WhiteCoat

A Classic Dr So-and-So Patient

ERP from ERstories.net  here again today and tomorrow… You know, WC needs a weekend off now and then…..

Why is it that certain doctors (usually primary care) attract a certain subset of patients? Our community is very heterogenous but I still find that several MD’s have tapped into certain subpopulations whether intentionally or unintentionally. Often, I find myself guessing (usually correctly) about who a patient’s doctor is before asking them. Clues like the med list, the last name, the insurance (or lack of it) they have, and PMH all give clues. I chuckle to myself when I ask them who the MD is and find I am correct. For example:

One doc seems to have about 90% of all the living Holocaust survivors in the US as his patients. (and he was not one himself) – usually on BP meds and Coumadin for Afib.

Another guy seems to have only patients with chronic pain, nebulous psychiatric diagnoses, and poorly controlled hypertension and diabetes. They often have Medicaid (which is honourable of him). However, even those with private insurance tend to be extremely challenging to deal with. Most are on Oxycontin, Wellbutrin, benzos, and Metformin.

One group sees only super rich entitled people who never have serious emergencies. However they often seem to have diagnoses of fibromyalgia and IBS way above the national prevalence. Hmmmm. Usually on Cymbalta, Xanax and something for chronic diarrhea.

One guy sees 90% patients from South America with no insurance – but they all have money and pay him cash. Often on random drugs they purchased on their last trip to Columbia.

One woman has a large non-English speaking, Russian population. They always seem to have some major issue going on. Often on no meds despite the acute MI they are having.

Another guy who is Asian seems to have all the really sick Koreans and Chinese in the area. Usually they are on dialysis and have a med list a mile long.

Another Asian doctor seems to only have the healthy ones. They tend to be on ziltch.

Of course none of this really matters since they ALL eventually become my patients! But thankfully they don’t REMAIN my patients until their next visit when I am on!

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11 Responses to “A Classic Dr So-and-So Patient”

  1. DaveyNC says:

    If I didn’t know any better, I would say that you are profiling! That’s a thought crime, you know.

  2. TK says:

    I hope it is only profiling if I treat them differently according to their MD. Either that or introducing myself as “Hi I’m ERP, so I assume your physician is Dr Entitlement?”

  3. throckmorton says:

    I love the patients that come in and badmouth their primary care docs who won’t give them narcotics and xanax for their “problem that no doctors can figure out”.

  4. SeaSpray says:

    Interesting post/observation.

    I thought the Asians were a healthy population.. or maybe that is if they aren’t on the American diet. ?

    I’m guessing the Russians are stoic and prefer to handle things on their own. ?

  5. Cal says:

    That is funny, I had not thought about this before. BTW, Colombia, not Columbia (unless there is a black market thing going on there).

  6. TK says:

    Pretty much in my experience, Russians (ie immigrants NOT Russian Americans) are pretty stoic especially the men. Korean (again immigrants not Korean Americans) men tend to be the same way. They often wait until they are basically dying before they come in! For some reason, this rule does not apply with women.

  7. TK says:

    You are right. Remember to pronounce it COLOMBIA.

  8. horsetech says:

    This happens to some extent in equine medicine, too. An unusual number of the horses referred in from one vet are either fine (the clients have money, horse walks in the door with a HR of 36* and goes home the next day), or are on death’s door (and the client can’t afford surgery). I have a theory (completely unsubstantiated) that he tells the wealthy clients to just ship the horse so that he doesn’t have to go out to the farm, whereas the ones he knows don’t have the money for surgery he sits on and dicks around with it until the horse is almost ready to circle the drain, then he foists it off on someone else. I have seen him work in the community/on the farm with other people’s horses, and he seems to specialize in doing repeated cursory exams and telling people “oh, give it a bit more time”, and/or coming up with his diagnosis of the week, which a) might not even be a recognized disease in horses and/or have any basis in reality, let alone the horse’s actual presentation b) has a better than average chance of involving prolonged treatments with expensive drugs and nebulous endpoints, so that he has to “recheck” the horse repeatedly for months (and can collect the markup on the drugs, since vets almost universally buy and sell their own pharmaceuticals). I’m sorry, I should stop rambling, it just pisses me off to see horses who never receive proper treatment for their ailments and sometimes pay with their lives.

    Cal, I hear South Carolina’s going downhill. ;)

  9. horsetech says:

    P.S. *The normal range for HR for horses is 30-44. I realize that a person with a HR of 36 is almost certainly in trouble.

  10. Lisa says:

    This is interesting, but perhaps not surprising.

    If someone in a subgroup finds a compatible doctor, they will recommend that doctor to others in their subgroup. It would be interesting to know how many of the patients for Doctor A are a result of a referral through a single connector who is a patient. I would bet that *if* you could map the patients, there would be some interesting social connections.

    Also, I’m sure that individual doctors have a bias toward treating certain diseases in particular ways, so while my PCP might try to help patients avoid statins through lifestyle changes, yours might prescribe statins even in marginal cases. And that bias will lead to patients who prefer that style to stay, while those who are looking for something different will leave.

    It does make me wonder if I’m typical or atypical for my PCP (and my specialist)…

  11. CJ says:

    I’m a third year medical student, and just finished an inpatient internal medicine rotation. We found the same phenomenon with patients admitted to the hospital on our team. It seemed as though all of the patients with very complicated medical histories and no clear-cut diagnosis invariably had the same PCP. I can’t count the number of times I heard my attending say, “Oh, that makes sense, this is Dr. So-and-so’s patient…” It really is funny that some doctors seem to attract specific patient populations, and I’m not even talking about an ethnic or cultural group, just patients with “complicated” problems or something similar.

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