How I curb curbside consults

Set limits, or you'll never get through the grocery checkout line, says this formerly hassled physician.

By John Egerton, MD
Family Practitioner/Friendswood, TX

Can you call in another prescription for me?" said the vaguely familiar fellow in the grocery store. "They really helped." I had no idea who the man was or what he was talking about.

"The little blue pills," he added, seeing my confusion. He paused and coughed. "Can't remember the name now, but they really worked."

This sort of thing used to bother me. Would I offend the patient by not remembering his name or his medication? But after years of being hounded in grocery stores, on street corners—even after church services—I've stopped worrying and learned how to discourage curbside consults.

Some people, like the man with the cough, learn from a polite correction: "Of course. Could you call the office? I'd hate to get the wrong dose, and we need to keep your records up to date."

Others require firmer handling. One Sunday afternoon, for instance, a mother and daughter who lived in my neighborhood stopped by my house. "Deborah is home from college for the weekend and seems to be coming down with a cold," said the mother. "Could you take a look at her? I'd get her usual doctor to call in some antibiotics, but he's not on call today."

I complied then, and even did so a few weeks later when they knocked on the door again. But by the third time, I'd had enough. "I have an office," I told Mrs. Neighbor. "That's where I practice medicine. If you have an emergency, that's a different thing, but this is my home."

Sadly, some people only respond to extreme measures. One day, a patient who routinely pestered me for medical advice, stopped me in the grocery store to ask yet another fatuous question regarding his health. "Right," I said, loud enough for other shoppers to hear. "Drop your pants and bend over, and I'll look at them right now."

He hasn't bothered me since. In fact, I haven't seen him since.

We love to give medical advice. After all, that's our job. But we must restrict our practices to the rightful places—not only for our protection, but for our patients'.

An orthopedic surgeon I know learned this the hard way when he called in some antibiotics for a fellow churchgoer who'd confided that she had a "bladder infection." Unfortunately, he didn't realize she was also taking medications for asthma. The resulting drug interaction sent her to the emergency department.

Another colleague got into a similar mess when he tried to help a family friend stop smoking. For years he'd nagged the lady to quit. Then she mentioned a medication that could help, but she didn't want to wait around in her physician's office for a prescription. Her friend said, "No problem. I'll call one in for you." But my colleague didn't know the smoker had a history of bulimia—a condition specifically mentioned as a contraindication to the drug. The lady had a seizure a few weeks later.

We've got to learn that it's important to treat the ambulatory patient in the office. That's where the correct equipment is. That's where you stick to your routine and are less likely to make a mistake. And it's where you have the patient's chart—including his name.

I met a familiar-looking man in the hardware store the other day and was immediately on guard.

"Everything working okay?" he said. It sounded like a question, but I assumed it was a report on his medical condition, whatever that was.

"Good, good," I replied, trying to identify him.

"No more problems then?" he asked. I stared at him blankly.

"The telephone. I'm the repairman who came to your house last week."

It works both ways.

 

John Egerton. How I curb curbside consults. Medical Economics 2002;17:60.