Clueless: Sometimes patients don’t want to know

Blonds are ditzy? Why would someone’s hair color make her dumb? If you think about it, how many real blonds exist? Most blonds I know get a little help from their friend Ms. Clairol. I almost never watched Married with Children, but I do remember one episode in which Peg and Kelly couldn’t remember their real hair color. (I remember my real hair color: blaaaack. Boring!)

Are some patients like the blond Alicia Silverstone in Clueless?

The answer is a humble, “Yes.” It’s not a judgment. It’s just a reality that some patients are completely clueless about their health. The reasons for their cluelessness range from disinterest to– well, maybe hair color. I guess it’s like how I am clueless in many ways when it comes to cars or home repair.

I can’t tell you how many times I’ve encountered something like this.

“So, when was the last time you saw your cardiologist?”
Patient: “?” 

“You know, a heart doctor.”

Patient: “Why would I see one of them?”

Usually at this point I don’t know how to break it to the patient that he has heart disease, and in most cases has had a previous heart attack.

“Well, your medical records show you had a heart attack about five years ago.”

Now everyone is allowed one good rationalization a day, so I brace myself for one.

“Heart attack? I didn’t have a heart attack, unless you count my being upset the Redskins didn’t make it to the Super Bowl back then.”

When someone doesn’t know he had or may still have cancer, that’s even more of a touchy subject. It’s interesting how I can ask the right questions but still not get the facts.
Therefore, the physical exam can become like the DaVinci Code in which I have to find the clues in order to solve the puzzle.

“Hm, strange. Where did you get this large scar across your back?”

Patient: “Oh, someone said he took out my lung.”
“Ah, do you know who removed your lung and why?”
“Haven’t a clue, doc!”

This is when I sometimes think about one-night stands: sharing an intimate experience and not even knowing your partner’s first name.

I see why a national electronic health record would be of use in these cases, because finding old records is as easy as talking to a live human being at Apple Support. (I own two Mac’s, and let me tell you: if the Apple doesn’t fall far from the tree, then the tree is petrified wood.)
Denial can be a reason for not having a clue, although usually you can figure out when a patient is avoiding an issue.

“Ms. So-and-So, your blood sugars are always high, but you didn’t mark on your intake sheet that you have diabetes.”

After a polite laugh and a Pepsodent smile, I often hear, “Don’t we all have a little sugar in our shoes?”

“Well, some of us do.”

“Honestly, doctor, I don’t see what is the problem with sugar. It tastes goooood. In fact, I’m gonna make you some of my sweet potato pie! You could use a little padding on your bones.”

Knowledge is power. Knowing about your own health and how to take good care of yourself has many advantages. It isn’t a sure bet that nothing bad like a heart attack, blindness from diabetes, or keeping cancer in remission will happen to you. It will, though, increase your odds of better health and longevity. After all, we all can’t be clueless and look amazing like Alicia Silverstone.
Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, Email him with your questions.