I had the opportunity to work side by side with another doc (gently "older" than me) the other day. I was doing a physical on an Air Marshall and he wanted to sit in. (These physicals are like "executive physicals" from the 80's that encompassed everything short of a colonoscopy- we have to make sure these government employees are ready for anything and fit to perform. As I was reviewing the Marshal's chart, I didn't see much of a problem short of the usual extra 30 lbs, scant scalp hair and few screening test abnormalities but I started asking my salvo of questions to make sure past and family history were devoid of risks for a premature departure from the job of crime fighter. I brought up the few abnormalities and along the way threw in a few fun fact suggestions for nose congestion, reflux, hearing problems..... He seemed to resonate with a few and started asking questions seemed to be interested in my few comments so I would give him more info then move onto the next body part......then more info.....so I could see he was hungry for info/guidance. In fact, what started as a simple review of tests and updating chart notes soon became counseling on using omega 3 oil and turmeric for the early arthritis in his ears (yes the 3 bones in there get arthritic from shooting a firearm for years) and cutting back on alcohol and considering stopping since he had some signs in his life of dependence. Then he opened up to both of us about chest pain for the last few months!! I appreciated his candor and took it that he was subconsciously concerned but at the same time he was always aware we were the doctors licensed by the government to flag Marshals unfit for duty. I am used to this as when I interview someone past 10-15 minutes, they usually open up and I find the juicy information that would have been missed on standard medical history taking. This is the info that helps shape the personal lifestyle change I create. I figure if we take extra time to figure how they got to this mess/at this decade of life, we can plan around addressing the cause of disease and not just treat it.
The other doc was perplexed as to why he was giving so much information. My colleague kept on saying that was very odd. (I was just snickering to myself, "that is the way you do it doc!") Truthfully I saw a man that wanted to get some help for drinking and was having problems controlling his teenage daughter-the hearing wasn't a concern, neither was the chest pain. Well, I sent him to an Ear Nose Throat specialist and got him to the hospital for a stress test.
I don't always have the luxury of extra time with patients but I can always continue next time. This is the trick I learned from Medicare. We are supposed to tell the patient after the first or second complaint that they have to follow up for guidance of the next few complaints at a later time since I only have time to address 2 major symptoms. (...and this is your grandpa who has 10 pills twice a day from 3 different specialists and may questions about the side effects to a few of the expensive pre-approved drugs. If I have to, I will guide my patient to concentrate on the major issues we in the medical community would be concerned with to continue functioning independently while we let go of any low grade nuisance symptoms.
So even some of the established docs don't have the right idea about how to really empower people to change the cause and not just address the symptoms. Shop wisely!