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House Calls / Dr. Michael Schwartz

Published 5:32 pm, Sunday, December 30, 2012
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Patients often wonder, "Why won't my doctor call in a prescription over the phone?" Or "Why does my doctor need to see me for a simple complaint?" After all, seeing your physician is time-consuming and usually requires a co-pay. Perhaps patients feel inconvenienced that they have to visit their physician for what seems to be a straightforward problem. Some might even believe that the required visit is motivated by the physician's monetary interest.

Actually, the plain and simple reason is that it's just good medicine.

When a patient is ill and has had similar symptoms in the past, he or she often expects that the doctor can just call in the "same" medication into the pharmacy. After all, it was a cold, it got treated and it got better. It worked before and should work again, right? Unfortunately, this is not necessarily the case. Many illnesses and diseases are not as straightforward as they seem.

Here are some examples illustrating the risk involved:

A patient called my office stating she had an ear infection. She explained that she had this type of infection in the past and needed an antibiotic. Upon learning that an appointment was required, she expressed her annoyance but reluctantly agreed to come in for an examination. After a thorough examination, I extracted a large beetle from her ear. She left the office embarrassed but relieved to be "cured."

I received a call from a patient stating he was suffering from extreme back pain which was a result of a strain from carrying some boxes. He requested that I call in some anti-inflammatory pills and muscle relaxants. He explained that he had a prior back injury and assumed he had re-injured the same area. He was reluctant to come in for an appointment, hoping to avoid the "inconvenience." However, upon my insistence, he came in for a physical examination and tests. An X-ray revealed a tumor. Further tests uncovered an abscess (infection) in his lower back. He required a surgical procedure and then received intravenous antibiotics.

A patient called stating that she had a urine infection. She noted blood in her urine and requested an antibiotic. She had been seen for urine infections in the past and believed her symptoms were consistent with past incidents. She very reluctantly came in to be examined. A test revealed no infection, but a great deal of bleeding. She was sent for an X-ray which showed a mass. Ultimately, she was diagnosed with bladder cancer. An antibiotic would have delayed her diagnosis and wasted critical time needed for treatment.

A patient called the office complaining of a head cold. She had been seen about a month earlier for a similar complaint, but had not gotten better with conservative treatment, so an antibiotic was prescribed. A week later, she called back stating that she was "a bit better" and wanted to know if we could call in a "few more" antibiotic pills. Given the fact that she was not responding to the treatment as expected, we asked her to come in. After an extensive history and physical, we learned that she was overusing Afrin (a nasal spray for congestion). When overused, this medication can cause severe congestion and sinus discomfort. She had "forgotten" to mention this medication during her previous visit and hadn't mentioned it when she had called a week earlier. Afrin was discontinued and another medication was prescribed. The patient's symptoms were gone in three days.

A patient called complaining of "pinkeye." She asked that eye drops be called in to her local pharmacy. Although "outraged" that she needed an appointment, she came in and was shocked to learn that she had a "foreign body" in her eye. Ultimately, it required a surgical procedure by an ophthalmologist.

The above examples emphasize the importance of in-person doctor visits. Often, patients will indeed correctly identify the nature of their problem. However, this is not always the case and if the physician simply calls in their request there could be severe consequences. Doctors are medically, ethically, legally and morally responsible for their patients' health and well-being. In order to administer good medical care the patient needs to be seen -- in person. This includes scheduled visits to follow up for blood pressure, cholesterol, diabetes, etc., as well as physical exams and wellness visits. Your physician is there to protect the most important asset you have: your health. The next time you have a "simple" complaint, remember, the phone exam is not as good as the real thing.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, please visit his web site at www.drmichaelbschwartz.com