{"id":2042,"date":"2017-02-24T08:00:26","date_gmt":"2017-02-24T13:00:26","guid":{"rendered":"http:\/\/blogs.nejm.org\/general-medicine\/?p=2042"},"modified":"2017-02-27T12:01:13","modified_gmt":"2017-02-27T17:01:13","slug":"worried-well","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2017\/02\/worried-well\/","title":{"rendered":"Z71.1: Worried Well"},"content":{"rendered":"
\"April<\/a>

April Edwards, MD, is the 2016-17 Chief Resident for Internal Medicine\/Pediatrics program at the University of North Carolina School of Medicine.<\/p><\/div>\n

I took my dog to the vet today. You\u2019d think this would be a straightforward sort of thing for a medical professional. You\u2019d be wrong.<\/p>\n

When I woke my dog up at 5:15am (my new daily start time, as it\u2019s apparently the only way I can find time to do board questions, and is also the excuse I use when I miss the majority of said questions), he seemed sleepy. He\u2019s a really hyper, ADHD-type dog, so slowly slunking about was not his usual M.O. Despite my rational patient-assessing abilities, I naturally assumed he had cancer and checked his lymph nodes and examined his poop. I stuck my stubby \u201cpeople\u201d otoscope in his ears desperately looking for otitis. No dice. He was still sluggish even after being more awake, so I took him in to the vet’s office\u00a0at their earliest appointment today. Where I then proceeded to be the worst patient ever.<\/p>\n

Nurse: \u201cWhat seems to be wrong?\u201d<\/p>\n

Me: \u201cHe\u2019s just not right.\u201d<\/p>\n

Nurse: \u201cWhy do you think that?\u201d<\/p>\n

Me: \u201cI mean, he\u2019s peeing and pooping fine, and can still walk and chase balls and stuff. He just seems not right.\u201d<\/p>\n

Nurse: \u201c\u2026..\u201d (*uncomfortable eye contact*)<\/p>\n

Nurse: \u201cOkayyyy. Well, what medicines does he take?\u201d\"bulldog\"<\/a><\/p>\n

Me:\u00a0 \u201cJust the regular stuff.\u201d<\/p>\n

Nurse: \u201cFlea, tick, and heartworm protection?\u201d<\/p>\n

Me: \u201cYeah. The regular stuff.\u201d<\/p>\n

Nurse: \u201cWhich brand?\u201d<\/p>\n

Me: \u201cYou know. The kind in the red box. The red box from PetCo. I mean PetSmart. Or is it PetCo?\u201d<\/p>\n

Nurse: (*protracted sigh*)<\/p>\n

I consider how I must sound to her, and I laugh out loud. The nurse continues to stare. But now that I\u2019m laughing at myself, I think I\u2019m funny, and I decide to continue my roll …<\/p>\n

Nurse: \u201cWhat kind of food does he eat?\u201d<\/p>\n

Me: \u201cIt\u2019s in a blue bag.\u201d<\/p>\n

Nurse:\u00a0 (*staring*)<\/p>\n

Me: \u201cYou know\u00a0\u2014 it\u2019s little brown pieces.\u201d (*bursts into giggles*) \u201cSorry, couldn\u2019t help myself. \u201c<\/p>\n

Anyway, after getting through the triage questionnaire, the vet checked out my dog, rectal temp and all. He\u2019s fine. Completely and totally fine. But I\u2019ve become one of the patients I sometimes see in my clinic. And I know, without a doubt, that the ICD-10 code is Z71.1: Worried well.<\/p>\n

I need these moments. These times of transposition where I am reminded what it feels like on the receiving end of a stethoscope. How, despite having a smart watch, I am not adhering to a diet and exercise plan of which anyone would be proud. And even though Zyrtec reliably helps my seasonal allergies, I can\u2019t seem to be bothered to remember to take it every day, and then tell colleagues how my allergies aren\u2019t well controlled. How the morning after I eat beets, I temporarily think I have renal failure. Every time. And a thousand other examples, some scary and serious, others mundane. Examples of being human.<\/p>\n

My patients remind me of my own humanity.<\/p>\n

 <\/p>\n

\"NEJM<\/a><\/p>\n

Residency isn\u2019t easy. But it doesn\u2019t have to be quite <\/em>so hard. Explore NEJM Resident 360.<\/a><\/p>\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"

I took my dog to the vet today. You\u2019d think this would be a straightforward sort of thing for a medical professional. You\u2019d be wrong. 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You\u2019d think this would be a straightforward sort of thing for a medical professional. You\u2019d be wrong. 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