Good morning! I am going to the doctor today! It’s time for my yearly physical exam!
Just a suggestion: there are things you should not see or read before a doctor’s visit, like John Oliver’s report on the ineffectiveness of state medical boards and how incompetent doctors are hopping from state to state to butcher patients.
It’s OK! It’s just a physical! How much harm could a doctor do in a routine examination?
Then I read Chuck Wendig’s account of an irritating examination by his doctor. Fortunately, I can say that my doctor is nothing like his callous, bumbling doctor. Although I have to admit, this part rang true:
So, he then asks, and once again, please wait for it, wait for it —
“What medications are you taking?” And then, you know, have I had surgery, who in my family is alive and how did the dead ones die.
At this point I’m fairly convinced that I’m being punked, like this is some kind of joke, right? They all tell me, ha ha, no masks, also, please give us the same information you just gave to the last three people. Is anybody writing this down? Two of the people seem to be tapping it into a fucking iPad, but at this point I’m pretty sure they’re just playing Wordle. There is literally no continuity of information. I sigh, and I tell him the information AGAIN.
Now that is familiar. I got a long questionnaire in the mail a few weeks ago, and I dutifully filled it out to bring to the clinic today. Then they sent me an email, telling me to fill out an online survey, which was just as long and mostly the same questions, with a few little differences. I filled that out, too. I expect that today when I get there a nurse will sit down with a clipboard and go through the same questions one by one by one, and I’ll sit there in exposed in my gown, nodding.
But that’s just the medical bureaucracy, which we all hate anyway. My doctor is someone I’ve known for many years now, she’ll be helpful and fine, and probably won’t stab me. I think!
I’m back! The good news: blood pressure is perfect, cholesterol & triglycerides perfect, no problems detected in any of my blood work. I guess I’ll have to cancel all my funeral plans.
Unfortunately, there’s always something to bring me down. I’ve been scheduled for a colonoscopy in August.
Oh, also, all those forms I filled out? The nurse immediately ripped out a whole page of densely packed questions and triumphantly threw it in the trash. I didn’t need to fill that out! How silly of me.
I’m not yet old enough to have these problems but I’m sure when my Mom fills out a questionnaire sent through her MyChart ahead of an appointment, she doesn’t have to worry about doing another one in the doctor’s office.
There used to be a question on medical history forms that went, “Is there any family history of tuberculosis?” To which I would answer, “Yes, but you don’t care.” That would get me a quizzical look and a request for an explanation. To which I would tell them that my grandfather died of it…in 1917. At that point they’d agree that they didn’t care.
I stopped filling out the pre-appointment questionnaire bc it was always the same damn 5? tedious pages of questions that they would always again ask in the office. My guess is that this is all for legal reasons, and specifically – if you dare to make an error on any of the 5 pages – that if you sue them, they can defend themselves by saying that you gave wrong or false info. Nothing about it felt like it was needed for my health.
Also, having read the piece, it reminds me of a comment a friend in the medical field told me a while back: as the economy shrinks, and health care becomes one of the few remaining reliable and well-paid careers, you’re gong to get more and more people who shouldn’t be in health care taking jobs in the field – and that’s going to hurt us all.
As crazy as it seems there is a rationale behind why they ask you the same stuff every time. First, they are checking your understanding of your medical history and how well you know your medications. Your answers can tell them about YOU. For instance, if the patient has ten medical conditions and can only remember two, it gives the interviewer an opportunity to evaluate exactly how much of an understanding the patient has, and then you can educate the patient as needed. When you do read back the patient’s medical issues to them, they should be able to recall them and elaborate as necessary. Also, if the forms a patient fills out and the verbal responses don’t match, you need to seek clarification. This is like law enforcement who interview the two crooks in separate rooms to see if their stories match. Having the correct medical information and medications is extremely important. Most of the people doing this in doctor’s offices are not medical professionals, so this concept is mostly not practiced. Rather than have a Professional Nurse, they hire people with limited training such as LPNs, Nurses’ Aides or Nurses’ Assistants to check your B/P, Temp, pulse and do the initial interview. This saves the doctor’s practice money, or should I say the corporation that owns the practice. PS, I’m not saying all Professional Nurse practice this way, I know many do not.
