“You’re a real piece of work!” he spat at me. He was a patient named Martin; I was the supervising physician, trying to role-model for a second-year resident how to conduct a difficult conversation with patients like this.
So far, not so good.
At first glance, Martin seemed an ordinary-looking older man, with close-cut gray hair and plain-framed eyeglasses. But I was struck by his scowl–he was expecting an argument, perhaps because during his interview with the resident he’d already encountered some pushback.
He’d brought a long list of laboratory tests that his biofeedback “doctor” had instructed him to get, saying that his fatigue and other symptoms were caused by “adrenal dysfunction.”
I scanned the list–thyroid, blood count, chemistries, vitamins, adrenal function. “Testing for vitamins,” I thought. “Are they kidding?” Normally, we test for only a small handful of vitamins; would our lab even know how to test for the others?
Outwardly, I tried to look neutral. “If I order a lot of tests, it’s statistically very likely that one will come back abnormal,” I said. “That may not indicate a real problem; it could only mean that you’ll end up having more tests.”
“I want all of …