Warning — I am about to complain. I am about to say some things born of frustration. However, I strongly suspect that this will resonate with other physicians out there. I am used to patients coming in having obtained a pre-visit consultation from Dr. Google. More recently, this seems to have transformed from an in person comment of, "I think my symptoms might be from an ear infection" to a phone call dictation that goes like this, "I have an ear infection. My spouse looked in my ear with our home otoscope and it is red, so I'll need you to call in an antibiotic." In the past few weeks, I've had patients inform me that they need a CT scan ordered or request specific treatment based on a home test of some sort.
I respect my patients. They are experts of their own bodies. I enjoy partnering with patients and shared decision making. What I do not enjoy is having my medical education and clinical judgment bypassed by the patient's own medical summation. Patients are often right about what is going on and I listen carefully to what they think might be causing symptoms. However, even with medical knowledge and clinical experience, I cannot diagnose strep throat over the phone or determine what diagnostic test is the most appropriate for a particular symptom or even if the testing is necessary.
What has led to this increasingly common phenomenon? Likely many things, but the leading contenders are healthcare costs and the ease and accessibility of healthcare information (and mis-information) on the internet. It costs money to see the doctor for almost all patients. I completely understand why a patient may balk at the time and cost of a doctor's visit if they are certain that they already know their diagnosis and what the treatment should be. However, this has led to the influx of calls and patient messages that now routinely lead to an extra 30 to 60 minutes per day to address. This time is not compensated, although the expectation is that you are providing evidence-based, appropriate care whether via an office visit, phone call, or email message.
Healthcare information is rampant on the internet. As we all know, much of it is either flat-out wrong or is not presented in the appropriate context. For example, a sore throat can be caused by anything from a viral infection to cancer. When the patient is reading through a list of possible causes, websites often do not distinguish between what is common or likely and what is uncommon or rare. As a result, patients may become alarmed by fairly benign symptoms or experience the anguish of believing they have a life-threatening disease when they actually have a self-limited illness.
These types of requests —for a specific antibiotic, for an order over the phone for a lab or diagnostic test, or for a referral to a specialist for something you've never seen the patient for — has been aptly named fast-food medicine. You figuratively drive up to the take-out window and place your order for whatever medical services you desire.
As our patients become transformed into customers and increasingly obtain partial or inaccurate information from the internet, friends, family, magazines, or alternative providers, it is incumbent on us, as physicians, to demonstrate respect for ourselves, our training, our time, our expertise, and our judgment by insisting and even demanding that we have the opportunity to fully use our skills to treat our patients.