Fair enough. If I were your doctor, I'd just write that in your chart,
and that'd be that. After the usual discussion regarding probabilties
and such.  ;-)

You should let her know your history, of course, if you haven't done so
already.

I wouldn't say that. For one thing, Ultracet is pretty expensive.
NSAIDs (most of them, anyway) are relatively cheap. Both have risks.
Neither is "better" or "worse" overall.

Well, neither am I. However, medications certainly have their place,
and in this day and age, many patients (not necessarily you) expect a
quick fix for every ailment. Whether that's appropriate or whether we
should indulge them is subject to debate.

Depends on the person and the pill(s). For my diabetics, for example, I
most certainly "push" a baby aspirin, an ACE inhibitor, and...in many
cases...a statin and metformin. For my cardiac patients, I "push"
aspirin, beta blockers, statins, etc. There is clear evidence that
these medications provide substantial benefits that far outweigh their
risks. They have literally become the standard of care, and to *not*
push them is essentially malpractice. Patients can protest, but I do my
best to educate them as to why I think they need the medication(s), and
if they continue to refuse, I document their refusal and the reason for
it in their chart. This is what's known as "covering my a.s." Sad, but
unfortunately necessary in these times. You can bet that I'll keep
bringing them up from time to time, too. Just like smoking cessation.

Depends how you phrase the question, I suppose.  ;-)

I recommend a board-certified family physician. (Hint: there's no such
thing as "GPs" anymore, at least not in the U.S. of A.)

I'd definitely mention the "partner in health care" part (music to my
ears, personally). I'd leave out the part about listening and treating
you as an adult, unless your doctor doesn't. Saying something like that
beforehand is like stamping a scarlet "D" ("difficult") on your
forehead.  ;-)

Fair enough, but keep in mind that I'm also going to be wary of a
patient who has a long history of not being satisfied with any of their
doctors or treatments. However, I'm usually willing to give such
patients the benefit of the doubt, knowing that the real bad apples
will show their true colors eventually. Remember, doctors *can* fire
their patients. They just have to do it correctly.

Screening tests aren't always painless, but they're certainly
tolerable. Few things are more painful than being told you have
metastatic cancer, and early detection can go a long way toward
preventing that in the case of breast CA. There are ways to make a
mammogram more comfortable (choosing a good mammography center, for
one). It's never going to be something you look forward to, but don't
risk dying because of the fear of a little discomfort. It's probably
not as bad as you think, anyway. As for "horror stories" from other
people, *never* let these dissuade you from doing the right thing for
yourself. One person's experience is just that; *one* person's
experience. It doesn't have to be yours.

I agree. That's totally inappropriate.

You can. Just remember that the doctor-patient relationship is a very
unique thing. You're not a "customer" (a purchaser of goods or
services), and they're not a "provider" (regardless of the HMO
industry's adoption of that terminology). If you treat your doctor as a
partner, I think you'll find that they will respond in kind. That
doesn't mean being overly solicitous or inappropriately familiar,
however. You don't have to be friends with your doctor in order to have
a good doctor-patient relationship. All you need is a common goal: your
good health. Most doctors appreciate patients who take an active role
in their health rather than a passive one ("Fix me!"), so do your part,
and let your doctor do theirs. Also, if you want your doctor to be
flexible, don't *you* be rigid. "I'm not taking that medicine" is
rigid; "I'm not getting a mammogram because it hurts" is rigid.
Instead, say something like "I'm concerned about the possible side
effects of this medicine", or "I'm afraid the mammogram will be
painful". I virtually guarantee your doctor will respond better if you
at least indicate that a subject is open to discussion.

I'm a board-certified family physician.

Good luck!

        ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

Yep. You can get sounds, or ringing in the ears, and such. A reversible
tinnitus. This is called an "anion-gap" disturbance. The Acid-Base
balance is out of whack. Bad news.

My BF likes to tell this story of working in the local ER:

A woman came in complaining of hearing sounds. The ER docs were uninterested
and passed this "crazy lady" onto the psychiatry service, so they called
him in to see her.

Fortunately, the BF didn't accept this acute onset as being a reason to
drug her up, or offer up a Dx, and went on to investigate further.

Well, whaddya know...Turns out: the "crazy lady" had been taking too much
Aspirin. <!>

He said it was very disappointing that his detection of an anion-gap made the
other Residents and medical students finally come running to look at her
(so they could see an "anion gap" in real life). *blah* A good case for
those interested in the nit-picking field of Internal Medicine.(The other
field that the BF had considered; that may be why he picked up this teensy
"little" detail of an anion-gap problem <G>, while others didn't investigate.):)

Moral of the story: if someone is acutely "crazy" -- look for something
medical factor, or crisis.

PS. This has even happened to me. Last year the outpt team i was on had a
schiz. pt. who was well controlled with meds. He started getting
restless and verbalizing/behaving in his usual prodromal-relapse way --
i had no idea, but my RN had known him for over a decade -- so knew
RN he was re-lapsing.

(FWIW, most LT pts tend to show the same signs of relapse when it is
beginning to re-occur. e.g you will notice them doing their own little odd
behaviours, and/or their own particular strange ideas ("fixed delusions")
mentioned. In my rotation, i saw this play itself out a few times.

My RN got him to the hospital. The acute worsening of is "usual" stomach
problems weren't *entirely* a delusion. A flat-plate Abd X-ray showed the
fellow was backed-up full of stool. No *wonder* he complained about
increasingly regarding his 'stomach', and had stopped eating!

Cheers,
Emma