Running into a doctor at a party is not an excuse to ask for a diagnosis
February 18, 2020
By Geoff Frost, UBC Physiatry Resident
- The Fiesta Consult -
I’m at a party minding my own business. Knowing me, I’ve parked myself near the appetizer table. Just enjoying the evening without a care in the world when, wham, like a freight train it hits me.
A friend, or even worse a family member, casually mentions they’ve been having back pain. I’m a doctor right? And didn’t my mother mention I’m training to be a specialist that deals with muscles and bones? It’s just a tweak in their back, nothing too major…. But it might be leading to some new weakness. What should they do?
The “Fiesta Consult,” as I like to call them, has always terrified me. But for the longest time, I did not know why. Fiesta Consults really do seem innocuous at worst. So I did some self-reflection. At first I thought the Fiesta Consult inspired a racing heart because I was so green. A young resident does not want to get the diagnosis wrong when talking to their brother or sister. But I progressed through residency, I learnt more, and still. Whenever I got the call, a shiver of fear ran down my spine. Maybe I just did not want to do extra work? I’m a resident after all, I want to enjoy my down time. But that wasn’t it either. I do lots of extra work all the time, like writing this blog, and it doesn’t seem to bother me. But then I finally figured it out, I hate the Fiesta Consult, because I’m bad at the Fiesta Consult. Like… really bad. And here’s the rub, I think everyone else is bad at it too.
- Why? -
Think about it. When you go see a specialist like a Physiatrist, you usually have between thirty and forty five minutes their time. That’s time to talk about your past medical history, your medications, your symptoms, the tests that have already been ordered. You cover ground. When I’m fishing at the appetizer table for some pickles and you mention a twinge in your back, you’re lucky if you get five minutes of my undivided attention. And there’s no way I’m asking about your medical problems in the middle of a party. That’s just rude. But at the same time, it’s essential to making the right diagnosis. And don’t even think about a physical exam. It’s just not happening. So… yeah, the Fiesta Consult never goes well because it was doomed to fail from the outset. I cannot possibly address your concerns in five minutes when it normally takes me forty five. That’s just not what I do.
And then I started thinking. It’s more than just time. Even if I get generous and spend say, ten minutes at the party talking back pain, I still muck it up. The questions I ask are clunky. I forget to rule out key red flag symptoms. I’m just not in the zone.
We’ve all heard about athletes that talk about being in the zone for a big game or a big competition. But sometimes I wonder if the concept is more mundane than that. A cashier that focuses on ringing in every food item correctly, can we say they are in the zone? Do they feel like they have achieved a level of concentration and flow that enables efficient work? I certainly feel like I have “Doctor Mode” and “Geoff Mode”. Geoff Mode is all about bad jokes and meandering thoughts. Doctor Mode, that’s a bit more concentrated. More purposeful. More put-the-phone-away-and-focus. And it leads to better results. When I am really focused on a task, I follow-up on a patient’s responses. I search out possible diagnoses, and tick them off an ever expanding mental list one by one. When I’m in Geoff Mode, I assume a diagnosis and just kind of run with it. I don’t chase important leads.
- The Uniform -
When I reflected on what causes me to enter Doctor Mode I was shocked at how seemingly mundane the answer was. I get triggered by simple queues. When I walk in the hospital. If I’m wearing clothes that I associate with work. If I put my name tag on. These environmental changes send a clear signal to my brain. You’re wearing the navy slacks, your name tag, and every part of the décor around you screams 1990’s hospital. It’s game time. Focus.
I have come to deeply believe that my mental mode is hugely influential on whether or not I successfully carry out my function as a physician. To the point where I now dodge and weave the Fiesta Consult like a Republican avoiding the impeachment hearings. Not because I do not want to be of service, but because I strongly believe that my mental state does not allow me to be of service.
I suspect I am not alone. I suspect there are insurance salespeople, bus drivers, and bankers all nodding along in agreement. Ask me about the stocks at work, and I’ll drop a knowledge bomb on you. Stocks over drinks? You’ll get nothing but nonsense. The person has not changed, but the situation and therefore mental state has.
So in the end, I must sadly report that if you find me at a party, I won’t be much help with your back pain. I might even evade the question. And while my little epiphany might make me seem rude at social functions, I like to think that in the long run, it means I’ve done one small thing that helps ensure quality patient care.
Geoff is a fourth-year Physiatry resident at UBC. He currently serves as the Director of Communications at the Resident Doctors of BC and is the host of the Pulse Podcast. Geoff is a professional engineer in Ontario, and prior to entering medicine, he worked as a biomedical engineering entrepreneur.