They actually tell our patient actors to do this so we get in the habit of asking in different ways to get all the patient history. So I ask about prior histories, and then when I do the abdominal exam I ask again about any surgeries (especially if I see a scar).
In all fairness, lots of pts don't know how to respond. I often hear of those who spend the better part of a day filling out the form sent to them ahead of time and the doc spending 7 seconds leafing through it before walking into the exam room.
Raquel - you don't understand! You see, when they are on lisinopril, Lipitor and Glucophage, their BP, lipids and glucose are normal, so They.Don't.Have.Hypertension/dyslipidemia/diabetes! Or so my patients also seem to reason (and yes, coumadin is always the last one to be mentioned as they are getting up to leave!) Not to mention previous malignancies...
When I worked an NCIC terminal, we had to flag missing people if they were violent. Person was missing from local 'home' for mentally ill. He was described as nonviolent, but he was on 3 sedating meds. I asked what happened when he wasn't taking them. "Oh, well then he gets right hard to handle, evil cuss..." Thank you for clarifying that.
I have a crazy family history of heart disease (heart attacks before age 40, diabetes, heart transplant relative, etc.), cancer, and rheumatoid arthritis. Honestly, I usually don't mention it to doctors.
We submit it to the secret database for the REAL government to view. So then they don't have to try and get radio signals past people's aluminum hats at Walmart.
I come across similar situations in transcription. "ALLERGIES: The patient has no known drug allergies, except penicillin, codeine and adhesive tape." Go figure.
I agree Greg. I fill out for form. Then the nurse asks me the same questions. Then the doc asks me again. Why did I waste all that time filling out the form if no one was going to use it???
i agree with a lot of you. i fill out the forms, answer the nurses questions then the doc asks the same damn questions. READ THE BLASTED FORM i just filled out with all the meds, surgeries, hospitalizations on it. i made a "fact" sheet with all that info on it so i could remember with dates and they don't read it. next time i'll just say "read first then ask?" but they'll probably boot me out because i've got an attitude. oh, well. what else is new
yep every time! Typical in ED even when there is a major scar down their chest from heart surgery - oh what is this then? A slight scratch??? "Oh yes but its all fixed now", sigh...
I think what Mr Needle is saying that is all the survivors in his family are healthy. The ones with diabetes, cancer or heart disease? Well, they're dead, so they don't count, y'see.
Lovinmyjob - It's not just the patients. I am on a beta blocker because of sinus tachycardia and my last visit my cardiologist told me I could cut my dose in half because I didn't need it anymore because my heart rate was normal. No lie and he was serious. He is no longer my cardiologist (and in the end I needed to double my dose to keep other symptoms under control)
We/they re-ask everything on the sheets because "that is everything I take" except for your herbals, over the counters, the psych meds prescribed by a different doctor, etc. I can get an extra 3-4 medications in most patients I talk to, even after they have written down what they take. I'm assuming it is the same for disease states.
the form is to satisfy the administrators who think that forms are important. the conversation is what determines the quality of your care. but i do check allergy lists and med lists. that pesky coumadin, plavix, asa, dabigatrin. and trickster practice patients are worse than worthless.
I can understand the answer sometimes. Heart disease and cancer? Well, yeah, I've had relatives die of those. The relatives were all over 86 years old and it was probably more likely they were going to die of heart attacks or cancers than automobile accidents, though...
Worse than the day-long forms are the offices which insist that the day-long forms must be filled out again once a year. Even if nothing has changed. I'm not allowed to take the existing form, cross out the medication I'm not taking anymore, initial and date the edit, and move on. Nope. I'm required to fill out the WHOLE THING again. I want to be a patient, not a clerk.
Now that I think of it, I might have this problem with my hand that flares up when I'm presented with long forms to be filled out for no good reason other than to satisfy some administrator. I'm so sorry, my hand hurts too much to write.
When performing admissions to home health, my telephone instuctions changed over the years from "Please get all of your medications together in one place so we can review them" to "I want you to bring everything from your bathroom and bedroom that you ever swallow, insert rectally, rub on your body, insert vaginally, inject into any part of your body, drop in your eyes, nose, or ears, gargle with, put on as a patch,or make tea or beverages out of."