Over the years I practiced as a Professional Nurse I came to learn so many subtle techniques for assessing a patient. A simple one is checking a patient’s B/P. When I brought a patient into the exam room I would walk slowly and strike up a casual conversation. I would talk about the weather, their family or something not medical (while trying to avoid talk about work). This would help put them at ease and shift their attention away from the dreaded medical visit. After getting some basic information, I would attempt to tell a joke or make a funny comment, this can help put the patient at ease. Checking a tense patient will give you an elevated B/P, or as it is called, White Coat Syndrome. As I checked their B/P I would explain every step and the whys of everything I was doing. I would tell them to place their elbow on the arm of the chair, keep their arm straight, sit up straight as possible, keep their feet flat on the floor, try to relax and breathe easy. I tell them this is how we can get the most accurate reading. A wham bam thank you ma’am is the way most people do it, but this can be detrimental to the patient. And don’t get me started on mechanical versus manual Blood Pressure Devices.
Think of a patient in a hospital bed, the lab person comes in and says, I’m here to TAKE your blood. The nurse comes in and says I’m here to TAKE your Temp or I’m here to TAKE your B/P. All this TAKING makes the patient feel helpless and feeling they have lost control. Eventually this takes a toll on the mostly helpless hospitalized patient. The way you talk to a patient can have a positive effect. For instance, state your full name, identify your job and ASK, the doctor has ordered some tests and I’m here to DRAW your blood, is that OK with you? Or may I CHECK your B/P. Just changing a few words can make the patient feel like they have control of what is happening to them. In the long run these little changes can boost their spirit which in turn help them heal faster. All healing begins (in) the patient.
Those are just two simple examples of how medical personnel can make a difference in a patient’s care. And (naturally) I’m referring to the perfect patient in the perfect world, neither of which exist.
I hate going for medical visits because I see all the mistakes my evaluators are making, I have to keep my mouth shut, you can’t piss off the people taking care of you.
Mine has decided that every single office visit requires filling out a supplementary online form that badgers you about how much exercise you are getting.
No, this isn’t targeted in any way. It is just given to everyone because of course we are all slobs that need to be shamed into exercise. They aren’t doing anything with the results, as far as I know. It is only for us to feel guilty about.
The urology practice that I go to since I was diagnosed with prostate cancer uses a log in system called Freesia, I think.
Every time I visit the office I have to fill out this form, either on line for pre check in or at the office on an iPad that they hand to me that has to be completed before I can see the doctor. Last year I had to go in for a procedure that was done in two visits, 3 business days apart. At the 2nd visit, the receptionist handed me the iPad so I protested saying I was just there 3 days ago. She said it doesn’t matter. It has to be filled out every time. When I saw the doctor I told him how stupid I think this process is because it’s the same inane questions every time that, obviously, no one actually reads because the nurse asks some of the same questions when she checks me in. He agreed with me but said he has no control because corporate management insists it be done and no one knows what they use it for because they never get any reports back from them about this Freesia BS. Since then I’ve made sure to be as contradictory as possible when filling out the multiple choice options and in the comment boxes I write all kinds of crazy shit. Nobody has ever commented or questioned me about it.
OT but may be of interest if ha-s not aready appeared here
Necrobotics: Biotic Materials as Ready-to-Use Actuators
Abstract
Designs perfected through evolution have informed bioinspired animal-like robots that mimic the locomotion of cheetahs and the compliance of jellyfish; biohybrid robots go a step further by incorporating living materials directly into engineered systems. Bioinspiration and biohybridization have led to new, exciting research, but humans have relied on biotic materials—non-living materials derived from living organisms—since their early ancestors wore animal hides as clothing and used bones for tools. In this work, an inanimate spider is repurposed as a ready-to-use actuator requiring only a single facile fabrication step, initiating the area of “necrobotics” in which biotic materials are used as robotic components. The unique walking mechanism of spiders—relying on hydraulic pressure rather than antagonistic muscle pairs to extend their legs—results in a necrobotic gripper that naturally resides in its closed state and can be opened by applying pressure. The necrobotic gripper is capable of grasping objects with irregular geometries and up to 130% of its own mass. Furthermore, the gripper can serve as a handheld device and innately camouflages in outdoor environments. Necrobotics can be further extended to incorporate biotic materials derived from other creatures with similar hydraulic mechanisms for locomotion and articulation
stuffin @5 sez “And don’t get me started on mechanical versus manual Blood Pressure Devices.”
This is the biggest bone of contention between me and whatever doctor I’m seeing. I’ve gone countless rounds with making them dig up manual devices, and for this reason, seeing a doctor primes me into a hyper fight or flight state just from walking in the door.
I reached my breaking point after spending a week in the hospital and having my BP taken at least 20 times per day. I promise you that is not an exaggeration. Where they might’ve been scheduled to check 4 times/day, each time required 5 or more attempts to get a reading that was at least “compatible with life.” Often after torturing me for several minutes the machine would give up and refuse to output a diastolic number, with the systolic being around 45-65 (as most know, norms are around s120/d80). They took readings with multiple sizes of cuffs, on every limb except my neck. Could any of the readings after all that be anything close to reality?
