • Urinary Incontinence • Weight Loss For Teens

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Displaying comments 98-79 of 158

My Dr. fits this to a tee knee pain no examination thyroid problem no examination ect.and her attention is totally on the computer screen.

By kerryn1 Oct 11, 2008

Yes... my doctor doesnt let me tell him whats happening to me, and doesnt even look at me when I talk to him, he just carries on typing on the computer.

By Vonny02 Oct 10, 2008

Yes... I had a doc (note PAST TENSE) that told me I was too young for peri-meno (I wasn't) and said 'I don't know' when I told her the statin drugs made me even more tired (I have CFS) and messed with my stomach and made me constipated and I asked her what I was supposed to do.

Not sure what to list those under, but I listed her FIRED.

By KweebsLS Oct 10, 2008

Dr.X does not wash his hands before examining you. In the middle of the exam Dr. X takes a phone call and proceeds with a obvious personal call.

By Maui Oct 10, 2008

I had a dentist who told me he missed doing a filling because he had a "senior moment". This same dentist had no emergency contact number. My husband had a root canal and the Dr didn't double check the X-ray so he didn't notice the infection had spread to the next tooth and his jaw. My DH was in the emergency room for pain that weekend where they couldn't do anything (he was already on pain pills). When he finally got hold of the dentist on Monday and was in tears from pain he was told they could see him Thursday! Needless to say we have a new dentist. Now, when we call after hours we are greeted with a message that includes the dentist's home number, cell number, and number for his lake house. He mumbles, but he does excellent work and has great hygienists. I have since been told by hygienists that the first dentists work is usually so bad it can be spotted from across the room. What can I say we were new in town, we didn't know better. We do now!

By hthomas98 Oct 10, 2008

One last time. Saw a psychiatrist 2 months ago . He says that if my son comes in twice week for 2 years. He will cue him. As far as I know there is no cure for caplexy.

By kly Oct 09, 2008

Pediatrician (to a first-time mom of an newborn): "I go to bed at 9p, get up very early, and I need my sleep, and once I wake up, I cannot go back to sleep, then I'm so tired, well there was once this patient of mine, who paged me at 10:30p, imagine!, and it wasn't even her first child, and the fever wasn't even that high, and after talking to me, they didn't even come the next morning, but the morning after that, and when she came in my office that second day, I yelled at her so bad for paging me for no reason, and you know what, she never paged me again - snicker, snicker...

This was like the 2nd or 3rd time I saw her? What was she thinking? (besides the obvious, "do not page") I switched.

By cb72 Oct 09, 2008

Also, I want to see accountablity. There is enough paperwork today to be able to catch the biggest errors. There is also a lot of procedures that can be standardized. I want to see the day when I could go to the insurance company, and say "this guy botched his job/didn't do squat/misdiagnosed in spite of informaton I offered/etc." and the Insurance companies could start dropping doctors, not the otherway round. Or they could just withold payment. It can't be done for all, but I want to see a system starting to be put in place.

In 2007, I went to my Urgent Clinic, (not ER), again in my big-ass medical center topping national charts and whatever, comlaining of pain in my chest (pleural), with history of recent pregnancy, recent thrombophlebitis, recent pain in my calf, and a very strong family history of DVT (deep vein hrombosis) - all high risk factors for clotting. They tell me I have a pinched nerve, and to go home and take some Advil. I KNOW I don't have a pinched nerve - it wuld hurt differently. This is NOT first-year resident I'm seeing, it is the attending (experinced MD) describing the diagostic process, so the resident can learn.

When they're done and gone, I get dressed, and manage to corner the resident in the hallway before getting out to the patient area. I happen to know that there is a blood test that indicates clotting processes and I ask him to prescribe that test. He agrees. (over his attending's advice, nice fellow) The front desk then forgets to process the paperwork and the test does not get done.