"AND in their original packaging if you can!"
Amazing what folks, especially the geriatric set, do and do not consider "medications".
(and I won't even go into those on Lasix and furosemide with a dx of syncope...)
I don't mind filling out everything (although I do have problems sometimes remembering the surgeries other than the 9 knee ones) and I keep a list of my meds along with all of my doctors in my wallet & purse. My biggest problem is with doctors who don't have a clue about taking a medical history. It doesn't happen often now that I'm back with my pcp, have a good pain doc & all of my other specialists are at Vanderbilt (or associated therewith). I just occasionally have to report the baby docs to their mentors. "You might suggest to BabyDoc that they ask about thus & so when taking a medical history" etcetera.
No, only real diseases like fibromyalgia and CFS...
ReplyDeleteThat's kind of like when a patient denies that they have any health problems, but then they are on Lisinopril, Lipitor, and Glucophage.
ReplyDeleteAnd I've had no surgeries.
ReplyDeleteOh but I have donated a kidney, my appendix out, and a mitral valve replaced.
Raquel- that happens so damn often it's not even worth blogging about anymore. Drives me nuts. Add Coumadin to the list.
ReplyDeleteThey actually tell our patient actors to do this so we get in the habit of asking in different ways to get all the patient history. So I ask about prior histories, and then when I do the abdominal exam I ask again about any surgeries (especially if I see a scar).
ReplyDeleteIn all fairness, lots of pts don't know how to respond. I often hear of those who spend the better part of a day filling out the form sent to them ahead of time and the doc spending 7 seconds leafing through it before walking into the exam room.
ReplyDeleteRaquel - you don't understand! You see, when they are on lisinopril, Lipitor and Glucophage, their BP, lipids and glucose are normal, so They.Don't.Have.Hypertension/dyslipidemia/diabetes! Or so my patients also seem to reason (and yes, coumadin is always the last one to be mentioned as they are getting up to leave!) Not to mention previous malignancies...
ReplyDeleteI think it is either a TRIFECTA or a HAT TRICK. Diabetes, Cancer , Heart Disease are the big three, but I am pretty sure.
ReplyDelete"The drummer was suspected of suffering from death"
ReplyDeleteWhen I worked an NCIC terminal, we had to flag missing people if they were violent. Person was missing from local 'home' for mentally ill. He was described as nonviolent, but he was on 3 sedating meds. I asked what happened when he wasn't taking them. "Oh, well then he gets right hard to handle, evil cuss..." Thank you for clarifying that.
ReplyDeleteI have a crazy family history of heart disease (heart attacks before age 40, diabetes, heart transplant relative, etc.), cancer, and rheumatoid arthritis. Honestly, I usually don't mention it to doctors.
ReplyDeleteI am wondering what the Dr does with the information he wants anyway.
ReplyDeleteWe submit it to the secret database for the REAL government to view. So then they don't have to try and get radio signals past people's aluminum hats at Walmart.
ReplyDeleteI knew it !!!
ReplyDeleteWith an answer like that, I wouldn't be surprised if there were some psych history in the family also.
ReplyDelete"It's just a flesh wound!"
ReplyDeleteI come across similar situations in transcription. "ALLERGIES: The patient has no known drug allergies, except penicillin, codeine and adhesive tape." Go figure.
ReplyDeleteBut, really, no one has a cold or anything so we're good.
ReplyDeleteI agree Greg. I fill out for form. Then the nurse asks me the same questions. Then the doc asks me again. Why did I waste all that time filling out the form if no one was going to use it???
ReplyDeleteIt always amazes me the people who say they don't have hypertension because the medication they take keeps it normal. That's crazy talk
ReplyDelete"Which my HMO doesn't."
ReplyDeletei agree with a lot of you. i fill out the forms, answer the nurses questions then the doc asks the same damn questions.
