Dr. Suzanne A. Salhab, is a multi-specialty Medical Physician, board certified by the American Board of Family Medicine, American Board of Multi-Specialties, and Board Certification in Addiction Medicine by the American Board of Addiction Psychiatry and American Society of Addiction Medicine. She recently opened up a brand... more
I see it every day; a patient comes in with a chief complaint, and instead of asking five questions, it's a quick referral and acute meds! One example is a headache; a male in his 30s came with a few days of recent headaches, albeit small headaches, so I asked,
- Have you started any new medications since having the headache? (Because most medications cause side effects)
- Have you stopped any medications that may have started the headaches? (Because stopping medications can do the same thing)
- Have you stopped anything like caffeine (this will give you the worst time of your life, by the way), withdrawal from anything, etc.
- How is your thyroid? (If they've ever gotten it tested)
- How is your sleep at night?
BAM! These five questions will get you where you need to be. So, instead of giving the patient a quick presciption for imitrex and sending him to a neurologist for his headaches, he says "my sleep is okay".
"Do you wake up at night or just feel tired during the day?"
"I guess both."
Then, I look around and ask, "Is this your significant other, your wife?"
To his significant other: "Does he snore, then silence? Then do you take your elbow, shove it and hit him, which causes him to breathe again?"
I get these terrified looks as if I was sleeping in the bed with them. "Uh, yeah."
"And you, my patient; I'm assuming you are tired during the day?"
"Alright. Here's a referal to a Pulmonologist." I am met with blank faces.
"To a lung doctor?!"
"Yup, you have obstructive sleep apnea." (Or at least I can bet on it!)
Days later, the report comes in, noting "severe obstructive sleep apnea".
Was that so hard? Imagine sending him to a neuro, who would've said "I don't know,", and this patient would've developed hypertension or heart failure if no one ever caught on that he had OSA.
Now, is it really that hard? No, it just takes more time. Now is it because Doctors don't care? To me, I wouldn't understand that, because going to work would be misery, and shoot, how embarrassing would it be when that patient comes back with the same complaint and a negative neurological exam. Then what do you do? Did you even order any type of baseline labs on this person?
So this is how I think. All patients that walk through the door must bring their medications so I can access side effects, and use their first visit as one of their physicals. Most insurances pay for it zero copay and the patient gets labs done! Obviously this is preventative, but you need that! Like I said, thyroid is a huge factor in everyone life, so that's why even in mental health, Get a TSH, panik TSH, GI: constipated TSH, Diarhea TSH, Derm: dry skin TSH, and so on.
So really, ask these five questions and be a good Doctor, or just take that white coat off and refer them. It's really not that hard!