So yeah, I’ve had it. Either do it manually, which hurts less, or not at all. I’ve finally realized I don’t have to submit to everything that’s easiest for them, and am about one more visit away from allowing one BP measurement per year and that’s it.
Good luck!
Now will be around half past one pm in America so I hope PZ has received a clean bill of health.
@#9 Ridana – Sounds like you have an atypical diastolic B/P. Diastolic Readings <60 are considered dangerous, especially if they can’t get one.
This explains the unorthodox attempts to get an accurate reading. After a check or two and not getting a reading “you like” you have to try different ways to confirm the B/P. The other arm is the first choice. Using the legs for B/P is not recommended because there could be a 10-to-20-point difference in the readings, but at least you have a reading. It then needs to be documented the B/P was taken in the leg. The readings in the upper arm (brachial B/P) are the gold standard according to the American Heart Association. However, if the patient has a condition the prevents a Brachial B/P you can use the leg, just above the ankle. The new thing out is the wrist B/P monitor which again is not recommended by the AHA. The wrist B/P monitor is becoming a favorite of people who need to check the B/P daily at home.
There are many reasons for not being able to obtain your diastolic. Artery structure like a deformity. The deformity doesn’t have to cause you problems other than making the B/P checker crazy. As long as you blood is flowing normally to the downstream tissues you should be OK. Another issue could be the condition of your blood vessels, is there any plaque? Has there been an injury creating scar tissue?
The description you present sounds like you have an atypical diastolic as you do not report any other symptoms. It is very difficult for a medical person to accept something like you present, it just doesn’t fit their paradigm. I learned, after many frustrating cases like yours, sometimes you have to accept the unbelievable. The truest way to get a B/P reading is via an arterial line. That is a small catheter is inserted into an artery and connected to a transducer which will convert the pressures in the artery into a numerical reading.
I worked the Intensive Care Unit for over 15 years, the minimum B/P check was every two hours. Less frequently were hourly checks. And on the really unstable patients it was every five minutes to every 15 minutes.
My first encounter with an abnormal situation: There was a young woman, in her late 20s who was admitted to the orthopedic ward with a broken ankle. She tripped in the parking lot leaving her job. I got her into the bed, made her comfortable and checked her vital signs. Her pulse was 32. Below 40 is considered abnormal and dangerous in most circumstances. Medications can cause a low heart rate. However, she was young and not prescribed any medication. We got an EKG which was normal except the heart rate was 32. After some agonizing, I found out she was go-go dancer who tripped coming out of the go-go bar. She danced 4 to 8 hours a day up to five days a week. Her Cardiovascular status was far healthier than all of us normal humans. Hard to accept but that was her norm.
stuffin, is it possible to have ‘reverse white coat syndrome’? There was a time I was undergoing treatment that required frequent clinic visits that included blood pressure measurements. During that time I was also measuring my blood pressure at home. It was pretty common for me to get a systolic measurement of around 140 at home, then take the bus to the clinic (including 1.5 miles of walking), and have my systolic measure at 105. How does this happen? Which measurement is more reliable?
@#12 anat.
Never heard of “reverse white coat syndrome,” but have known several instances of the B/P being lower in the clinic or the doctor’s office than at home. This is kind of rare but not unusual. I would say the accurate one is the one at home. I would have to see how they checked your B/P at the clinic. If they used a manual B/P device, they could have performed the procedure very wrong producing a lower reading. The manual device relies on the person inflating the cuff and then releasing the air in the cuff. If they open the valve too much, they will let the air out too rapidly. This causes the mercury on sphygmomanometer to drop rapidly, this can result in the person listening for the sound of the blood (passing through the vessel) and matching it to the level of the mercury to miss 2 or 3 heart beats. This will produce a faulty systolic and diastolic measurements. Also, heart arrythmias, like A-fib, can produce odd or unusual readings. An irregular heartbeat can produce wacky numbers and drive a person crazy.
Also, a gentle walk could lower you blood pressure. The arteries will dilate to let more blood flow to the (leg) muscles which causes lower systemic B/P. OTOH, a strenuous walk could increase B/P. The higher demand for blood will cause the arteries to constrict raising B/P.
B/P reading are not an exact science. There are multiple variables including the emotional and mental state of the individual, physical condition, disease or sickness at the time the B/P is checked.
Some pointers for checking your B/P at home.
Try to relax a few minutes before checking your B/P.
Turn off the TV or radio, the news today can cause a myocardial infarction.
Checked B/P two to three hours after taking any B/P medications.
Check B/P the same way every time.
Check in a comfortable sitting position.
Have the right size cuff, read the manufacturer’s instructions.
