Scott: How do you tell your doctor what's wrong with you when you can't even yourself really put words to it and communicate what it is? We'll give you some pointers on what you can do so you can get better next on The Scope.
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Scott: Dr. Miller I have a feeling that there are a lot of patients out there that maybe aren't feeling 100%. They're not healthy but they really can't describe what their symptoms are.
Dr. Miller: But they're worried about it.
Scott: But they're worried about it or they just want to feel better. Right?
Dr. Miller: You know it's not something that's just happening over one or two days, but maybe it's been going on for several weeks.
Scott: Yeah but they're afraid. It's like when you go to the auto mechanic. By the time you get to the doctor the auto mechanic is going to have to start throwing parts at the problem.
Dr. Miller: It's a little bit overwhelming to come to the doctor's office and enter this large medical system where many things might happen.
Scott: Yeah, and then we're afraid you're going to start throwing tests at this problem and we're never going to find out what's wrong.
Dr. Miller: I think that inhibits people from coming to the doctor. So in reality, Scott, many times the diagnosis can be arrived at through a history and a physical.
Scott: Even If I just have vague symptoms?
Dr. Miller: Absolutely. And I think some people believe that rightly or wrongly they will need imaging. So a CT scan or an MRI or they'll need a lot of blood work or they'll have to get onto a treadmill. They might think a test is going to give them the answer. And that's not true. At least initially.
Scott: Okay.
Dr. Miller: And the other part of that is, or on the opposite side of that, patients might not want to do that because they don't have the funding to do that. They don't have the money to do that and so they're afraid that the physician is going to order many tests that they can't afford and that will just confuse things even more for them. They just want straight talk.
Scott: They want straight talk and then want to feel better and they don't want to have to take a lot of pills or do a lot of tests or come back to your office eight times.
Dr. Miller: Right. So two camps. One camp of patients might want testing that they think will make them better when in fact they don't need specific testing. They need to have a good history and a physical. And the other set of patients might eventually need testing but they are worried at the get go you're going to run up a whole bunch of bills performing tests. And that's not true either. It begins with a history and a physical.
Scott: That's your first line when somebody comes to you with this sort of a problem, you start doing a history. And how?
Dr. Miller: It's an age old approach to taking care of illness and it's still the best way to do it.
Scott: And how?
Dr. Miller: It's absolutely the best way to do it.
Scott: How often do you figure out what's going on just from that first step?
Dr. Miller: Probably 90% of the time we'll figure out what's going on or you'll have a general idea. You can create broad categories of diagnoses and those can be sorted out usually within the first visit for the patient by taking an adequate history.
Scott: So you do that history. What about for the 10% that that doesn't help? What would happen at that point?
Dr. Miller: It depends on what you find out. So that's a little bit hard to sort out. But I think the message here is that patients coming into the office will have some type of an answer by the end of the examination and then a more focused approach to what testing will be needed. And most of the time that testing is not extensive.
Scott: Yeah. Have you ever had a case where you couldn't figure something out?
Dr. Miller: Sure. Sure. It takes a while and sometimes you don't figure it out. That's rare. That's not very common. In general when you can't figure it out or put a name to it, the patient continues to do well. They may have complaints but in general it isn't a life threatening or chronic condition for them.
Scott: So you could take some relief in that.
Dr. Miller: They can and I can and you keep the door open and they keep coming back. If reassurance is important for them then that is an important thing to provide. Reassurance is a very effective treatment sometimes even when you can't find a diagnosis. But you can say, "I don't think this is going to lead to something terrible."
Scott: Is there something that the patient can do before they come to visit you for that first time to prepare for that kind of history probing that you're going to do?
Dr. Miller: Well we talked about this in another interview and I think that main thing for them is to write down a set of questions before they get to the doctor's office because many times patients sort of lose their words by the time they get in to see the doctor. They are a little bit anxious and they don't remember all the questions that they wanted to ask. So writing down those questions before they come in is important.
Scott: And those specific symptoms?
Dr. Miller: Right and sometimes bringing a family member to double check what they are seeing and thinking. Especially in the older patients it might be very helpful. Especially if there's issues of memory and forgetfulness associated with how they're acting and feeling.
Scott: So bottom line. If somebody is not feeling well they really should just come to see you because odds are you're going to be able to figure it out in that one visit.
Dr. Miller: Right, they should be able to go and see a primary care physician or a provider who provides primary care and ask questions. Spend some time having a physical and history and that's the beginning of the process of learning what is going on. I would say the majority of times, it's not usually something that is seriously wrong.
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