"Patient Profiling" and Maximizing Your Doctor Visits

I encourage anyone who sees a physician in the US to look at these two articles:

Are You a Victim of Patient Profiling? - Dr. Pamela Wible

Dr. Gopal Chopra - 5 ways to maximize your doctor's visit

The first article is written concerning the ways in which doctors can stereotype patients and come to inaccurate conclusions. It's almost impossible, in medical education, to avoid doing this; medical education is pretty well obsessed with the "typical presentation" of diseases, which seems reasonable on the face of things.

Young woman with a sudden decrease in energy, weight gain, fatigue? Hypothyroidism! African-American woman with enlarged lymph nodes? Sarcoidosis! Middle-aged woman with fatigue, stiffness, paresthesias, and terrible sleep? Fibromyalgia!

(Seriously, sarcoidosis is almost a running joke in my class at this point. Per our exams and Step prep, apparently every African-American woman who goes to the doctor has it. Except its actual incidence is 1-40/100,000. It's a rare disease, guys.)

So the current heuristic-based system works great, unless you have an atypical presentation of a disease or just a rare disease. This can be a problem. Physician visits are almost always scheduled to be short, unless you have a concierge doctor. Occasionally you can get lucky, and find a primary care doctor who is older and made his or her money decades ago (or who at least has stopped caring about maximizing revenue). My personal experiences with doctors right out of residency has not been incredibly favorable--while they have a good chance of being at the top of their game in terms of medical knowledge, many of them have just figured out 3 things:

1. They have a lot of debt (on average $170,000 per the AMA)
2. They are finally at the stage of their life where they can make Serious Money...
3.  ... if they see as many patients as humanly possible

These 3 things do not really correspond to your goals as a patient: to maximize your time with the doctor, quantitatively and qualitatively. So, towards that end, I recommend you read the CNN article by Dr. Chopra.

Of that list, I personally feel the most important point is the following: Don't be afraid to challenge the doctor if you think he/she is wrong.

I like to think I'm a reasonably informed person, and for quite a while I ended up seeing a physician who incorrectly thought I had rheumatoid arthritis, based on an early miscommunication. This was, as you might imagine, a tremendous waste of time, and I ended up on medicine I didn't need and delayed when I actually began to receive useful treatment elsewhere. I was somewhat confused by the diagnosis at the time, but I have a well-developed instinct to go along with whatever medical professionals say. So I went along with it until it became painfully obvious that nothing was working... 2 years later. This was a huge mistake.

One final thing, of course. If you don't like your doctor, find another. Life is too short.