Shocking as it may seem, when I interview a patient (and examine same), I actually have a plan in mind. In the course of that interview, and that exam, I have both findings that I anticipate finding, as well as findings that, should they be present, redirect me from my initial assumptions.
That might be considered “testing my hypothesis”. Sort of like, oh, I dunno, as if it were derived from the scientific method, or something.
So, therefore, when my next patient’s opening conversational gambit, in response to my introduction and query, “what can I do for you?”, is something like, “Give me something for my bronchitis”, well, it is sort of at a tangent to the information that I am seeking.
For some reason, I assumed (yeah, I know….) that the diagnosis part of the interaction was, also, **MY JOB**, along with the plan of care part.
I tried again, in a different manner. “So, what sort of thing led you do conclude that you have bronchitis?”
“I googled it.”
Not helping. For some reason (perhaps I am a glutton for punishment), I tried again. “What sort of thing did you google, in order to establish that you had bronchitis?”
I had a couple of competing thoughts right about then. One was, ONE MORE STUPID ANSWER! JUST ONE! would lead me to remedy their zithropenia and depart. Another was, I was soon going to have problems buying hats, due to the hornlike callus that I was certain was growing from my forehead, secondary to beating my head against just this sort of wall, repeatedly. The third thought, and the one upon which I acted, was that I both had a professional obligation, as well as a morbid fascination, to pursue this conversation, and determine if I was, ever, going to elicit a recitation of symptoms, history of those symptoms, efforts already undertaken to mitigate those symptoms, and how those symptoms have progressed, if indeed they have progressed at all. Oh, yes: and if there were any illness among this soul’s acquaintances.
The conversation continued, with, painfully extracted, the retinue of symptoms seeing light. I conducted my exam, and, unsurprisingly, found this individual had mucoid post nasal drip (just like every other soul in The Un-Named Flyover State!).
Mr. Google asked about an antibiotic. I reviewed my examination findings: breath sounds did not indicate any pneumonia or bronchitis, and therefore, an antibiotic directed at same would be targeting problems that he did not have. Eardrums were not red or bulging, indicating the absence of a bacterial middle ear infection, and therefore an antibiotic for a bacterial middle ear infection would be treating a problem that he did not have. The back of his throat was not red, nor swollen, and did not have the patchy exudate universally described as “white spots”, and therefore strep pharyngitis was not among his maladies, and treating a strep infection that he did not have, would provide him no advantage.
I concluded with the observation that he **DID** have post nasal drip, one’s throat was, apparently, not well engineered for post nasal drip, and commonly became irritated, with this irritation manifesting itself as pain and a sore throat, or a “tickle” and a cough, or both. I continued to note that reduction or resolution of his post nasal drip, accomplished by my stated plan of care, would remove the stimulus for his cough and therefore, address his symptoms as well as his problem.
I refrained from asking if Google had explained THAT shit to him? Hmmmm?