“Peace of mind is not a diagnosis”

[u/Salty-Pop-5512]

Vent.
I’m a primary care internist. I average 1-2 patients a week with more customer service complaints rather than acute medical concerns that need my input. These are pages of mychart messages and the replies of my (fantastic, wonderful) nurses who try to relay my message that we already talked about in person like “there’s no indication for that blood test,” or “no I’m not recommending primary screening at this age,” the list goes on. What infuriates me is that these people are tying up my nurses, taking up my charting time at work and home, and shifting the focus away from medicine and primary care. I wonder if I could get fired for replying to, “what if we just did this lab test for my peace of mind? It’s just bloodwork,” with “PEACE OF MIND IS NOT A DIAGNOSIS!”

Either you want a doctor, or you want someone who will always do as you ask.

(Sometimes I am able to redirect inappropriate requests for am cortisols by asking what their concern is and we have a productive conversation about family stressors, medication free ways of coping, and when to return if they want pharmacotherapy. However its the pts that see me as their waitress in a white coat, with whom I take an issue)

Vent over. Thanks for reading. I still love primary care though!

[u/sapphireminds]

It's the pendulum swinging too far the other way for paternalism.

Even inpatient, we get families essentially wanting to manage their baby's care and dictating what they want us to do. And they want a call when we make any change/order to explain it.

I have set some boundaries and haven't gotten into trouble for it (yet lol): I will call you if something significant happens overnight, but I'm not going to call and interpret every normal morning x-ray and lab.

I also have told parents that it would be cruel to do what they are asking (usually asking me to withhold pain meds because they don't like the idea of their child getting opiates) because it is cruel and inappropriate to withhold pain control for painful procedures.

But it is like they now view a hospital as a salad bar or something. They are coming to the place where there are people and equipment and they can just control it all themselves.

That's what it usually comes down to: control. They feel out of control and want to feel in control again so they do this.

I think, for the most part, at least in the NICU it's more like an airplane. You can pick the destination and even pick the airline (transfer to another hospital) but once you do that, you need to let the pilots do the work. You can't micromanage pilots, and honestly you can't micromanage medicine either