That test would have come up positive, and I would have been put on anti-coagulants ASAP. But as it turned out, two days later, my pain came back with a vengeance, and I ended driving my self to the ER in the middle of the night, in unbeliavable pain (I ended up on morphine for two days), and I ended up hospitalized for a double Pulmonary Embolism. I was later able to see the damage to my lung on the CT scan - a huge chunk of my lung was damaged. Some of it would have been avoided if I was diagnosed properly in the first place. Moreover, Pulmonary Embolism can and often is fatal, even if you're young and healthy. I could have DIED. I knew a guy who died from it right after a long plane flight; my brother's basketball buddy dropped dead from it in the middle of the game - he could have been 25, no more. People die, and I could have die. It was pure luck I survived.

I want to see OVERSIGHT. If my car mechanic screws me over, I can take him to small clams court, or I can take him to Judge Judy (haha). I want my doc to be acountable to someone somewhere. I can't even write to the State licensing board, when the residents and attendings change all the time in the Urgent Care Clinic, and the signature on my papers is not necessarily that of the person making decisions. My daughter's birth certificate lists my OB as leading birth. In fact, she was on vacation (and I ascribe a lot of delivery problems to her not being there - she was a great doctor). When she was leaving, I asked why and she said "she can't practice the way she thinks she should in the present environment". Umm... well, what does it say of the people who stay? I asked, and she did not reply.

By cb72 Oct 09, 2008

I was talking to a MFM (high-risk OB) doctor. I had a pregnancy recently that ended tragically in a 24th-week abortion, and in the aftermath I acquired two more risk factors (plus obesity from all the stress and some of the medication). :P The Dr. came in and started talking IMMEDIATELY, and without stopping. I had to kind of push against the flood of her words, to be able to squeeze my questions in. And as you may imagine, I had quite a few, but I wasn't getting much attention for my time. Finally, after her spending a couple of minutes talking after I asked my question, I said "I'm sorry, I'm going to have to ask you that question again, because you have talked and talked all around and around my question, but not answered it." On the second try she gave me quick and clear answer. High five me!

By cb72 Oct 09, 2008

I saw an ear specialist, who after keeping waiting for more than 45 minutes in the examination room (after 20 mins. in waiting room) - he came in, no apology, and if anyone could be said to be walking into a room at the very same time as he was walking out, I swear it was him. I never felt so rushed and dismissed in my life.

By lobeliapeppergrass Oct 09, 2008

no, it sounds like you've covered it all. i'm one of the lucky ones. i have a wonderful doctor who i've seen for the last 10 years and recently brought my hubby as a patient there because his previous doctor fit almost all the descriptions you just listed. my doctor is also going to start seeing my daughter because she had the same doctor as hubby. in fact, recently i had to bring my daughter in to see previous dr before i changed her over for a possible ear infection. one ear was clear and not infected, but the other had wax in it. instead of having one of her assistants come in and flush it out with lukewarm water and hydrogen peroxide, she told me to go home, but a kit at the store and flush it out myself and sent us home without making any more effort to examine that ear at all! i was outraged! what if my daughter's ear is infected?? please tell me she can be held responsible.

By heartstring Oct 09, 2008

I can relate to this entirely. I had a doctor that literally would tell you that your appointment was at 2pm and you would sit an extra 20 minutes in the lobby and then an additional 20 minutes in the exam room. He would come in and rush you out the door. I never left feeling like I had my questions answered as he would constantly cut me off thinking that he knew what I was asking. One time I told him, "Would you please listen to me for once?"

This doctor refused to believe that I had sleep apnea even though my brother did simply because I was not overweight. I told him that my wife has observed me breathing funny when I would sleep and sometimes gasping for air, but he felt that other things could cause that such as shallow breathing. I told him that I would wake up with a racing heart and he felt that I possibly had a nightmare. I told him I couldn't sleep as I had to urinate nearly every hour and his recommendation of not drinking any liquids 2 hours before bed didn't work. I told him about the fact that I snore so bad that my uvula would actually swell and touch my tongue. I informed him about my excessive headache and day-time tiredness and that it was affecting my job performance. I told him that I would often wake up suddenly and literally feel my heart pounding out of my chest. Here were the following erroneous diagnosis this guy did refusing me the whole time a sleep study as he claimed my symptoms were inconsistent with sleep apnea:

1st, I was depressed and that was why I was waking up suddenly as that was a symptom of depression and not sleep apnea. I was placed on Xanx that did nothing so I pulled myself off of that.

