"Ok, you're ugly too..."

... As a primary care doc, I see a myriad of ailments and complaints from a variety of people who are all shapes and sizes from all walks of life.

But there are a few common threads, observations, demands that pop up enough from my patients that merit some translation through my "Doc, what I'm really saying" translator (coming sooon as an app for your iPhone :)).

What they say: "I'm having trouble losing weight and I'm tired all the time, I'd like to have my thyroid checked out."
What it means: It usually comes from the 30 to 50 year old female wearing too much eyeliner and clothes that are 2 sizes too small - screaming kids are optional. They have a knock-off handbag that is filled with mentos and a 2 liter bottle of Mountain Dew. What she means is "I haven't exercised in years; I still eat like I did when I was a teenager; I like to drink and smoke .. alot. I'm starting to get fat and lonely and I want an easy solution that doesn't require any real work." Trust me, it's not your thyroid. Put down the twinkie and go for a walk.

What they say: "Your nurse said my temperature is 98 degrees; that's a fever to me because my temperature is usually 95 degrees."
What they mean: This usually comes from the mid 30's to mid 60's professional or soccer mom who looks pissed that they have to take a break from their busy day to see the doctor. They're not really that sick, but it usually means "This virus is annoying and disrupting my already too-hectic life. Write a prescription for an antibiotic, you little twit, so that mentally I'll feel better through the placebo effect. And no, I don't give a crap about causing community-resistance to common bacteria, I've got shit to do." Relax, take a day off of work, put your cell phone in a drawer, sit on the couch and eat chicken noodle soup and watch cartoons - the world and it's problems will still be there tomorrow. Yes, I will also validate your assertion, that because your "temperature is normally 95 degrees", you are unique and special.

What they say: "Tylenol and Ibuprofen don't seem to work for me."
What they mean: The patient will have some sort of pain complaint - twisted ankle, migraine headache and the classic, non-specific lower back pain. He or she is wincing and groaning and being incredibly histrionic - Emergency Room patient identification bracelet optional. Ocasionally will have rotten teeth and may actually be actively 'tweaking'. Their body language is screaming, "Give me oxycodone, hydrocodone, hydromorphone, morphine, tramadol, valium, horse tranquilizers, those frogs that you lick from the amazon-freekin-rainforest - anything that will get me high as a kite so I can get away from my miserable life for 10 minutes." I used to be sympathetic. Now, It just makes me sad.

What they say: "What? Hop along marietta beaver?"
What they mean: This is an elderly couple, usually in their 80's to 90's. She is deaf but refuses to wear hearing aids. He is pleasant but has dementia and always wears a baseball cap too high on his forehead. They are usually being seen for vague symptoms like fatigue, lightheadedness, insomnia and achey joints. This is usually the response to when I ask "How long have you had a fever?" What they really are saying is "We're old and tired and in pain. We want someone to listen to us and take us seriously. We know we're coasting into the 'beyond' but we want to enjoy the trip and remember the ride. Thanks for listening." Besides tweeking (not 'tweaking') their medications a little bit, that's all I usually do and it's that all they usually want.


Avoid saying any of the above and your doc may take you seriously the next time you're seen. Oh, never ask me for a 2nd opinion as you'll get the response (I can't help it) that's in the title ...