February 24th, 2017

Z71.1: Worried Well

April Edwards, MD

April Edwards, MD, is the 2016-17 Chief Resident for Internal Medicine/Pediatrics program at the University of North Carolina School of Medicine.

I took my dog to the vet today. You’d think this would be a straightforward sort of thing for a medical professional. You’d be wrong.

When I woke my dog up at 5:15am (my new daily start time, as it’s apparently the only way I can find time to do board questions, and is also the excuse I use when I miss the majority of said questions), he seemed sleepy. He’s a really hyper, ADHD-type dog, so slowly slunking about was not his usual M.O. Despite my rational patient-assessing abilities, I naturally assumed he had cancer and checked his lymph nodes and examined his poop. I stuck my stubby “people” otoscope in his ears desperately looking for otitis. No dice. He was still sluggish even after being more awake, so I took him in to the vet’s office at their earliest appointment today. Where I then proceeded to be the worst patient ever.

Nurse: “What seems to be wrong?”

Me: “He’s just not right.”

Nurse: “Why do you think that?”

Me: “I mean, he’s peeing and pooping fine, and can still walk and chase balls and stuff. He just seems not right.”

Nurse: “…..” (*uncomfortable eye contact*)

Nurse: “Okayyyy. Well, what medicines does he take?”bulldog

Me:  “Just the regular stuff.”

Nurse: “Flea, tick, and heartworm protection?”

Me: “Yeah. The regular stuff.”

Nurse: “Which brand?”

Me: “You know. The kind in the red box. The red box from PetCo. I mean PetSmart. Or is it PetCo?”

Nurse: (*protracted sigh*)

I consider how I must sound to her, and I laugh out loud. The nurse continues to stare. But now that I’m laughing at myself, I think I’m funny, and I decide to continue my roll …

Nurse: “What kind of food does he eat?”

Me: “It’s in a blue bag.”

Nurse:  (*staring*)

Me: “You know — it’s little brown pieces.” (*bursts into giggles*) “Sorry, couldn’t help myself. “

Anyway, after getting through the triage questionnaire, the vet checked out my dog, rectal temp and all. He’s fine. Completely and totally fine. But I’ve become one of the patients I sometimes see in my clinic. And I know, without a doubt, that the ICD-10 code is Z71.1: Worried well.

I need these moments. These times of transposition where I am reminded what it feels like on the receiving end of a stethoscope. How, despite having a smart watch, I am not adhering to a diet and exercise plan of which anyone would be proud. And even though Zyrtec reliably helps my seasonal allergies, I can’t seem to be bothered to remember to take it every day, and then tell colleagues how my allergies aren’t well controlled. How the morning after I eat beets, I temporarily think I have renal failure. Every time. And a thousand other examples, some scary and serious, others mundane. Examples of being human.

My patients remind me of my own humanity.


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4 Responses to “Z71.1: Worried Well”

  1. Ana Jeronimo Alves says:

    Very interesting… the same happens when we go to our mechanic with our car… Itś even worse! These moments remind us how we are only experts in our only small field of knowledge. In every other aspects we behave as abnormal as our patients who we usually call ignorants and we are sure that they have no interest in their health! 🙂

  2. Jen says:

    Firstly, you are the client and not the patient. Second, just like a parent should know what their kid can/can’t eat pet owners should know these details about their pets. It isn’t a laughing matter for a parent not to know what medication their child is on, especially if that parent is a doctor. As a veterinarian, when I walk into a doctors office I am immediately judged as “not equivalent”. However, I 100% of the time know exactly what I take, how much, and when, follow my doctors instructions or have a conversation with them if I think I won’t be able to, and can do this for my elderly parents and both of my pets as well. As doctors, regardless of our species of interest we have to hold ourselves to a higher standard than we expect our clients/patients/caregivers to. The behavior this person describes is professionally disrespectful, not humorous.

    • April Edwards, MD says:

      Thanks for your comments, Jen. I hadn’t meant to endorse this kind of behavior, but rather I wrote this to demonstrate the importance of physicians realizing that we too are prone to some of the same mistakes and oversights that we sometimes find frustrating or annoying on our end of the stethoscope.

      While it is great that I was able to reflect on that, and learn appropriately what information is pertinent to my dog’s health–I think it is completely indicative of being human that I was ever in a position to not be doing that. It is wonderful that you are such a good advocate for your own health, and it would be great if everyone was already on that page. But the reality is that they are not–and there are myriad complicated reasons this can be true. Your perspective, as you note, is undoubtedly colored by your own health literacy from your Veterinarian training, which many of my patients don’t have the privilege of sharing. Rather than fault them for not being up to the high standard you mention, when they can’t remember Trimethoprim-Sulfamethoxazole for their treatment of cellulitis,, I find instead that it is more helpful to our therapeutic relationship for me to meet them where they are, and then go from there.

      It would be wonderful if we someday are to a place where clarity of communication and uniformity of education that everyone can equally understand and participate in their own health care, but we have a lot of work to do before we get there.

      So let’s roll up our sleeves!

  3. Dr D. Markus says:

    It reminds me of the need to be patient with my PATIENTS and never to be in a hurry.

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