2nd, I must have allergies and was given Rhinocart and Astelin that did nothing. He tried Zyrtec but it made me feel like I was dying because I was so dead tired.

3rd, He tried Ambien that ended up putting me in the ER because my heart was going absolutely bizerk, but that dumb ass told me that I must have panic disorder and instructed me to take Ambien again. I knew that my heart going nuts was related to the Ambien. I thought at the time it was a side effect but the doctor told me that it wasn't. I still refused to take it.

I found a better doctor that immediately recognized my symptoms and had me go for a sleep study. In 90 minutes I experienced 72 apneas. They even count the shallow breaths too that my former quack talked about as being normal at times. The sleep doctor said that Ambien was not a smart thing to take as my body was trying to wake up to take a breath. This was not panic disorder that was causing my heart to pound but the stress that not breathing places on the heart. The frequent urination can be a sign of severe apnea as I learned but the former quack did not know that. Waking up suddenly is another one too and it doesn't mean that you have depression. I didn't know that my blood oxygen levels dropped a lot when I slept because of my problem.

I now have a CPAP machine that has an air setting at 18. I rarely wake up having to go to the bathroom and if I do then it is only once that I go. I do not wake up with a racing heart anymore. You literally cannot even tell it works until you lay on your back and remove the mask from your face and then you literally feel like a weight comes on your chest and you start to make an effort to take a breath as it greatly aides in your breathing. It works wonders!

I tried convincing my parents that this doctor is a complete quack especially after they told that quack that I was diagnosed with sleep apnea and the jerk said, "I thought he did" but then why didn't he have me tested and always fought me on it? I had PPO and not HMO so what was his issue??? My parents felt comfortable with him and continued and my dad ended up dying because the doctor never did a PSA check on him. By the time the problem was discovered it was too late. The cancer from the prostate went to the bones. They castrated him hoping that would stop fueling the cancer but he died within 2 years of diagnosis. My dad hated this doctor after his diagnosis with cancer since another doctor doing the simple finger in the anus exam noticed immediately a lump on the prostate that my dad's doctor kept missing for some reason. This new doctor did not know why a man over 65 years of age never had his psa levels checked ever.

I could only tell my dad that I told him in advance that this doctor was a quack. This doctor was probably loved by the drug companies because he loved to prescribe meds for about anything. Go there and tell him that you have a chronic nose bleed and if there is a medicine that might do something or there be any possible condition or virus that might cause it then he will prescribe something.

Thank goodness this man retired!!!!!!!!!!!!!!!!!!!!!

By Cody39 Oct 09, 2008

Had a mammogram and a ultrasound and a biopsy in March on my right side. Received a notice for my 6 month follow up for my my left side. Haven't had a real doctor in years. Son had his apenex burst. Took them a week to find the problem. They say he was lying -looking for attenchen- all in his head-nuts. He all most died and no one said Sorry.

By kly Oct 09, 2008

Great Post Dr. O!! I have worked in the medical field for most of my working career and with many different doctors, I have seen a lot of the things you mentioned. The only thing I can add is that I wish the doctors would have the nurses call patients with lab results more often. Because even if everything shows up as being normal patients still want to know. And believe me they call non-stop for weeks hoping to hear any kind of news.

By katiebell68 Oct 09, 2008

Passing out for the past 9 years. All the bs. Maybe this month they will find out whats wrong. Doctor after Doctor or should I say Quack Quack.

