The Doctor Will See You Now [Non-Fiction]

Chapter 81: General Medicine

Yet another OPD story.

Lists. The bane of my life. Please note: whilst I have nothing against patients wanting to ask things about their own health, there is a right thing to do at the right time. Asking your general health questions in a specialist internal medicine outpatient clinic where you get 8 minutes per slot is not the right time. The right time is when you see your GP or family medicine physician.

I see a woman in the warfarin clinic. Warfarin clinic is, as the name states, just for adjusting warfarin doses. Nothing else. This woman had a pulmonary embolism (PE; blood clot in the lungs) 1.5 years ago and she has been on Warfarin ever since. This is unusual because guidelines for untriggered PE is only for six months. My senior suggests we can stop the medicine unless she feels strongly about continuing.

"So what do you want to do about your War--"

The woman whips out a list. My day just got ten times worse.

"Can you tell me my INR (blood clotting measurement)?"

I read out all her readings for the past few months. She jots them down.

"So because you've had a PE," I tell her, "your risk of getting another one in the future is higher than the average person but because yours is untriggered, it's unlikely you'll get another one again unless there's something sinister. All your cancer markers came back normal. So I would advise for you to stop it unless--"

"But what about my ultrasound last time?" Issue number two.

Her ultrasound four months ago shows she has gallstones only.

"But my gallstones -- do I need them taken out?"

I sigh. That's a general surgery issue, not internal medicine, and definitely nothing to do with her warfarin. But I answer anyway: no, no surgery for gallstones unless she gets unwell from it.

"Well, I guess I'm not unwell..." She pauses. Just when I want to ask her about the Warfarin again, she says, "But I've been getting this really bad shoulder pain."

Issue number three. Shoulder. Orthopaedics. Not internal medicine. And not Warfarin-related.

"I can't really move it. It gets up to about here--" She shows me. "--then it stops because it's so sore. The other arm is OK." She shows me again. "But this one, it gets so crampy when I get it above--"

"Look, this is a specialist outpatient clinic to see you for your Warfarin."

"I have an orthopaedic appointment pending--" she continues as if I haven't spoken. I can't help but note she just answered her own question. She has an orthopaedic appointment to see that shoulder. So why is she bringing this orthopaedic issue up at her medical appointment?

"Do you want to continue to stop the warfarin--" I am cut off.

"Just let me finish asking first, OK?"

What? No. Just, no. We are at fifteen minutes now and she still hasn't answered my question, the only question that mattered in that Warfarin clinic, which is whether she wants to stop or continue with the Warfarin. Without that question, I can't give her a follow-up (or close her case if she stops the medication), can't give her more medications, can't give her follow-up blood tests. I'm stuck in my own OPD because she won't answer the damn question. Because she thinks her non-internal-medicine related question, with which I can't actually help, is more important and more relevant.

"There's this thing I saw--" She literally whips out this brochure for some pod-shaped device. Issue number four. "--it's meant to be really good for back pains and shoulder pains."

"So what's your question?" I ask, tired. Does she want to know if we have it? If I would recommend it? If there are contraindications with using it? I don't even deal with shoulders.

"It has no radiation. It just straps to the joint and is meant to quietly vibrate to loosen muscles--"

"So what's your question?"

"I don't know if you have this sort of technology, but I'm told it's really good--"

"So what's your question?"

Nothing in life peeves me more than people who don't answer questions, especially a wrong question at the wrong place at the wrong time. Like now.

"I want to know if it'll interact with me taking Warfarin, this device."

"No, it won't, if it has no active medicines in it. Look, I have a lot of patients to see. We're at twenty minutes and you still haven't answered my question yet."

She doesn't look the least bit self conscious and takes a good ten minutes to umm and ahh over her decision whether to stop or not. Even though I advised she can probably stop it without much risk in the long-term.

And, you know what? Ultimately, she said she wants to stop the Warfarin. Which makes her spiel about that stupid shoulder device utterly pointless. Twenty-five minutes. Enough time to see two more complicated patients or four straightforward patients, now all taken up by this very stable patient here to adjust (or stop) her Warfarin dosage.