I often get calls requesting a medication for a recurrent problem, like a sinus or urinary tract infection. And sometimes, after I send something in and my nurse calls the patient to tell them I did, they say “that never works” or “it took two rounds to lick it last time”.
I wish patients didn’t expect me to remember such things, or that – between my old EMR and my new EMR – I have enough slack in my clinic schedule to research those things.
Everyone should know that phone calls and messages are not given specific time in doctors schedules. They are handled on the fly, shortchanging patients with appointments, cutting into lunch hours and quitting time in today’s healthcare environment.
Calling your doctor, if you know what you need, please say so. Whether you get sulfa or ciprofloxacin or nitrofurantoin makes little difference to me, so just tell me – they’re all good choices. Now, hydrochloroquine for Covid would be a different story.
And, I need specifics. If somebody says “what you gave me last time worked really well” it would help me immensely if they also said a month ago or three years ago. Because searching for things in EMRs is not as easy as it should be.
I also need clinical specifics. A call like “What can I take for a headache” is too open ended, just like “I have a cough and I’m raising green phlegm”. Three days of coughing, no treatment as it’s probably viral, much longer and getting worse, that might be bacterial and deserving an antibiotic. Daily headaches for 20 years or headaches with menstruation, make an appointment. The worst headache of your life, started 10 minutes ago, call 911.
And “That salve the dermatologist gave me worked well, can you get me some more” would be much easier to deal with if my patient had the old tube in front of them.
Good clinical decision making requires specifics: how long has it been going on, what are the symptoms, what makes it better or worse, is it stable or getting worse as time passes? There is a lot of intuition in how we work, but first we need basic information. In today’s hectic clinical environment, it helps a lot if people volunteer the specifics when they call for advice.
Twenty questions is a fun game, but not an effective way of practicing medicine. Volunteer the information, don’t withhold it.
Twenty Questions
A Country Doctor Writes: 
I’m not a physician (I’m not even in the medical field), but at one of my former jobs, we used to joke about people who failed to attend customer school. Certainly it seems obvious to you that I’d know whether I responded better to Cipro than to Sulfa, but to many laypeople it all just falls under the category of “medicine” (similar to the way that any hospital staffer who is not the doctor is “the nurse.”) We all try to be better consumers of healthcare, but some people may be intimidated by simply pronouncing the names of drugs that have worked (or not). Also, in today’s era of interconnected EMRs, I think there’s an expectation among patients that all of our doctors have access to all of our records (that’s certainly how EMR vendors peddle their wares); those of us with even tangential connections to healthcare know that’s about as far from reality as we can get.
Perhaps some gentle coaching (e.g., “patient school”) is in order — “I’d be happy to prescribe something, Mrs. Smith. Did the amoxicillin work well last time you had these symptoms?” Maybe I’m different, but if my doctor prompted me like that, I think I’d file that nugget away for future reference, at least subconsciously, and provide better information the next time around.
But I need to know when you last had an antibiotic, last week or three years ago? EMRs aren’t like Google. Searching is not usually a practical option.