Sometimes you just know it's not going to go well the minute you step in the room, as it did with the mother of this teenage girl. Her daughter sat quietly on the exam table, coughing here and there. Next to her was mom, probably in her mid to late 40s, but by her clothes seemed to be clinging to her youth--her clothes--tight jeans, bright pink sweater, it looked like she shopped at Forever 21 in her local shopping mall. Her hat, a puffy billed urban thing, belonged on the top of a hip hop star instead of on her dyed blonde, well-to-do suburban one.
I'd barely had a chance to sit down when mom started right in. She had a snooty tone in her voice, the kind that says "I know exactly what's wrong with her" while she's told me her kid's story (by the way, wasn't the kid old enough to tell me anyway?).
"She's been coughing for TWO weeks. Nobody's sleeping at home, and now I'M getting it too. I've given her half a bottle of cough syrup, but it' NOT working. Her dad had it and HIS doctor game him codeine cough syrup, and even though he's still coughing, he's sleeping better."
I cringed. I had been in this room less than 2 minutes, and in less than 30 seconds, I knew I didn't like this woman. My glare hardened and my lips curled in as I replied.
"If that's what you want, you won't be getting it from me," I told her sternly. Prometh cough syrup is no better than over-the-counter stuff, and the only reason people sleep is because it contains 12.5% alcohol. You might as well give her a bottle of wine."
I know. I shouldn't have said it that way. I'm usually much better at talking to parents, even demanding ones, and negotiating some kind of agreement. I should have explained to her, professionally and courteously, that prescription-cough medicines have not been shown to be any more effective and safe than over-the-counter ones, and that there have been reports of young people taking this particular cough syrup and dying from respiratory failure. I could have even told her how a few years ago, one mother in my practice kept calling and demanding the same medicine for her kids from me and my colleagues. She turned to an alcoholic who was drinking bottles of the stuff herself.
But, overcome by prejudice, I didn't. I told her, basically, she was out of luck. Her demand for medicine was not negotiable.
After all, who was I really here to see? The patient, who's hadn't even spoken yet? Or mom, who demanded the all of the racket in her house--the coughing, sneezing, and sniffling-- stop now because she hasn't been sleeping (she told me her daughter actually was sleeping, despite her cough)? If it's sleeping pills mom needed, then she ought to drive her luxury SUV over to her psychiatrist's office.
I moved on, turning my attention to my patient, still sitting, there looking annoyed (with me or her mother?). I asked her a few cursery questions--do you have any nasal congestion? runny nose? fever? Then I listened to her lungs with my stethoscope--crystal clear.
"Her lungs sound fine right now, but with a dry persistent cough, this could be a case of viral bronchitis. The best way to treat that wouldn't be with cough medicine, but with a couple of inhaled medicines that reduce inflammation and open the airways. I think you'll see improvement in 5-7 days."
"But why did my husband get cough medicine, then? I'm just saying, he's sleeping better at night. Sure, he's still coughing but he's starting to heal."
She went on. "And what's she supposed to do while we're waiting for the medicine to work? Is she just supposed to cough? That'll be another THREE-FIVE DAYS?"
I wasn't going to back down. "Look, based on what I've heard and my exam, this is the best way to go. But if you're not sure, we can do an xray, or you can get a second opinion with your regular doctor. But if you want to get to the root of her problem, this is probably the best way to go. What would you like to do?"
I'm expected her to walk out right there, and probably complain to someone on the way out about her visit (I probably deserved it). That's when I heard the first complete sentence out of my patient, the young girl sitting on the table who I'd almost forgotten because this mother is so overbearing. "Mom, let's just try it."
Grudingly, mom took the prescription for inhalers. It'll take a few days for her to see the earliest signs that her daughter is getting better. I'm pretty confident she didn't have that kind of patience, and she'd be back in a day or so.
It wasn't by best moment as a physician. I was stubborn, blunt and dismissive Doctors should work to serve their patients, whether you like them or not. It's best for both sides when that pact takes the form of a partnership, where both work together to figure out what's best by combining science, instincts, and heart.
That was not me. And I think the reason for it is because that word, partnership. We all agree that patients don't like to be treated like children, talked down to, or told to just "take 2 of these and call me later." But doctors don't like to be treated like waiters--taking orders from a menu prepared by the patient.
In that sense, maybe we both deserved better from the encounter--she deserved more professionalism, empathy and reassurance from me, and a clear, calm explanation as to why there were better ways to handle her daughter's illness than with cough syrup. I deserved to be the chance to actually consult with my patient, this teenage girl, and have the time to take a better history, without having this mom bear down on me with her demands and expectations.
On the other hand, maybe it wasn't going to work out no matter what. Sometimes, for reasons we can't ever explain, people just don't like each other. Why should it be any different between those two if one happens to be a doctor and the other a patient?
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Davis Liu, MD
Judy Berman
Barbara O'Brien
thedrmommy
david edwards
Patrick D Hahn
Salon.com
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thx
I spent some time trying to explain poison ivy to the Doctor, who, being English in England might never had heard of it. I got anti-biotics and a lecture. I looked up the diagnosis in the Merck manual when I got home and lo, and behold! it looked like the Doc knew more, not less than me.
I took the medicine and got better, proving that whatever the rash had started as (I'm still stubbornly clinging to the poison ivy thesis) it was an infection three weeks later.
Sometimes you're just sure you know.
I know, I'm not so good a soul.
Anyway, good story. I'll try to be more patient.