By kly Oct 09, 2008

Well, I have yet to read all the other comments but I felt a need to empress my sympathies to the fellow called Jimster. This all puts me in mind of my own experiences over the past 18 months. Having Spina Bidia Myelomeningocele I've been considerably more fortunate than a lot of others but I do have a small amount of nerve damage to my bowel. For several years I'd had problems with some very severe constipation but as soon as you mention constipation to a doctor they switch off - as though dealing with constipation is somehow beneath them. The most they will say is go home and take a laxative. I would have thought that given my Spina Bifida etc. they would pay a little more attention to the problem but apparently not. Anyway, it got so bad that I ended up in and out of hospital several times (including a very popular private hositpial) and the most any of the doctors who saw me actually did - and there was only one who did - was poke my stomach, tell me I was "a bit full" and prescribe more enemas and laxatives. Finally, it was my new GP who sent me for a catscan. Turns out that my "bit full" was a 20 by 10 cm tumour that no laxative was going to move. I had not one but three of the four types of ovarian cancer, including the most aggressive type. Because I'm an aggressive so and so myself, I kept pushing and seeing doctors because I knew there was something wrong with me beyond just constipation and it's fortunate I did because it's apparently unusual to catch the most aggressive of the three types of cancer so early. I'm still alive because I trusted myself rather than a bunch of doctors who were too snooty to deal with constipation. These are the same doctors who like to label me as "difficult". I personally think that labelling a patient as "difficult" is an excuse for doctors to avoid looking at their own behaviour because I was treated like some kind of social pariah by most of the doctors I saw - especially the one at the private hospital. The immediate change in his attitude towards treating me when he found out that we could indeed afford his services was obvious and disgusting to both myself and my husband. I don't care that he didn't like me. I cared whether or not he was doing his job. As for misdiagnosis? He told my family that I had a heart problem and might need open heart surgery - scared the hell out of my Mother and Father. Given it was cancer I'd say his skill as a doctor is seriously impaired by his personal prejudices.

Doctors today have much to answer for. These are just a couple of examples of what I have been through at the hands of folks who are supposed to be there to give others the help they need. It seems the hypocratic oath no longer has any meaning and is just a collection of words they mouth so that they can get on with earning money they don't deserve. There are many truly good doctors out there still - my new GP for example. She is worth her weight in gold but good doctors used to be rule rather than the exception that they have become today.

By RAAFBrat Oct 09, 2008

wow,,all of those things happened to me in ONE visit i had last week. the wait was an hour and not one "im sorry for your wait" from anyone!! i feel like a doc should also EXPLAIN the medication they want to put you on. my high cholesterol was finally addressed and without explaining how crestor worked, how it would benefit me, etc...he just sent the prescription to the pharmacy before i knew it!!! all he did was tell me not to go on the internet and let the "side effects" scare me. im aware that all side effects are listed and can be quite rare or scary to read about..but i would at least like to talk to him about it. i was told that if i didnt take it i would end up with a stroke or heart attack by the time i was 50. this may very well be true..BUT HAVE SOME EMPATHY AND KINDNESS FOR WHAT IM GOING THROUGH!!!! i switched docs before i left the office. :) switched to a female i should say..LOL!!

By lovemy2 Oct 08, 2008

Dr. X complains about not eating lunch to see their patients.
Dr. X seems to be in a rush and doesn't make sure you understand test results.
Dr. X or Nurse X wont where gloves when drawing blood

By Wanalive Oct 08, 2008

HISTORY!! if a doctor will take the time to listen to a complete history, not only of past problems, but of what is causing/irritating/influencing,etc. the current problem, then many questions would be answered. case in point... if a patient has a breathing problem, instead of assuming its because they smoke, ask about current possible allergy triggers, etc. some doctors just don't listen...they assume. they base a diagnosis on chronic behavior instead of current conditions. drives me nuts!! (and that's a short trip! lol)

By tadlem Oct 08, 2008

I have hcv and the hepatologist I go to does all of the above. Should I find a different specialist?

By violettt Oct 08, 2008