Primary Care Physician
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…
10 Things Your Primary Care Doctor Does That Should Make You Run for the Hills
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'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 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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OB Nurse Practitioner: (with a pat on the back) "Honey, that sounds like a bit of postpartum depression to me. Why don't you go home, have a glass of wine, and try to relax a little?"
By cb72  Oct 08, 2008
OK, now not to be all negative... I had lots of issues with lots of doctors, including my PC who told me, quote, "you are crazy" when I asked for a certain medication that is used for helping lactation overseas (the US version has depression as a side-effect, and I was trying to avoid PPD). So I switched (a whole another story) to a different guy.

This new guy is the most professional doctor I've ever had. I've seen him a handful of times, and every time, he's addressed every issue and answered every question (I do come in with a list). For every issue, he has done a full physical examination - my knee, my jaw, my neck, my thyroid... As he's working, I can see the textbook pages flip in his head - systematic, methodical, no shortcuts. I KNOW coming out of his office, that ALL major possibilities were examined, that the diagnostic algorithm was followed. That makes me feel secure.

The flip side is that he is not very personable. His work tends to be mechanical, he does not chit-chat, I never see much emotion, good nor bad. He won't cheer with you about some good news, BUT he will also answer the stupidest, most tedious question, relevant or not, with a 100% attention to it. I guess one never knows if a "stupid" question is actually quite relevant to the patient.