Rule 1: The teen (my patient) gives the history. I explain to the parent that this helps teach him/her how to give a medical history for their future
Rule 2: Teens are given private time. Even during sick visits, we need to assess how they are doing with regard to depression/school/ home issues
Rule 3: Teens are examined in private. Respect for body
So I would have invoked the pre-established rules and vanquished her to the waiting room. Sure I would have had the dialogue when she returned, but at least by then, I would have gotten a history and done the exam without her having been all up in the kool-aid, so to speak!
Don't smell sarcasm here, because there is none to be found. No mater how finely tuned your (bedside) intuition.
But no, Dr's posts all contain the same elements: "I know I'm right, but I'm operating outside the box. Whatta ya think?" And, you want to present the scenario, as you see it, to the general public for consideration. I don't blame you.
Yours must be such an insular, almost lonely, world where your decisions and conduct operate beyond the experience of almost everyone else. Again, no sarcasm.... Physician's are members of a very lonely club, I imagine, where even among peer members they must operate sheathed in odd, solitary vacuums which provide little breathing room.
So, actually, I have nothing to attach to your story, because I am not a bird whose feathers maintain orbit in such precarious climes as yours. But only to say that it is quite admirable that you have the good sense to reach down and dangle your digits into currents
which flow through places like these.
Regards,
Rh
What changed? I'm a not-very-fashionable white female in my late 20s, I'm pretty sure I don't look like the type to be mixing up purple drank...
your letter is so eloquent it should be a post in and of itself.
you touch on a great point--customer service,which, in the end, is what this is about to a good extent. Personally, I think doctors ought to receive some direct training in some of those skills as part of school
to answer your question about the prometh/codeine thing--
cough meds are falling out of vogue in general for two reasons--studies tell us that they generally ineffective, and there are increasing questions about their safety. As I said, it's probably the high alcohol content that puts people to sleep rather than any anti-cough properties of the medicine.
I do not why but I somehow do not like going to a doctor and I have gone to great lengths to avoid such visits often causing myself harm in the process.
So its always my mother who drags me to them and does the talking, with me only correcting her or adding to her comments. Maybe your teenage patient was like me a doctor-phobic?
I had the same doctor from birth to age 30 outside of the time I was in the Navy. He knew me, I knew him. We knew what worked for me and what was less effective. He asked me to let him know how meds and other treatments were going and when I told him he did me the courtesy of respecting what I had to say. Now things are different. Doctors rarely stay in this area for more than a couple of years. I can't really blame them for looking to make the most money thay can, but, it does interfere with long term patient health. While we're on the subject most of these new doctors are plenty know it all and overbearing themselves. I've learned that if I have the audacity to suggest a particular method or medication then I wikk not recieve it. I think that if I know that something doesn't work for me that information would be valuable to the person treating me. I find that it isn't. I have been more than willing to try a new med if the doctor feels it may do a better job if this is the case isn't it also reasonable to expect my feedback to be a valuable tool in my treatment?
This woman who you made so many blind assumptions about may be reacting to the simple fact that she is tired of being ignored by health care providers. If that is the case then your own attitude is the culprit and it is time to consider that all who seek health care are not idiots who are so unqualified to venture an opinion that they must be ignored and absolutely defied to maintain your level of infalliability. No offense intended.
Two things worked to make them better: a steam vaporizer and vodka. The vodka was actually discovered on accident when I was 14 or 15--we were out of cough syrup, and since the main ingredient in that is alcohol, Mom said to see if a shot of vodka would do the trick. It worked better, and was a hell of a lot cheaper. Probably didn't stop me from coughing, but at least I was able to sleep.
Since I moved out of the Midwest to Louisiana six years ago, I have had exactly one cough like this--while I was visiting home for a month in the winter of 2003. I think the extreme humidity here even in the winter keeps the cough from developing in the first place.
you have every right to comment--all views are welcome in my book. My assumptions probably had a lot to do with it, but she didn't reverse any of her assumptions with her behavior.
It's a tricky thing, seeing teens with their parents. We can't insist that parents leave, but when it comes to sensitive infomation like sexual activity, most states have laws allowing for confidential care of adolescents. The bottom line is that we doctors need to focus on their health, some of which can be sensitive just was with an adult. If a parent doesn't leave, it could be inadvertantly putting the child at risk because he or she won't be transparent, and we can't provide advice or prescriptions to keep them safe from pregnancy, STDs, etc.
fair enough.
This year I got a horrible double-whammy: bronchitis and strep throat. I asked the doc for Tylenol 3, because I know from long experience that codeine is the *only* thing that will a) get me to sleep, and b) knock the pain down enough that I can actually swallow (long history of strep throat, multiple long-lasting infections as a kid). Thanks to the T-3, I was actually able to get the sleep I needed for the antibiotics to do their job.
I'm still coughing, 8 weeks later, but that's another story. :)
And yet, some woman who clearly thinks she knows better wants to show up and tell you what to do?
I'm glad you stuck to your guns. People like her need to be put in their place. They don't know what the hell they're talking about, and yet they act like they know more than the experts.
I just had surgery myself, and when the anesthesiologist came in to meet with me, I told him that he was the expert and I'd defer to him, but I thought he should go light on the dosing because when they go with the standard dose, it takes me a long time to wake up.
He asked a few more questions and that's what he did.
That's how you discuss things with someone who's an expert in a field that you're not an expert in. What your patient's mother did was ridiculous.
By the way, if you want to, I just posted a piece on my rotator cuff surgery. I'd love to have a doctor comment on it.
And I think that makes for a better medical experience. You get an informed patient who has a better idea of what to expect and what he needs to do in order to get the best results.
I'm not saying this is what happened here; it sounds like the mom jumped right in. But it's also possible that she'd been down this road too many times before and simply decided to proceed with the inevitable.