“Doc, I can’t stand him. I don’t want to go back. Ever.” She sat with her arms crossed across her chest, scowling.
“Oh.” I felt awful. I work hard to refer to the best possible specialists. Did I miss the mark for her somehow? “Tell me why.”
“He told me that my dizziness was because of BPPV and that most doctors don’t even know what those letters mean.”
Most doctors meaning me?
“Benign paroxysmal positional vertigo?”
“Yes! THAT! You know what it is?” She sounded impressed.
“Uh. Yeah. I was not aware that most doctors don’t know what BPPV is…”
“Well, then he said sarcastically that he knew I would go home and read all about BPPV and then I would know more about it than any doctor… any doctor except for him, that is.”
Any doctor, including me? Why did I feel defensive, like he was pointing the stupid finger at me, too?
“He is one hell of a pompous ass. I know you like him and all but he just rubs me the wrong way.”
I sent this patient because she was convinced that she had had a stroke.
Sometimes I send patients to specialists because I really don’t know what is going on. I am not supposed to know every single detail about every single possible disease or symptom out there. There is an awful dang lot that can go wrong with the human body. It is my job to try to rule out the easy stuff and refer to a specialist when necessary.
Sometimes, though, I already know what is wrong. Like this time. Not that she remembered the conversation we had had about BPPV some weeks before. She was a super nice, very sweet, intelligent woman but patients are conditioned to regard primary care physicians with a certain amount of suspicion and some just won’t let go of the worst case scenario until they hear it from an “expert”.
This has become a pattern with him. I guess I will stop referring patients to him. For now. When they start forcing us to only refer to other physicians within the system, I won’t have a choice.