Family Medicine

OK, its been a while. It seems I start all my posts this way. I am busy with work and family so sue me. I now work in family medicine. It's been nearly 5 years since I graduated PA school. A few things I've come to learn, Number one: Patient's don't listen. Or they listen but do they do not process what they just heard. Well, most of them don't. A few will do exactly as I ask of them and they tend to do fine. Some hear chest cold and leave thinking pneumonia. Many patients come in wanting, no expecting, a certain treatment based no past experience. The last Dr. I saw gave me Augmentin and I felt fine in 5 days, I want augmentin again. They don't listen to what I have found during their exam and why I think they have xyz. Mostly because Dr. Google or a friend told them they have ABC. They stop taking their antibiotics once they are feeling better, saving the remainder for a rainy day, despite out talk about antibiotic resistance. They don't agree with the diagnosis - they want to have something nasty so they can take antibiotics for a week or week two not knowing what antibiotics are even used to treat. Or, in the case of the ubiqutous head and chest cold, if they aren't healthy in a week, they are back in my office expecting an instant cure, something they imagine I have been keeping on a special shelf, for only the worst cases and most important patients. This is despite the warning that I gave them initially that it may take 2-6 weeks to get back to normal, but as long as they aren't getting worse, they be fine eventually. They come in with 9/10 right lower quadrant abdominal pain, anorexia, nausea, vomiting and diarrhea and wince and moan when I palpate their belly. I tell them I think they could have appendicitis, and explain why I think this is the case and the need to obtain more diagnostics to determine if this is true. I explain that, while I can't look into their abdomen, their history and physical have me concerned enough that I want to get a CT. I have my staff drop everything to schedule the CT for today, and ask the radiology unit to call me on my cell phone with the results, whenever they come back. I send the patient off with direction and instructions for the upcoming scan and explain to them that while it could be many other conditions, this could be a life threatening condition and that we may have to admit them if the CT shows something serious. They leave the clinic armed with verbal and printed information and instructions for their pending diagnostics. I spend the next few hours slightly worried, curious as to their condition and diagnosis. The next couple of hours after that, I consider the reasons why I haven't yet gotten a call from the radiologist. Surely the CT is done by now. I get a call just before bed. It is the radiology tech. She informs me that my patient never showed for their scan. I spend the next few days trying to follow-up with the patient, but their phone goes unanswered. I send a certified letter asking them to follow-up as we had discussed. No reply is ever received. Then a 3 weeks later I see a notice on the EMR. It indicates a patient of mine is in the ER. I open to see that my patient, the one I had worked so hard to get a rapid and accurate diagnosis, has been worked up and will be sent emergently to the OR for a ruptured appendix. The same appendix that I suspected was causing a problem 3 weeks earlier.