Open- vs close-ended questions and the problem of time

I was conversing with Dr. Dino the other day, and we were discussing OTC products, and which ones I recommended. Now, pharmacists don’t diagnose. Most of them don’t want to, and many of them will tell you that. (This is one reason reading statements like “Pharmacists are just people who didn’t get into medical school” really gets my goat, but that’s a rant best explored another time.)

We got to talking about how I asked people about their symptoms, and we discussed how I asked nothing but close-ended questions. And this is quite true. Intentionally. In pharmacy school (like medical school, presumably) we are taught to ask open-ended questions. This is great in principle, but pharmacists can’t stand and have a 15 minute conversation with someone about the etiology of their sore throat and chest congestion. Prescriptions need to be filled, phones are ringing, and goddammit Mrs. Smith is going to have a stroke if you don’t get her triamcinolone cream out in the next 46 seconds.

So I very much have a flowchart mentality when dealing with minor complaints. My advice is usually ended with “If it doesn’t get better in X number of days, you’ll want to see your doctor.” (Where X is adjusted anywhere between 3 and 7 days depending on the type of complaint.) After all, the first law states:

The Art of Medicine consists of amusing the patient while nature takes its course.

I like to think I do my small part in keeping the common colds and poison ivy and other trivial maladies of the ER/doctor’s office/clinic while nature runs its course.

It’s easy to have a flowchart mentality. I’ll just have to remember later — when it’s my job to diagnose — that I need to be more open-ended. In the pharmacy, however, the opposite is mostly true, though there are certainly times when it’s better to be more involved. Good judgement always applies.

[tags]Medicine, pharmacy[/tags]

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