ReplyDeleteREAD THE BLASTED FORM i just filled out with all the meds, surgeries, hospitalizations on it. i made a "fact" sheet with all that info on it so i could remember with dates and they don't read it.
next time i'll just say "read first then ask?" but they'll probably boot me out because i've got an attitude. oh, well. what else is new
Major illnesses in the family?
ReplyDeleteNah, nobody in our family ever got past private first class!
yep every time! Typical in ED even when there is a major scar down their chest from heart surgery - oh what is this then? A slight scratch??? "Oh yes but its all fixed now", sigh...
ReplyDeleteI think what Mr Needle is saying that is all the survivors in his family are healthy. The ones with diabetes, cancer or heart disease? Well, they're dead, so they don't count, y'see.
ReplyDeleteLovinmyjob - It's not just the patients. I am on a beta blocker because of sinus tachycardia and my last visit my cardiologist told me I could cut my dose in half because I didn't need it anymore because my heart rate was normal. No lie and he was serious. He is no longer my cardiologist (and in the end I needed to double my dose to keep other symptoms under control)
ReplyDeleteWe/they re-ask everything on the sheets because "that is everything I take" except for your herbals, over the counters, the psych meds prescribed by a different doctor, etc. I can get an extra 3-4 medications in most patients I talk to, even after they have written down what they take. I'm assuming it is the same for disease states.
ReplyDeleteThe 'form' reporting issue is interesting. I have spent hours filling out copious amounts of paperwork that was rarely referred to.
ReplyDeleteReporting the same information verbally makes sense too, since watching and hearing is more revealing.
My question is:
Are the forms used to dictate various reports? Something to refer to later?
Why does the doctor only glance at it?
I know there is a good reason....I just don't know what it is.
the form is to satisfy the administrators who think that forms are important. the conversation is what determines the quality of your care. but i do check allergy lists and med lists. that pesky coumadin, plavix, asa, dabigatrin. and trickster practice patients are worse than worthless.
ReplyDeleteGood job that Mr. Needle's family don't suffer from any serious stuff........e.g. an ingrowing toenail.
ReplyDeleteCliff
I can understand the answer sometimes. Heart disease and cancer? Well, yeah, I've had relatives die of those. The relatives were all over 86 years old and it was probably more likely they were going to die of heart attacks or cancers than automobile accidents, though...
ReplyDeleteAdore those accurate medical HXs!!!
ReplyDeleteSounds like my husband, had 2 sisters die of cancer but they were dead so it didn't count.
ReplyDeleteCandy
Worse than the day-long forms are the offices which insist that the day-long forms must be filled out again once a year. Even if nothing has changed. I'm not allowed to take the existing form, cross out the medication I'm not taking anymore, initial and date the edit, and move on. Nope. I'm required to fill out the WHOLE THING again. I want to be a patient, not a clerk.
ReplyDeleteNow that I think of it, I might have this problem with my hand that flares up when I'm presented with long forms to be filled out for no good reason other than to satisfy some administrator. I'm so sorry, my hand hurts too much to write.
When performing admissions to home health, my telephone instuctions changed over the years from "Please get all of your medications together in one place so we can review them" to "I want you to bring everything from your bathroom and bedroom that you ever swallow, insert rectally, rub on your body, insert vaginally, inject into any part of your body, drop in your eyes, nose, or ears, gargle with, put on as a patch,or make tea or beverages out of."
ReplyDelete"AND in their original packaging if you can!"
Amazing what folks, especially the geriatric set, do and do not consider "medications".
(and I won't even go into those on Lasix and furosemide with a dx of syncope...)
Pattie, RN
I don't mind filling out everything (although I do have problems sometimes remembering the surgeries other than the 9 knee ones) and I keep a list of my meds along with all of my doctors in my wallet & purse. My biggest problem is with doctors who don't have a clue about taking a medical history. It doesn't happen often now that I'm back with my pcp, have a good pain doc & all of my other specialists are at Vanderbilt (or associated therewith). I just occasionally have to report the baby docs to their mentors. "You might suggest to BabyDoc that they ask about thus & so when taking a medical history" etcetera.
ReplyDelete