Place the cuff on the arm above the bend in the elbow. (it does not need to an inch or two above the elbow)
Rest your arm at the level of your heart, this is not a very feasible task (instead).
Rest your elbow on the table, desk or arm of the chair, a small pillow under the elbow for comfort and support.
Feet flat on the floor.
Make sure the air hose (this is where they place the sensor) is on the inner third of the inside of the elbow (this is where the artery is).
The hose should run straight down the arm ending at the ring finger or pinky.
TRY NOT to watch the numbers going up and down. I tell patients to close their eyes and concentrate on breathing easy.
DO NOT RECHECK B/P immediately if you don’t like/agree with the readings.
Wait five minutes before rechecking, the inflated cuff temporarily cuts of circulation to the arm and
It takes a few minutes for the body to rebalance the blood flow.
Everybody has a different physical structure so all these things will not apply equally to everyone.
Another technique used is to check your B/P three times waiting a few minutes between each reading. Then average the readings. This may be a better scenario for people with an irregular heartbeat or someone with a labile B/P.
stuffin, thank you for the detailed response.
I might have “reverse white coat syndrome”. The thing that relaxes me most at a doctor’s visit is to get a blood draw first — just watching the red stuff fill a vial is very soothing.
Other good news: tomorrow I’m going in for more blood tests!
Ah, yes. Sanguine.
Having my blood drawn doesn’t bother me. The cold sharp metal piercing my soft warm flesh is exhilarating.
If only I could convince them to do this instead of the cuff we could all get along. I’ve even suggested it several times, but of course no one takes me seriously because they can’t believe the pressure is that painful to me, because it’s not that painful to them. I would much rather be stuck which barely hurts than endure the pain of the cuff. The fact that the automated cuff often leaves me in tears before it’s over with ought to be a sign to them that regardless of what reading they end up with, it’s not an accurate picture of my blood pressure. Somehow, my obvious distress during the procedure is of no importance to whoever is administering it, as long as they get numbers they can record. And it has always been that way. I have an appointment next week and already I’m feeling stressed out in anticipation of the battle that awaits me.
Sphygmomanometer is a fantastic word.
Can’t believe you requested an arterial line insertion. They can be dangerous. Many caregivers are in fear of them. Mainly because they see (fear) the negative side and not the benefit of having one. If you know what to do, and have confidence in your skills, they are pretty easy to manage. That does take some experience working with them.
Having one placed would require a hospital admission and special stuff. Like a doctor or other certified professional who can insert one, plus a transducer and monitor that can handle it. Not sure if the surgical outpatient clinics could handle them. I would think the ones that perform the more extensive surgeries would be able to support that procedure. While pretty invasive they can monitor a person’s B/P continuously without the need for the cuff.
Two side here, YOURS: “I have an appointment next week and already I’m feeling stressed out in anticipation of the battle that awaits me.” What you are going through is perfectly normal for your situation.
The Medical Person: As mentioned previously, you don’t fit in their paradigm, so they reject your personal experience regarding your B/P. They know they can get a B/P, after all, they do it all day long, day after day, without an issue. You are the exception they refuse to accept.
If I was in your place, I would give them a fair opportunity to get a reading. Let them check it on one arm twice, then have them use the other arm. If the problem continues after two or three tries, you have the option of declining (refusing) any treatment that is prescribed for you. If they do this against your will it becomes assault and battery. You will be surprised how good you will feel by stopping their nonsense. It is all about control and you will have taken control back. Give them a decent chance to perform their task, once you see it is futile, politely tell them to fuck off. In your defense you can ask them: “If there was a problem with my B/P, how is it I took a bus and walked 1.5 miles to get here? Also how is it I’m talking to you without any dizziness or other manifestations? We know our bodies better than anyone else.
One issue is the doctor may challenge you and want to personally check your B/P. Let him do it once or twice before telling him to fuck off. He may insist on trying the ankle B/P, then you have to make the decision whether or not it is worth it for you. As medical professional my recommendation is for you to do what you feel is right for yourself. It will make you much happier.
I was getting out of my car in the GP practice’s car park when my door gently touched the neighbouring car – so gently their was no sound, and certainly no mark – the driver got out and started shouting at me, she went on shouting at me despite being shown the lack of a mark, getting very nasty. I eventually fled, signed in and got called immediately, and the first thing the nurse did was take my blood pressure, which she immediately rejected asking if I was upset. I explained the shouting woman, the nurse did the blood draws I was actually there for while we chatted about nothing in particular and I calmed down. The blood pressure was then taken again and was down to the normal range – if she hadn’t already looked at my previous numbers she might well have taken the first result, as my pressure is low for someone of my weight and the first reading was nearer what you might expect from someone as over weight. I was impressed.