“Alternative therapies do not work either.”

Warm saline is sometimes just the thing for a woefully plugged up nose. I’m also fond of Simply Saline nasal spray, which has no preservatives so it doesn’t sting and irritate. When the humidity is low a humidifier can also help. Medicine is more than just pills.

Interesting comment by Markman MD above about same day appointments making it MORE likely that doctors will prescribe antibiotics that are not needed. Umm, first step: ‘Just say no.’ If you prescribe drugs you do not believe are indicated just because someone else will do so if you don’t, shame on you. Poor judgment, and your patient isn’t getting good advice.

Another consideration and a logical conundrum: There are patients who will wait 3 weeks with a cold UNTIL they are quite ill as you indicate should happen, and then when they call for an appointment, are told the doctor will see them in…3 weeks (since of course you want to avoid ’same day’ appointments since they are only made by people who aren’t really sick but just demanding). By that kind of rationing behavior, you DRIVE patients to demand drugs, and demand them soon, because if the patients wait till they are really sick, they’re doubly screwed — sick AND neglected, since all patients by definition come in when not really sick and demand drugs they don’t need. You have then taught a behavior you deride: patients calling sooner in the course of an illness (because of the delay in receiving an appointment) and demanding meds early in the course of the illness (because of the delays in getting initial or follow up appointments). This behavior on the part of patients is a rational, if unintended, consequence of the mess at the front desk in too many medical offices — triage performed by the receptionist — and then the assumption that any patient who has deceived his/her way through triage can’t really be sick. You leave us not much choice.

I understand this setup doesn’t work properly — but it’s a mirror image of the system doctors are setting up, and both are twisted. The basic assumptions promoted above are that (1) patients seek care when they are not really sick and so you should delay seeing them to be sure they really are sick; AND (2) patients demand drugs unreasonably because they are seen when not really sick. You can’t have it both ways. Either see us when we call and refuse to prescribe unwarranted drugs, or see us later when we are very ill and then prescribe appropriately. But please don’t put us off and then refuse to prescribe when warranted simply on the assumption that patients are unreasonably demanding. Sometimes we really ARE sick…especially after waiting and waiting for an appointment.

Rich Goldstein MD in the previous post has it right. Doctoring is more than dispensing pills. I want to know if I have something serious after lingering for several weeks with an illness, and what to watch for to know if it’s GETTING serious. That last step is one doctors virtually never go to: “If your temp goes up to x, or if purple snot comes out your nose, call me.”

Helen, I would like a full practice of informed, rational patients like you who can leave a medical visit fully satisfied after receiving an evaluation, advice, reassurance and no prescription. Unfortunately, you are in the minority. My patients don’t wait three weeks for an appointment. They are seen no later than the next day for any acute illness. However, as the above patient stated in the top of this string, “I may not necessarily want antibiotics, but I want something.” That’s the problem. Patients want “something” even when the best approach to their illness is NOTHING. I have spent 20 minutes with some patients evaluating their cold and explaining that time will take care of it. Two weeks later I receive a request to transfer their records to another physician. After 25 years of this, it gets pretty old.

Here’s a question I never would have thought of till recently: Do docs look at the kind of insurance I have before they decide how much time to spend with me? If you get a bigger reimbursement from my insurance, do I rate a few more minutes of time?

I am about to completely rearrange my health insurance so I can see the doctors I want to instead of having to play dodge ball with my PCP’s front desk dragon…who seems to exercise more medical discretion than her boss — at least in my life. Until the switch over to the new plan and docs is complete, I have decided just to go ‘private pay’ — so when I recently saw the new doc outside of my current plan, did I get more of his time and attention because he got to charge me full freight, cash on the barrelhead? A tad disturbing, if that’s so.

I see tremendous variations among doctors’ offices in how accommodating they are about appointments and follow up and general management. They are all apparently up against the same reimbursement issues, yet some run ever so much better than others. Human variability, I suppose. It just goes to show that it’s possible to do it right, still.

One of the comments above said every patient wants to leave with ’something’ — how about an explanation that you understand that the patient wants to be well, and you would gladly give them medicine to make them so, but given the diagnosis, there are no pills to fix what ails them. It’s the truth. Can’t hurt to try it, and believe me, there are precious few doctors who treat patients with the respect the patients deserve in a collaborative relationship.

I am terribly distressed by the nasty, mean comments I read from doctors in some of the medblogs I frequent (does not include the docs above). It frightens me to think how these sourpusses disdain, resent and even hate their patients. Not good to place your life in the hands of a person who neither respects nor values you. Very sad. Very scary.

Hi,

I waited 2 weeks since the first symptoms before seeing a physician. My doctor prescribed me Nasonex for my sinusitis. I must say that it’s working well… It cost me nearly 40$ but I have the privilege to have a good health insurance. I can undestand that for others who are not in my situation, it can be problematic.