Other People’s Patients

How many of us remember Naughty By Nature’s 1991 hit song “O.P.P.”? Come on, guys. You KNOW you sang along:

“O.P.P., how can I explain it
I’ll take you frame by frame it
To have y’all jumpin’ shall we singin’ it
O is for Other, P is for People… scratchin’ temple
The last P…well…that’s not that simple…”

Ah, that last P. It really isn’t that simple. In the song, that last P was for… slang terms for genitalia that are not appropriate for a family blog. You could say, “Property”. Yeah.

In our practice of all part-time primary care providers, we often see each other’s patients. What’s so funny is all the different styles of practice around this. Some providers are more possessive… Like, “Why did my patient see you for their vaginitis/ sinusitis/ asthma flare? I was here in clinic!” Yeah, and you were running two hours behind. “But you could have grabbed me to discuss her before letting her go!” Right, and then get behind myself, for a straightforward issue…

Others are so happy to have something taken off their plate, you can’t get them to participate much. Like, “Hey, can I chat with you about your patient who may need a biopsy of a mass/ MRI of the brain/ stress test?” “Uh, sure, but whatever you want to do is fine, really…Do you need me to do anything?”

And, honestly, it’s all good… Seriously. I’m poking fun, but honestly, these approaches are valid. We all practice differently, and I can roll with that.

Though it can get tricky. If I’m seeing a colleague’s patient for one issue, but I notice another issue… Do I act on it, or pass it off? If a patient with a history of anorexia nervosa comes in with a sinus infection (NOT a real case), and I notice that she looks markedly thinner than the last weight recorded in the chart, do I try to weigh her? How do I broach that, in a visit for sinusitis? I don’t have a working relationship with this patient, I don’t know her psych treatment history, and getting a weight in an eating disorders patient can be a very emotionally charged issue. It may be more clinically appropriate to let her primary care know my concern.

On the other hand, if I know that her provider is very hands-off, and that my concern will be met with a “Thanks! I’ll followup on that at her next physical! In a year!” then I may be remiss in not addressing the issue.

And I’m sure that my practice style can be perplexing to my colleagues… I am fairly strict with prescriptions for stimulants, benzodiazepines and narcotics, but when they’re indicated, I’m good with that. I have definitely had colleagues approach me apologizing that they prescribed narcotics for an injury or benzos for severe anxiety for one of my patients. I say hey, I trust you, use your clinical judgment… I prescribe these things too!

I also feel very strongly that a good match between patient and provider is key to the therapeutic relationship. There have been patients who haven’t clicked with me, and if that is clear, I usually offer them a switch. Why waste everyone’s time? Find the patient someone they can work with. This happened recently; the patient had a very holistic, alternative medicine approach to her health, which is fine; but I can’t practice that way. I was trained in traditional Western medicine. I’m open, but I can’t manage herbs and compounds and dessicated pig hormones. I suggested a practice with this kind of philosophy and offered to help her switch over. (again, not an exact real case; rather, a composite, as this has happened multiple times)

I’m also OK with switches FROM me to another provider in our own practice…This has never bothered me. Sometimes, patients request to switch TO me, from another provider in our own practice. My approach has been, for the most part, it’s up to the patient. But some providers get ruffled feathers, or even hurt feelings. They wonder what they did wrong, why didn’t the patient like them, etc.

Hey, sometimes you just want a different hairdresser/ waxer/ therapist/ doctor. It’s usually not personal. It’s just…O.P.P!

“Come on, come on, now let me tell you what it’s all about
When you get down, you can’t go ’round runnin’ off at the mouth
That’s rule number one in this OPP establishment
You keep your mouth shut and it won’t get back to her or him
Exciting isn’t it, a special kinda business
Many of you will catch the same sorta OPP is you with
Him or her for sure is going to admit it
When OPP comes, damn– skippy I’m with it

You down with OPP (Yeah you know me)
Who’s down with OPP (This whole party)
You down with OPP (Yeah you know me)
Who’s down with OPP (This whole party)

Break it down!”