Forty Two Days discussed on AFP: American Family Physician Podcast

Automatic TRANSCRIPT

Fourteen to forty two days for a coupon lin rightous i guess one study people were going up to forty two days as routine care spiraling empiricism morris better right that's right that's right also interesting seven or fewer was as good as more than seven in community acquired pneumonia in adults so just as dr bell says in the article any time someone asks can i get away with shorter course of antibiotics the answer is yes you can all right guys so that that does it could episode actually just had one one more question okay i mean it was actually the reason why i came today i just had one more thing i wanted to talk about if that's okay we just spent a bunch of time on these topics there's other podcasts waiting in the next room we gotta get moving i'm sorry i if it's okay with you i just have one more really pressing thing you know wonder about this last article yeah fair enough so this probably sounds very familiar to many of the clinicians out there it's the doorknob phenomenon and in this issue we have a curbside consultation the door not phenomenon in clinical practice from doctors faden in gordon from temple university in philly so i know we're all familiar with this the doorknob phenomenon or doorknob statement occurs when a patient waits until the very last moment of the of the clinical encounter you know just as the physicians hand is on that doorknob leaving the room ready to be done and move onto the next tweeting patient and they bring up some new information forcing us to immediately side whether it's something we've got to act on immediately something to defer to the next visit what do you guys think whenever that happens you have a tendency to like have like a pitfall out in the middle of your stomach like oh no generally those statements from the patients generally volunteer one of two categories one might be the patients kind of reflection of ambivalence or about potentially medical problem they're having or an effort to prolong the clinical visit which sometimes can be out of retribution for a a long waiting period like sitting in your office or something i don't know about you guys but the topics that the patients bring up to me or often some of the more serious ones if i had to put my finger on it most of the time i would say patients bring up severe depression or anxiety after we've already talked about four other problems and i'm on my way out the door yeah totally there like usually super sensitive topics that you have to give some time to a very common one is tolerance function or sexual dysfunction in patients as well yes so this curbside consultation has a few strategies they'll deal with it right research is mainly focused on how to elicit these statements prior to the end of the visit so asking specific questions like agendasetting at the very beginning and asking is there anything else you would like address today prior to even launching into their other concerns so you can have rehearsed appropriate responses for in this occurs right because like luke mentioned you get that pit in your stomach sometimes you feel frustrated sometimes angry sometimes just like throw an off so one thing you can practice saying is i appreciate you disclosing that to me but we'll need to schedule another appointment to explore this further and this is perfect for those statements that are of low urgency that you don't need to act on right away you can talk about it the next visit of course it is prudent in cases of higher gency to take to take the time the extra time to address the person's need especially in a potentially life threatening situation or a medical concern that might require emergent workup and so what i find useful is is utilizing some answer larry staff potentially social work or other behavioral specialists in the clinic to help offset some of the time that's required for that and then being extra apologetic to your next patience in line so sometimes this can become a habitual thing though with some patients so when a pattern is noted it's important to defer addressing the statements for later visit saying i recognize this as an an important issue and i'd be happy to discuss it in more detail at your next visit at.

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