Ask Dr. Rob: Doctor Tricks

Our next question comes from PJ, who asks:

Why do you always measure the patient\’s blood pressure at the beginning of the visit, instead of halfway through or at the end?

First off, I would ask how you know what I do in my office. Have you been spying on me? Are you the one who put the listening devices and webcams secretly in my office? Are you the one who put the GPS device on my stethoscope? Are you the one who posted the video of me on YouTube? Are you the one who put those voices in my head that constantly tell me to move to Idaho and open a llama ranch?

Oh wait, those all went away with the medication adjustment. Sorry.

Anyhow, this raises an interesting fact that most people don\’t know about doctors: we have tricks that perpetuate our business and ensure job security.

The checking of blood pressures at the start of a visit is a prime example of this. We purposefully get scales that read approximately 10 lbs higher than normal scales and force a patient to sit in front of this scale while they get their blood pressure taken. If their blood pressure is not already high from the terror of the prospect of being weighed, we weigh the patient (proclaiming the weight loudly), and then their blood pressure is undoubtedly at least 20 points higher than it is normally.

The effect of stress on the blood pressure is a well-documented phenomenon known as white coat hypertension. This comes from the fact that often when people faced the prospect of standing on the scale in the doctors office, some of them would not only get high blood pressure, but also have a nervous breakdown, necessitating a call to the "men in the white coats" to bring the patient to the psychiatric hospital.

Then there is the whole process of taking a person\’s blood pressure. Did you know that a blood pressure cuff is called a sphygmomanometer? It is a documented fact that nearly 10% of medical and nursing students failed to get their degree simply because they could not pronounce this word. Simply hearing the word sphygmomanometer is good for raising the blood pressure by at least 10 mm Hg in the general population. I am actually at a substantially increased risk of stroke because I have written the word sphygmomanometer in this paragraph. If I don\’t move on from this subject, I may actually start losing readers to blood pressure related fatalities.

To take a blood pressure reading, the healthcare worker takes out an inflatable fabric cuff and puts it on the patient\’s arm. If it is a woman, the worker is instructed to say: "Oh, we need to get a bigger cuff because your arm is too…uh…the size is not right." This is sure to raise the pressure. For men, the opposite tactic is employed, implying that the lack of any significant muscles in the arm necessitates the use of the child-sized cuff (usually a pastel color).

As you see, PJ, these tactics enable physicians to have far more patients labeled as having high blood pressure and requiring many more visits and a higher visit charge. I have not even mentioned the tactic of putting fake patients in the waiting room and calling them to see the doctor before real patients who have been waiting far longer. The possibilities are endless.

There are several other techniques commonly employed by physicians to ensure job security:

• When examining a patient\’s abdomen, it is common to push down and utter the words "does it hurt when I push here?" If a patient says it does not, then you simply push harder. Once you have pushed hard enough to cause pain, you can charge more for the visit.
• Keep exam rooms cold and then ask about chills or keep them hot and note fevers. Both of these are common ways of necessitating return visits.
• Keep the patient in the exam room for extended periods and force them to read 10-20 year-old magazines. Or you can stock the room with only Highlights for Children and Rod and Gun magazines. This causes headache and nausea in a significant number of people.
• Tell a person to fast before a visit and then schedule the appointment late in the afternoon.
• If someone calls for an appointment, tell them that the first available appointment is sometime in 2008. This way the minor problems become major ones.
• Pediatricians commonly teach infants how to pull on their ears while parents are not watching, raising the number of visits by nearly 50%.
• Some children can be paid to act terribly sick while at home, and then be perfectly well when they come in to the doctor\’s office. This not only increases office volume, it provides hours of entertainment for the office staff.
• My dentist had a trick when I was a kid. The hygienist would check my teeth and they would be perfect. Then the dentist would go at my teeth with a pointy metal device. He would poke and dig and then proclaim he found a hole in one of my teeth that needed filling. I knew good and well that he had just dug that hole.

So there you have it. Now you know the "trade secrets" of physicians. Hopefully I haven\’t dashed your faith in our noble profession. Yes, we do some questionable things, but we do help people in many ways. If you doubt me, then you are invited to make an appointment at my office. I am sure I can work you in to my schedule sometime in the next 16 months.

Don\’t forget to send me more questions to dr.rob.questions@gmail.com.