In case it's not obvious, I love this guy. It feels good to feel safe in your doctors hands for a change.
By cb72  Oct 08, 2008
I might as well get my few cents in. One of the two main peeves I have regarding the current medical system (aside from the costs, insurance, etc) is the chase for the almighty dollar and the terrible undertreatment for pain.
My wife has had Fibromyalgia for the last 16 years, sometimes flaring up and causing severe "thumping" pain, other times in a quiet state. Our current PCP is still of the school where they consider Fibro a mental disease, without a real physical cause and certainly nothing to provide pain relief for...antidepressants maybe, Vicodin/Percocet no. A recommendation of advil and losing a few pounds is as much as we could expect since there doesn't seem t be any way to confirm Fibro with any degree of certainty (my wife's SED rates are always normal...slightly elevated but normal) regardless if she is in the acute or remissive state. This continues as there are no Rheumatoid Doctors in this area, Cortisone is the answer to all problems, which is miserable to take...not to mention the side effects.
The second peeve, which combines the undertreatment for pain and the quest for the almighty dollar occured when my wife's aunt was living with us and had Osteoporosis. She passed away a few years back, but not without enduring hell at the hands of some so called doctors. She presented to the ER with terrible back pain. After waiting in the ER on a gurney (in front of the linen closet, which caused her to be moved constantly) for 12 hours, the doctor informed us that she was constipated. She spent the next few days with enema after enema, her output seemed normal but there was no mass exodus than prolonged constipation would typically impactions, nada. After 4 or 5 days of this, it was determined that her kidneys were the cause of the pain. She had kidney problems, but nothing too severe and didn't require dialysis. The resident nephrologist (sp?) collaborated with a surgeon and insisted that she needed stents put into her renal arteries...the only drawback was that the procedure would damage her kidneys and she would probably need dialysis after the procedure. The lady was 86 and not a good candidate, despite the drawbacks the surgeons called us repeatedly for authorization to do the operation. The nephrologist and surgeon couldn't explain the benefit of placing the stents when it would kill her kidneys, and called in a fashion of a car salesman after you showed interest in a car on the lot...the sale cannot be lost! In a moment of Divine intervention, the lady's regular kidney Dr came into the hospital and my wife (who was in tears over all of the developments) asked him why she needed the operation..he had no idea!! He stopped the proposed surgery and promised to stay on top of the case, leaving the resident nephrologist and surgeon in a foul mood. By now 3 weeks had passed and she was still in terrible pain. He attending physician refused to prescribe anything other than Advil, since she was hospitalized for constipation (which had been discounted after the enema treatment produced no relief). No darvocet, not Tylenol W/ Codeine, nothing. After reaching the end of our collective ropes with no diagnosis found, another round of x-rays, CTScans and MRIs, it was discovered that the cause of her pain was from fractured vertebrae, which didn't resolve well on Xrays due to her Osteoporosis. By now the vertebrae were beginning to heal, but since they were never set properly another operation was discussed to repair them.
The poor lady suffered for a month before coming home with us, refusing any more hospital treatment. I can't say I blame her as I saw one Dr after another take the easiest course (not necessarily the best or correct course) for getting rid of this lady, not to mention trying to make a couple of bucks off of non necessary surgeries. (We later found that the resident nephrologist also ran a dialysis center...I hate to say it but was he doing this to gain a bigger customer (and Medicare) base??
Sorry for the rant, the frustration just flows once I start thinking of the suffering I have seen at the hands of some of the medical professionals. Of course, I hope most Doctors are compassionate, but other than old school Doctors, the current selection looks a lot like the cast of a Hollywood Doctor's Only social club, where the true reason for their years of med school have a lot more to do with their image and wealth than their service to the sick and needy. BTW...when you see a Doctor, its nice to see a real doctor and not a PA, which seems to be the rage these days. My apologies to all of the true Doctors that try to help and heal their patients regardless of their wealth or social status, most people don't want charity, just a little dignity.
By jimster  Oct 08, 2008
Frankly, I'd be happy just to FIND a primary care doctor in my area. It seems today that everyone has a specialty, leaving it up to the patient to put all the individual diagnoses together (including diferrentiating advice, depending on a particular doctor's area of expertise) into one complete package, which I'll call the care of the human body, and come up with a plan of action the best you can. This coming from one very frustrated Granma.
Just wondering if anyone else has found this to be true.
By Gmaaaa  Oct 08, 2008
i once had an GYN/OB Dr tell me before being diagnosed with pelvic inflammatory disease- PID and having severe abdominal pain," your just bonking too much", i never went back to him.
By reesebug  Oct 08, 2008
You are the kind of doctor most patients dream of having!
By LanyL  Oct 08, 2008
WOW.....What about the doctor that says....."OK, hm, OK...." and never seems to answer any questions, continues to give you the same old meds even after saying they dont work or are causing issues....or they forget that you have an underlying issue (like RA) and treat you like a normal healthy person....grrrrrr
By gabesbabe  Oct 08, 2008
I once had a doctor tell me that if a condition doesn't respond to medicine then it must be "all in my head."
By NightGoddess  Oct 08, 2008
Just once I would like to hear a doctor say.."I don't know"
By Lillian74  Oct 08, 2008
Yike ! all my Dr's say this to me !
What a bunch of bullwacky. (No.8)
By Lillian74  Oct 08, 2008
A Doctors office that does not contact you or make an appointment when exiting because you have a chronic illness that needs contionous monitoring.
By jody417  Oct 08, 2008
Iam 42 yr young women, born with birth defect of hearing loss.........
1997 fell and herniated L4 & L5 unemployed and have shitty INS. "Colorado Indigent Care Program, CICP" EVERYTHING ABOVE MENTIONED I'VE EXPERIENCED !!!!
By tomi  Oct 08, 2008
Hey, you must know my primary care. He chews tobacco, often leaves patients waiting for long periods of time, and his office staff is extremely unprofessional. Case in point, I was left in a room for over an hour and a half and eventually went in the hall to make sure they didn't forget I was there. He is also quick to respond that if you don't like the way he practices medicine, go elsewhere. I also have no problem reporting the physician to the State Licensing Board! I went to college with many of these people, although I'm not a physician and I think the elitest attitude comes from the med school application process. Remember, the guy who graduates at the bottom of his med school class is still called doctor. Thanks for the post.
By RobertC  Oct 08, 2008
How about a doctor who prescribes medications without revealing some of the major side effects - especially ones one should avoid?

My underage son was going to be admitted into a drug treatment center and because he smoked, he needed something to relieve his cravings since he wasn't allowed cigarettes while in treatment. I had asked the doctor about the Nicorette gum and he thought writing a script for Chantix would be better for him. First of all, our son was experiencing depression, second....the major possible side effect of that drug is that is can cause depression. Don't ask me why we keep seeing this doctor because he does this all of the time. I guess from now on I must make sure to ask him. It isn't that hard for him to do, being that he has a computer right in front of him.
By mom of 3  Oct 08, 2008
How about a doctor who prescribes medications without revealing some of the major side effects - especially ones one should avoid?

