What a doctor shouldn't do during an appointment

Last week I attended the immunology clinic at a teaching hospital in Perth. I’ve had mixed experiences there but was fortunate enough to see the consultant the last two times and was quite pleased. This time I had a registrar (student doctor) and things were quite different. Below is a list of things a doctor shouldn’t do during my specialist appointment.

• Don’t ask the patient why you’ve been coming to the clinic for the last two years when you start the appointment. It’s always useful to read the notes and find out at least a little of the patient’s history before starting any line of enquiry. This should be obvious for appointments marked as follow ups.
• Don’t ask the patient questions that have no relevance to the clinic. This includes questions about menstrual periods and the reasons why the patient takes thyroxine. Also, it should be quite obvious to even the most basic doctor why a patient is taking thyroxine.
• When the doctor finally gets around to a line of questioning more appropriate in the clinic, don’t just sit there without taking notes of what is being said. This could account for why certain details might have been missed.
• When issues are raised about cold hands and feet, swelling and discoloration, don’t neglect to do a decent examination of the hands and feet.
• If a registrar is waiting to discuss the case with the consultant doctor, please don’t sit in front of the patient and read case notes for other patients, especially for an extended period of time. This is especially true if the doctor has failed to take any notes of what is being said because it would be an ideal time to continue the conversation begun earlier and possibly to get around to taking notes.
• After conferring with consultant doctor, don’t neglect to respond to the issues raised by the patient in some way.

I realise the student doctors are learning but most of this was pretty basic and I honestly don’t think this doctor was ready to be handling appointments on his own. I get one appointment yearly and it was extremely unproductive. I don’t really think there would have been much difference in the outcome but at least it would have been good if I felt like the information I provided was actually recorded for future use. I didn’t bother mentioning some other issues related to the hands and feet because I lost any confidence that any appropriate response  or notes would be made. The doctor did order some blood tests, which I had done in the pathology department before leaving. There’s a bit more on the blood tests later.

Today I went to see my gp to discuss a variety of issues. We ended up having a pretty decent discussion where the situation with the boys was covered and a referral to the psychologist I see for the boys was extended. Then we discussed my recent appointment. Some of my blood tests had come back and a few hadn’t. There weren’t too many surprises there. Almost all were normal aside from my always high ANA. I spent a long time recounting my experience and explaining about the issues that I had wanted to discuss with the specialist doctor. We also discussed the pelvic pain I have been getting around the time of ovulation before renewing prescriptions for thyroxine and the Nexium. It was a good appointment.

My gp almost always prints out my test results so I can keep a copy for my records. The printouts include reasonably detailed information. My gp was curious as to whether the doctor had ordered an ENA test, which is an extension of the ANA. I didn’t recall it being listed on my form. Considering I have some sort of autoimmune thing going on, this should be automatic as it will be more likely to reveal something new than just the ANA.  I noticed the gp spent a bit of time reading the notes listed for the ANA. I assumed they were the same as the past two tests at the time. But tonight I read it  more carefully and it noted there was reason to order further tests. Considering the level of competence I had with this registrar, I feel it’s extremely unlikely he will order the additional tests. The antibodies suggested almost all are indicators of potentially significant disorders. Two of these are autoimmune liver disorders and my very uncommon ANA pattern is often seen in one of them. I’m going to have a pelvic ultrasound shortly so I’ll discuss this with my gp further when I see her again.