I prefer the "bad" parts of outpatient over the "bad" parts of inpatient....but yeah, outpatient is getting pretty bad. Patient's attitudes seem worse in general. Doctors are not respected like we used to be (from what im told), I get treated like a vending machine. We get evaluated on patient satisfaction scores...
I've had some patients get mad when I mention diet & exercise at a visit they made for obesity. They just want wegovy cause, you know, theyve "already tried everything"
I get messages through portal requesting antibiotics cause theyre sick. When I decline and ask them to schedule an office visit for an evaluation first, some get angry cause "i know my body" "you just want to charge insurance!"
I had a recent patient complaint: Patient upset about not hearing about knee xray results. I check the chart... Knee X ray was ordered by a different provider. Results were available 2 weeks after our last visit which was for DM follow up and patient didnt mention the knee. Apparently they think I'm responsible for following up on another doctor's workup in addition to everything i do. Its silly, but they have an avenue to file complaints and therefore leverage.
I put my obese patients with OSA onto the CPET machine and then prove to them they have no cardiopulmonary disease but are deconditioned Then I take the time to be empathetic with them and tell them that they have no organic disease and that weight loss will help them.
Then I use the resting VO2 to calculate their metabolic rate and tell them this is them magical calorie number. Then I tell them to use Noom and/or see an R.D. and work at that calorie deficit.
Then I give them a pedometer ($3 on amazon... most people are not going to get it themselves because... people....) and tell them to get those steps up there and to increase their N.E.A.T.
Then I tell them I hate going to the gym also as I see lots of giant muscle steroid heads hoo-ing and hah-ing and I get shy and want to leave too.
Then I tell them if you can get these things done for a month and use the CPAP (which will give you more energy to do these things!) and it begins to come down, then I'll help you get your GLP1 agonist therapy (provided its covered.... if they have DM its so much easier for Ozempic)
when the patients give me the "i've tried everything line." I tell them, you've not tried these steps. you've not attained a caloric deficit despite what you think. now I empathize and tell them "I believe that you believe that you have tried everything. but if you did we wouldn't be having this conversation. now email me your Noom progress through the app so I can guide you through on my cell phone when im doing my walking at night in my home."
for reference I get 15,000 - 20,000 steps in per day (measured by pedometer and most of which I literally hop and prance around in my office room in between patients while typing on the keyboard) and the rest I get on an incline treadmill I do for about 20 minutes a day on weekdays (and 1 hour on weekends) doing 12% at 3MPH or a bit faster sometimes as well as walking in circles in my home at night while im on the phone (as I am doing now... posting on SDN...) and I maintain 12% body fat. I work 80 hours a week as well. I was never an athlete growing up. But as I approach my middle age, I must take all the efforts to stay in shape to prevent disease.
yeah the Z-pak mania is annoying. for those who just want some antibiotics because... I tell them how about I prescribe some cough / URI therapies / viscous lidocaine over the phone? free of charge its on the house. if its not better, then you come in and if you have signs of pharyngitis, pneumonia, sinusitis over 10 days etc... then we get you those antibiotics.
of course all of these things I do are only easy as I own my own practice. I can imagine all the "red tape" involved in a hospital based practice in which a doctor cannot just "give the patient a $3 pedometer"
luckily deal with a lot of bronchiectasis and COPD patients in whom any report of purulent sputum and worsening cough is good enough for me to give them something (provided they gave me sputum cultures before to ensure its not some crazy Pseudomonas in there)
it's also annoying when I see an NTM-LD patient who has smaer positive disease and cavitary disease but whose MAC or other organism is resistant to macrolides. I ask them did you have a lot of Z-paks in the past? the answer is yes everytime they had a cough. sign.