First, a word of thanks to KevinMD.com for picking up my post on family physicians and uncertainty.
I’ll make this post short and sweet.
What do physicians do when a patient lists a series of symptoms that make no sense; have never appeared in any medical text book? “Doctor, what does it mean when I look to the left and my right elbow hurts, I get bad gas, my left thigh twitches, and I sneeze? It happened once last week and it hasn’t happened since.”
Family physicians commonly treat this ambiguous set of symptoms with one treatment and one treatment only: reassurance. No x-rays of the elbow, no MRIs of the thigh, no CAT scans of the sinuses. No narcotic pain killers, no antibiotics, and no stomach medicine. Just a smile and a friendly pat on the back that it’s a normal part of life and nothing to worry about.
There’s no ICD-9 or ICD-10 code for this. Because the CMS payment system punishes doctors who don’t order a lot of tests, the family physician is ripped off for being a good listener to a concerned patient. But we do it anyway because it’s just part of the fiber of our being.
Maybe one day we’ll be paid for this important work that adds so much value to our healthcare system. I’ll keep dreaming.
My challenge is that I am getting patients who are not happy with reassurance. They want a referral. They want a test; they want a better answer; they want another doctor who will order all of those unnecessary test.