- A patient suffering with hip pain seek treatment
from their physician who not only neglect
to perform a physical exam,
but lies about it in their notes.
This is bad medicine.
You recently went to see your doctor
because you were having some pain.
Tell me about that pain.
- I had gone to the doctor after two weeks-ish
of having some lower back hamstring pain.
- And this doctor, do they work at a renowned institution?
Are they an academic?
What kind of doctor are we talking about here?
- My doctor is a well-respected physician,
a highly respected hospital institution.
A lot of folks under him, also takes role in management
and also academics.
- What has your relationship been like so far?
Positive, negative, any issues along the way?
- It's been a positive relationship
until I, as a patient needed something
that required investigation and more than just emails
and more than a quick visit or a blood test.
- So when it was time for your appointment,
take me through that experience.
- I explained that I had an athletic injury.
I wanted him to ask me to take my short off maybe
or bend down or do something.
So I actually physically got out of the exam chair
as a way to sort of implicitly say,
it's okay, I'm okay if you wanna take a look at anything.
- It is absolutely ridiculous that a patient
needs to insinuate, hint at the fact that a doctor
needs to perform a physical exam.
Did you expect for him to wanna do a physical exam?
- I had hoped and I did expect it, yes.
I was saying to myself, once he takes a look at me,
he'll be able to tell me what's wrong,
but he didn't do that.
- Not every medical visit needs
a full, comprehensive physical exam, this is true.
In fact, just speaking with a patient,
you could tell if they're alert, or oriented.
That being said for a musculoskeletal problem,
you need to do a physical exam.
The doctor didn't perform a physical exam,
how was he able to begin making a diagnosis
or an assessment or a plan?
- Well, we had a discussion and once I got up
out of the chair, I voluntarily did some movements
to show things that I was able to do, and things that hurt.
Again, I did those things to almost suggest like,
maybe there's something else you wanna take a look at.
- What the patient's talking about here are special tests.
We actually do special tests to see if certain pain pops up,
if certain sounds are made by the body,
in order to figure out where the element is coming from.
- And after I did those things,
I was prescribed what I would call
a very general prescription for overall pain.
- In addition to the medication,
did your doctor give you any kind of imaging to do?
- I got a MRI of my lower back
and I followed that immediately.
- Rushing to do an MRI is one of the biggest mistakes
I see young doctors make in their careers,
but also experienced doctors that are treating VIP patients
who want answers quick.
The problem with getting an MRI too soon
is that oftentimes you'll see findings on an MRI
that are actually not contributing to the problem at hand.
Why do you think the doctor ordered a low back MRI
when your pain was actually your hip?
- Well, part of me thinks it's because
they may have been busy and didn't have the time
to examine me with their hands.
- We need to reevaluate,
especially in the field of primary care
how much time is given to doctors to spend with patients.
Because if ultimately we keep shortening that time
and asking doctors to do more,
the only person that really suffers is the patient.
Do you think had they had the time
they would have known where your pain was?
- What I would hope for is that if I come into an office
with pain and then able to point to it,
that someone else is able to touch it,
someone else is able to look at it,
someone else is able to talk to me about it.
- I think it goes to show the failure
of the healthcare system, not this individual doctor,
that we're actually encouraging doctors
to spend less time with patients, focus more on computers
and typing in electronic medical records
and making sure we're box checking
as opposed to caring about the patient
sitting in front of us and making the correct diagnosis
with the art of the physical exam.
How accurate do you think your doctor's "diagnosis" is
without doing a physical exam?
- For me, it felt like there was some box checking.
This patient has this issue, here's the solution,
without a lot of personalization.
I know he was a little late for our own exam.
He was probably running late with others.
Back pain's not going to kill anybody,
box check it and move on.
- Back pain can kill somebody.
A missed pyelonephritis, an infection of the kidneys,
a kidney stone causing a blockage
leading to a hydronephrosis.
In fact, you can catch a tumor early through back pain,
but you won't know the signs of an infection of a tumor,
unless you do the physical exam.
Once you got the result of the MRI,
what was it and how did you feel?
- The results left me feeling a little bit better
because I knew that there was nothing wrong with my back,
but I was left with wonder, because as I said,
the MRI didn't include my hip.
When I got no information on my hip,
I was worried because I said to myself,
well, I probably still can't go back to gym.
- While failing to perform a physical exam
on a patient suffering with pain is poor form,
it's not nearly as surprising as what happened next.
When you went back into your chart after that visit,
did you find anything in there that surprised you?
- I did, I found a full assessment
and know about my visit, when it was prescribed,
and also a physical exam, which didn't happen.
- The doctor lied.
How did you feel seeing that there was
a physical exam document that on this legal paperwork
and it never happened?
- I almost wanted to send an email
saying something about it, but I just didn't.
And I'm sure a lot of people don't.
- How did that make you feel about the healthcare system?
- It tells me that some things need fixing.
It tells me that patients need to speak up.
Doctors need to be educated about how they interact
with patients and patients need to be taught
how to ask doctors questions
sometimes if there are uncomfortable.
- This emphasis should fall only on doctors.
Well, yes, we want to educate individual patients
about strategies on how to deal with bad doctors
or negative experiences with health care.
The real goal is to make system wide changes
because this is a systemic failure.
Does this discourage you for seeking care
for your future conditions?
- I'm not discouraged from seeking care.
It's just been ingrained in me,
if I have a problem, I'm willing to go
and ask a question about it,
but it does make me question the threshold
of when I'll go back to the doctor.
If it's something that's simple or I think it is,
I probably won't go.
- This is the biggest loss of this whole situation.
Yes, there was a misdiagnosis,
and yes, the patient didn't recover
as quickly as they could have.
The fact is that this patient now will hold off
getting medical care in certain instances,
potentially worsening their situation,
potentially letting a cancer become more advanced
because of this negative outcome.
This is terrible, terrible, terrible stuff.
So the doctor gave you a prescription, did they MRI,
did your pain improve?
- No, my pain pretty much stayed the same
after my appointment.
- And what did you do then?
- I actually went to another doctor.
- Getting a second opinion from another doctor
is a patient's right.
Remember, medicine is as much art as it is a science.
So two doctors can come to two different conclusions
and have two different treatment plans
and they could both be right.
So a second opinion is crucial.
And was that experience any better?
- The experience was a 180 from the other practice
that I was at.
I made an appointment, went in to see the physician
who really didn't have a lot of history on me.
We talked a little bit and to my surprise,
he immediately started to perform a physical exam on me.
I was stunned.
- And so they did a physical exam, and what did they find?
- He told me, and I don't really remember the exact issue,
but that I had a hip problem from the photic injury.
The doctor prescribed me physical therapy.
- And, have you improved since then?
- A ton.
I've gone to the physical therapist
per the regimen that was prescribed
and I'm slowly recovering, probably about 90% now.
- You mentioned to me earlier that this doctor
that you went to for the second time
wasn't from an esteemed institution,
wasn't wearing a buttoned up shiny white coat,
what does that tell you?
- It tells me, all the glitters is not gold.
The first doctor, fancy degrees on the wall,
pictures with famous people.
The second doctor, it was a 180.
And to my surprise, I got a physical exam at this place.
No glitter, but gold service.
- Hands-off doctors aren't the only kind
of bad doctors out there.
In fact, I played six more of them right here in this video.
Make sure to check that out.
As always, stay happy and healthy.
(upbeat music)