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Curbside Consult with Dr. Jayne 3/27/17

March 27, 2017 Dr. Jayne 2 Comments

After my recent adventures in healthcare, Mr. H asked me my thoughts about “playing the doctor card” when a physician becomes the patient.

I’ve had some experience with it at multiple times in my career and have chosen different strategies depending on the nature of the situation and the potential risk/benefit equation. It’s definitely more straightforward when you’re dealing with an emergency situation or if you’re in a situation where you’re seeking care at a facility where you are on staff vs. just being a physician. If you’re at your own facility, depending on how large it is, the odds that someone will recognize the fact that you’re on staff are higher, so sometimes it’s better to just identify yourself and avoid awkwardness.

I’ve done that when calling ahead to the emergency department to let them know I’m bringing in a close family member who has an emergency, and also to ask who is on call for whatever specialty care might be needed in case I want to go somewhere else based on the call schedule, or call a colleague and ask them to come in when they’re not on call. To be honest, though, I would do the same thing for one of my patients, so I’m not sure how much that really is playing the doctor card.

If I’m having difficulty scheduling an outpatient appointment, or want a certain time slot (first patient of the day, something like that) I may mention to the schedulers that I’m a physician and looking for a particular time so that I can accommodate patient care hours. I wouldn’t ask them to double book me or work me in, though, but rather add the physician component just so they understand I’m not trying to be difficult, but just need the first available appointment that meets my criteria so we don’t waste time looking at slots that I won’t take. Sometimes this is an issue when offices are performing practice improvement activities, when the staff is pressured to get patients on the schedule quickly, but I need to wait.

When I was recently in the emergency department for acute abdominal pain, I didn’t play the doctor card until I was in the room being seen by the physician. It was more for context since I wasn’t going to mince words about my symptoms and didn’t want to put him in the position of trying to figure out why I was spouting medical jargon. It seemed the best way to expedite care and also to give him the picture that, “Hey, this must be bad if she’s a physician who is going to have to call in for her shift because she’s here” as far as the severity of my symptoms. It turned out that his wife is one of my colleagues, so it was a bit of a bonding moment as well.

The decision to mention you are a physician or not can often be difficult. On one hand, you want to be able to interact with your treating clinicians at a higher level. But on the other hand, you don’t want them to leave things out because they assume you know more than you really do about an issue.

My recent appointment with the genetic counselor was a great example of a visit that went well. Since the patient history forms asked for occupation, I’m certainly not going to hide it — it’s a fact of demographics and social history just like my education level. The counselor asked open-ended questions about why I was there and what I hoped to get from the visit, which let me explain what I knew and didn’t know, and which allowed her to figure out where I was coming from. When we arrived at the discussion of the risk model, she asked if it was OK to skip the overview of genetics and inheritance and go straight to the details. I appreciated the fact that she asked, as well as the fact that we could have a deeper and more specific conversation due to the fact that I already knew most of the background information.

My recent inpatient stay had a couple of interesting interactions around the fact that I was a physician. The nurse who did my intake on the med/surg floor specifically asked if I wanted to be called “Dr.” or something else. I said to use my first name and she made a point of saying she just wanted to check, since I had “earned it” and she was happy to honor my preference. I appreciate that her statement was beyond just the, “How would you like us to address you?” question that all patients should be asked.

Once she put my name on the whiteboard, though, I was back to being Jayne, and no one asked again. I didn’t have to mention it until the craziness with the overnight nursing staff who had difficulty administering scheduled medications on time, and I attempted to be a “normal patient” until the delays became ridiculous and then I played the MD card. In that situation, however, they probably should have been more worried about the fact that my brother is a personal injury attorney rather than the initials behind my name. Fortunately there were no negative outcomes, however, so I didn’t have to play that card.

I’ve also been very upfront about being a physician when I’m about to do something that would be perceived as unusual for a “typical” patient. For example, rolling into a seemingly routine outpatient procedure with a copy of my healthcare power of attorney and living will. It’s more of a, “I’m a physician and I know things can go south even for the smallest procedures, so here are my documents” statement rather than a request for special treatment. I feel pretty strongly about my end-of-life wishes and want them honored, so I’m not afraid to play the card there.

My general thought process around when I say I’m a physician or leave it out is this. Does the person I’m interacting with really need to know? Is it germane to my care? Would I be mentioning it just to mention it, potentially creating an awkward situation? Or would mentioning it help diffuse an awkward situation? Is there something inappropriate going on where it might help correct the issue? Will I get better care if I mention it?

I’ve only had a negative reaction once when mentioning that I’m a physician, and that was in a situation where the care missed the mark so badly that I wasn’t surprised. It was a last-ditch effort to improve the situation and their response to it was very telling.

Putting on my physician hat, I’ve had multiple experiences where I have cared for other healthcare providers and wished they’d revealed their professional background sooner in the encounter. Case in point: I tend to have detailed discussions with my patients about why I’m choosing one medication over another and how it’s going to work to take care of their problem. I wish the patient who was a faculty member at the local pharmacy school would have jumped in earlier when I was discussing the relative effectiveness of various antibiotic families and why I was recommending one drug over another. When he finally did, though, he had a sense of humor and said he would give me an A+ on my explanation.

I’d be interested to hear from other clinicians on their experiences, positive and negative. Being on the front lines of healthcare delivery is like being part of a somewhat bizarre fraternity. No matter where you trained or where you work, you’re still linked by that underlying kinship and by subsets of shared experiences. Sometimes mentioning that you’re a clinician is in lieu of the secret handshake and just intended to say, “Hey, I’m one of us, it’s OK, I understand.”

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Currently there are "2 comments" on this Article:

  1. So funny about the physician card. I wrote my 3rd HL7 Lab and microbiology interface in my 20-year career this past year. So when I got a very bad Nocardia infection back in August, I was able to ask some specific questions about bug and drug match and when are those results going to be in and why hadn’t somebody called the outreach lab to follow up (rather than depending on the hospital lab to relay the information–or at least ask the hospital microbiologist to follow up with them). My doctor kept asking each visit how I knew so much. Finally on one visit he said, “Oh right… you’re that computer person.”

    • I’ve worked in EHR design & support for the last 14 years or so, and when I was hospitalized in I think 2007 I got multiple comments on what a good historian I am. When it got around to the social hx question about my work, the universal reaction was “oh THAT’S why”.

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