Dr. Virus: I actually do not believe the July business at all. I think it’s an urban legend. I say never have surgery on a Friday if you can help it because I think the doctors who are on weekend coverage don’t know you as well.
Dr. Heart1: Weekends are complete black holes in the hospital. The worst time to get admitted to the hospital is, you know, Friday noon or later because everybody’s rushing to get out of the hospital, especially during the summer. Their doctors are going to the Hamptons. Plus there’s always that extended weekend elderly drop-off phenomenon.
Elderly drop-off? What’s that?
Dr. Heart1: Families will drop their elderly mothers and fathers because they’re about to go on a five-day vacation and they’re not going to see their parents for a couple of days. And, yes, their parents obviously have lots of medical problems, and they’re things that can be addressed at the hospital, but they could have been addressed two weeks ago at the doctor’s office also. So then, before an extended weekend, sometimes you have a surge, especially in the geriatrics floors.
Has anyone here had to fire a patient?
Dr. Virus: The patients that I’ve gotten rid of have been incredibly verbally abusive to staff or have stolen my prescription pad. We must tolerate anything short of abuse.
Dr. Baby: Well, there are many, but I remember one patient was horribly obnoxious. Every time she came in, there was something wrong. To my staff she was rude and demanding. If she had to wait more than five minutes, it was horrible and it went on for at least a year and I finally sat down with her and I said, “Look, you don’t like me. I don’t like you. Why are you coming to me?” And she started crying and she said, “You don’t like me? I thought you liked me.” And I said, “I didn’t mean that exactly,” and I had to start backing off a little bit, but I said clearly, “I think it is better if you find another doctor. I just don’t think we’re getting along.” She moved on.
Dr. Heart2: It’s hard to fire a patient. There are rules—a patient has to essentially be violent or very noncompliant, but I’ve seen doctors who sort of edge patients out of their practice just because they’re difficult or they display difficult traits that just demand understanding. Or sometimes the patients are just very sick and they take up a lot of time and the doctors are more than happy for them to go somewhere else.
“The worst time to get admitted is Friday noon or later because everybody is rushing to get out of the hospital, especially in the summer.”
What’s the most common mistake doctors make?
Dr. Heart2: One of the issues that I see frequently is overtesting. Someone I know was complaining of arm numbness, so he went to the emergency room and a neurologist there ordered a series of tests: a CAT scan, a carotid ultrasound, an MRI, a transcranial Doppler study, and then a transthoracic echocardiogram. Thousands and thousands of dollars later, there was nothing. He was put on medication, and he was told he was at an impending risk for another stroke. So he went home, and about three days later, the tingling returned and he thought he was having a stroke. So he went back to the emergency room, and the neurologist ordered more tests. It turned out a nurse diagnosed him with a slipped disk, which didn’t require any workup—just Motrin and rest.
Dr. Virus: But patients want the CAT scans. They only think they want Marcus Welby.
Dr. Lung: Would the patient be happy if the person was seen and sent home without a cat scan? They would not be happy.
Dr. Heart2: Patients are coming in and they got on the Internet and they’ve read about some valve problem. So they come in and they say, “Doctor, is it possible I have this valve problem?” How am I going to say, “No, you don’t have this valve problem” without giving all these tests? And if I don’t do the tests, they go down the block to Mr. X cardiologist, who is more than happy to do them. And then they go around telling people, “I went to this cardiologist who didn’t order the tests, and this other guy was so thorough!”
Dr. Baby: My father was a general practitioner, and he would say that you can sit and talk about how an antibiotic is not effective against viruses—but at the end of the twenty minutes the patient will say, “Are you going to write me a prescription for an antibiotic?”
Are most doctors good at what they do?
Dr. Virus: Ten percent are unbelievably horrible, 10 percent are great, and the great unwashed are in the middle.
Dr. Baby: The 80 percent in the middle are adequate.