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The Undefinable Work of a Family Physician, and How it Saves Society a Fortune – Part I

November 11, 2012
By

The following story is true. My imagination isn’t rich enough to make up this stuff. A colleague told me about this clinic encounter.

A 60-year-old man came to clinic to talk about several issues. He had the insight to state that he was depressed. His parents died 5 years previously; therefore his mom could no longer cook for him, because she was dead. A woman started coming over occasionally to cook for him, but he was further depressed because her cooking wasn’t as good as when she first started coming over. They had sex occasionally after the meal. No word on who cleaned the dishes. He told his family physician he was depressed because he wants a woman to cook for him and have sex every night. Occasional sex just wasn’t satisfying him.

He then said he wanted medicine for asthma. This threw the doctor, because to her knowledge he did not have that diagnosis. So she had to ask a bunch of questions to try to sort out the symptoms and their full history. He probably never had the diagnosis formally made in the past. There was no history of childhood wheezing, ER visits for wheezing or other trouble breathing, ICU admissions with intubations, or any breathing/inhaler medicines in early adulthood. As they kept talking he finally offered that he only wheezes when he smokes crack cocaine, but it happens pretty much every time he smokes crack.

Then the man said he wanted a wheelchair because he tripped on a tree root a few days before and hurt his leg. Mind you, he drove himself to clinic and walked about 200 feet without assistance to make it from his car to the actual clinic room.

Then the man asked for a Viagra prescription. He apparently had this notion that it would jazz up his sex life. Given that he had no trouble with sexual performance when he did have the opportunity, and his desire was for even more sex, he and his family physician mutually decided that his junk (the Latin term) was actually working fine and that a Viagra prescription really wouldn’t help anything.

Finally, he told his family physician that he feared for his life. His physician considered possible connections to his depression such as depression with psychotic features, bipolar disorder, or paranoid delusions. After further conversation, a proper diagnosis was made and the physician could relax that she did not need to try to initiate a psychiatric commitment. The diagnosis was:

 

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Wait for it.

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The boyfriend of the woman who cooks for the patient had recently come to the patient’s house and beat him up, and the patient was afraid the boyfriend might come back and beat him up again, or worse.

I thought the family physician came up with a very appropriate treatment plan for this final conundrum. She advised her patient that “Sometime in a man’s life he has to stop thinking with his little head and start thinking with his big head.”

Next week I’ll talk about the financial implications of this visit in light of how family physicians are (not) paid by all the major payers: Medicare, Medicaid, insurance companies, etc.

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4 Responses to The Undefinable Work of a Family Physician, and How it Saves Society a Fortune – Part I

  1. Bob on November 12, 2012 at 8:31 am

    A powerful story of the patient experience as a complicated one – for the physician and patient in their interaction. In the current environment of patient engagement through patient portals and social media, this represents the other side of engaging patients that has always been important – in the clinic and in the neighborhood. Thank you for sharing and your book is next on my Kindle.

    • Richard Young MD on November 12, 2012 at 6:18 pm

      Bob,

      Thanks for recognizing the complex work provided by family physicians. And thanks for your interest in my book, American Healthscare.

      Richard

  2. Laurence Bauer on November 12, 2012 at 9:14 am

    Wow. this strikes me as one of those wild stories that would play well on a TV series

    Larry

    • Richard Young MD on November 12, 2012 at 6:23 pm

      I’m afraid that the only way this story would interest today’s medical drama writers is if the physician gave the patient Viagra, stole his crack cocaine, slept with the boyfriend, and killed the girlfriend/cook by beating her to death with the wheelchair from the prescription she wrote.

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