Man, do I hate it when patients second-guess my diagnosis.

[Aristus]

A guy came in yesterday with an open and shut case of bleeding hemorrhoids. Classic risk factors, classic presentation.

“Nah,” he said, “I don’t think it’s hemorrhoids.”

“Well”, I responded, “it could be a case of rectal polyps. I’ll need to do a digital rectal exam to know more.”

“Ugh! No! I don’t want that again!”

“You’re bleeding down there. I need to figure out why.”

“I had a colonoscopy five years ago, and they gave me a clean bill of health.”

“That was five years ago. A lot may have changed since then.”

“No. I don’t want the exam.”

I gave up. I ordered an occult blood test for him. I prescribed standard treatment for bleeding hemorrhoids. It’s up to him if he wants to adhere to the treatment plan.

If his occult blood test is positive, I’m going to refer him for a flexible sigmoidoscopy. But, man! Coming in for medical advice and then dismissing that advice out of hand seems like such a waste of one’s time. It was sure a waste of my time.

[madaboutharry]

1. Does he have a degree from The Google School of Medicine?

Those graduates think they know everything!

[Aristus]

3. He didn't mention Dr. Google, thank goodness.

But a quick glance at his problem list is pretty convincing evidence that this guy is not too keen on a healthy lifestyle and taking care of himself.

[erronis]

2. I can sort of relate when it comes to riding that Silver Stallion

I don't mind the prep and procedure of a full colonoscopy (had my 4th). Nice to know that I'm as clean as a whistle (for now.)

Since you're opening up this can o'worms: Should I continue getting 3 or 5 year checks (late 70s and last one clean)? My family does have some history of CRC.

[Aristus]

5. Most gastroenterologists recommend a follow-up period commensurate

with the result of your scope. Usually three, five, or ten years. Whichever they recommend unless adverse symptoms develop in the meantime.

[CincyDem]

4. Maybe a sphincter rupture issue from having his head so far up there?

[Aristus]

6. ...

[erronis]

8. Reminds me of a saying that goes around in certain meetings...

S: You'll know when you've understood when you hear that loud popping sound.
R: What do you mean?
S: You'll hear that popping sound when you finally pull your head out of your ass.

[Marcus IM]

7. Self diagnosing dental patients are the de facto. n/t

[Irish_Dem]

9. Interesting case.

He is rejecting your diagnosis right off the bat.
He doesn't think the bleeding is caused by hemorrhoids.

I would have asked him what he thinks is causing the bleeding.
He seems to have something else in mind.

Then when you suggest doing some diagnostic testing he rejects that too.

I wonder why he came in. Did a family member insist?

Is he worried about cancer? But doesn't want to face it?

Sometimes to go fast, you have to slow down with a patient.

It was not a waste of your time because you got this patient to do an occult blood test
and then can refer him to a specialist. It is going to be harder for him to argue
with a specialist who has a lab report in hand.

Humans are complicated creatures and sometimes you just have to meet them where
they are.

[DJ Porkchop]

10. I must remind everyone the details of a rigid sigmoidoscopy (you know, for laughs)

[multigraincracker]

11. I love my doctor.

She has these nice long thin fingers.

[getagrip_already]

12. He already consulted the good doctor maga...

And is on a course of bleach and horse laxatives.

So the rw chat groups have already diagnosed him

[3catwoman3]

13. Some years ago, I walked into an exam room to see a teenage boy with a...

…history of asthma and allergies. As I recall, I got about as far as saying hello before his mother, a very stern looking woman with quite a sourpuss expression, said, quite emphatically, “He won’t use an inhaler, and he wont take any nasal sprays.”

I replied, gently, “Well, that’s not going to leave me much to offer you, is it?”

What I wished I could have said was, “Then why the hell are you here?”

[Aristus]

14. I remember you telling me that story.

I wish you could have had the satisfaction of telling her what you really wanted to say.

I’ve told my new employers that I don’t see pediatric patients. It might affect my productivity numbers, but I don’t care. Bitchy, self-important, anti-vaxx parents, I can do without.

[czarjak]

15. My neighbor goes to the doctor thinking she's the smart one in the room.