My underage son was going to be admitted into a drug treatment center and because he smoked, he needed something to relieve his cravings since he wasn't allowed cigarettes while in treatment. I had asked the doctor about the Nicorette gum and he thought writing a script for Chantix would be better for him. First of all, our son was experiencing depression, second....the major possible side effect of that drug is that is can cause depression. Don't ask me why we keep seeing this doctor because he does this all of the time. I guess from now on I must make sure to ask him. It isn't that hard for him to do, being that he has a computer right in front of him.
By mom of 3  Oct 08, 2008
You missed the main one. Dr X is condecending, shows little interest in you as a human being and does not listen properly.
By willi  Oct 08, 2008
Thanks sooo much for your Dr's blog....makes me feel better about MY Doctor. While I've had some really, really bad doctors, my main G.P. is a GREAT doctor. He is an "old school physician" always ready to admit when he just doesn't know what is going on, and send me on to a specialist....or to show sincere compassion for any bad news that comes my way. I now feel better about seeing my doctor...knowing that at least I'm going thru your list. Thank You!!!! :) M-
By kakalover0220  Oct 08, 2008
Dr O always a pleasure to hear from you, or read your blog.
I wish more doctors would be considerate like on your very accurate list.
After having the best young doctor for years, he was replaced by yet another young doctor from Montreal, and I had to get used to him, and he to me.
Being very interested in medicine, and when I visit my PCP I always have a list of everything that needs to be address, so I always type it very neatly, a copy for him "my file" and my copy, and we go thru it together.
But it was not the case at first meeting.
But soon he saw that I knew my body, and knew exactly what I was talking about when addressing one of my issues, since I always do my homework on any of my health issues.
The next thing I knew he came to appreciate all the preparation I did on my behalf, since in our days and age we need to be our own medical advocate.
Just today I had went to the pharmacy, knowing that I was going to be prescribed another medication for life, since it's alergy related, and a needed a few information on a new antidepressant or rather something for my anxiety and panic attacks that I have been experiencing since my best friend, passes away on the Fourth of July this year.
So what I did is go to the pharmacy first, I always go to the same, and they know me quite well since both Richard and I did the 48 weeks of chemo treatment "interferon & ribavirin" since 2002.
So I explained to them about my visit to the eye doctor, for teardocks blocked, may need the surgery since they are clogged, but may be due to alergies that she saw while examining me.
But unfortunately, I tried the nose spray that I had been prescribed last year, and my eyes still cry all the time.
So I got the information for my PCP on what kind I could get, the best to the one without cortizone, also needed to be covered by my private medication insurance.
I did the same with the anxiety pills, and brought all the information all ready for him.
He tells me that if only all the patients he gets thru is door would be organized like this, he would never have patients waiting that 34 to 60 minutes between each appointments.
So yes I do agree with you list, my only hope would be that they did have coffee in their office, lol.
Love & Respect, Mckenzie
One day at the time.
ps: we need more considerate doctors like you and my doctor.
By Mckenzie  Oct 07, 2008
This is a great post Dr O. I just wish more of us had the ability to fire an insensitive or incompetent doctor and seek out another. Many of us are hindered and restricted by our HMOs or Group Health Plans or have no insurance at all and are at the mercy of county facilities. We have limited choices in what docs we can see unless we can pay out of pocket. If healthcare was reformed and all of us could choose better PCPs and DID, many of these substandard docs would be forced to clean up their acts or go out of business. Unfortunately, that's not the case. It was so scary to read some of these responses and I've had many bad experiences with health care professionals myself over the years. The "system" is flawed and needs to be fixed.
By wannabewell  Oct 07, 2008
Thanks so much for this. I always thought I was just too picky or sensative sometimes. Its nice to hear it from a doctor.
I used to have an alcohol problem and when I told my primary dr that I was trying to quit he wrote in big,well huge Red letters across my file that said,"alcoholic" I couldnt believe it and never went back.
Also I wanna say that my pain dr is very guilty of more than 2 of the above mentioned. I just thought I was being too picky or sensative. Well tomorrow I call a new pain dr.
Thanks again!!!
By flchristi  Oct 07, 2008

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