The ODOMT Factor
Written by Jeffrey R. Waggoner, MD   
Dr. Jeff Wagonner 

My niece’s roommate is about to graduate from medical school. She’s struggling with the choice of specialties. Her father is a successful, very busy family practitioner. At one time, she had planned on joining his practice, but it was purchased by a medical school. Now, she’s not so sure about family practice.

She’s worried that family practice is about to become obsolete—about to vanish, like the Leaping Grey Dormouse—gone, extinct. She says that her medical school experience has suggested that all medical care will be delivered by specialists.

I have talked to her and tried to convince her that this should not be a concern. I fear I was ineffective. I didn’t want to appear biased. If I remember correctly, I spent most of the conversation stammering, fighting off the urge to say, in an inappropriately loud tone of voice, “ARE YOU KIDDING ME? What about ODOMT?”

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Specialists could never deliver primary care because of the, “Oh Doc, one more thing” (ODOMT) factor.

Many reasons have been studied for doctors’ choice of specialties. These have included gender, concerns about quality of life, peer pressure, and perceived income. The nitty-gritty of people’s skills has been more difficult to assess. The fighter pilot self-confidence that allows a good cardiovascular surgeon to make cool, rational decision when a surgical field is suddenly obscured by a tsunami of blood is difficult to quantitate. So is the patience and tolerance of a good psychotherapist.

No one has even considered the ODOMT factor. For those of you unfamiliar with primary care, this is the predilection of patients to obscure the real reason for an office visit until doctors have their hands on the doorknob at the end of an appointment. It is a frustrating, schedule-busting characteristic of a patient who is either embarrassed by a problem or frightened to death.

ODOMT complaints run the gamut from, “Does chest pain ever mean anything serious?” to “I got this really painful thing on my butt.” The ability to handle the frustration engendered by the ODOMT factor is one of the things that defines excellence in primary care.

In truth—it’s also a skill typically lacking in specialists.

The reasons that it’s lacking are many. First of all, many doctors choose specialties because they are aware that they do lack this skill. That fighter pilot cardiovascular surgeon? Cool in a surgical crisis, hardly cool when facing an ODOMT question.

Secondly, specialists have the built-in TNMAS means of ignoring an ODOMT question. Oh—TNMAS is the acronym for, “That’s not my area. Sorry.” With that sort of expiation, most specialists can leave patients with ODOMT questions hanging on their lips and feel absolutely no guilt. If they do feel guilt, they can always add SYFD (See your Family Doctor.)

Unfortunately, tolerance of the ODOMT factor is crucial but little appreciated. There are times when good care even requires an ODOMT provocation.

I recall a patient of mine who had presented with a strange kind of back pain. It defied my understanding, and she refused muscle relaxants and even an excuse for work. With my hand on the doorknob, I dredged up one more question, “How you sleeping?”

When she said she was awakening at three every morning, I made a rather precipitous leap and asked her if she was suicidal. She related to me the fact that she had a forty-five caliber pistol on the seat of her car and planned to use it on herself in my parking lot.


We moved her to our coffee area and my MA sat with her until we arranged hospitalization. There was indeed a pistol on the seat of her car.


Perhaps my niece’s roommate is correct. Perhaps health care will continue to devalue tolerance of the ODOMT factor. If so, patients will greatly suffer, and specialists will be asked to develop a skill they would rather not develop.

Anyone recently seen a Leaping Grey Dormouse?

About the Author

J.R. Waggoner, M.D. practiced family medicine for thirty years in Aurora, Colorado. He also worked as a consultant and herded cats as the managing general partner of a general partnership of physicians. Three years ago, he left his practice to study health care policy and write. During his time away from clinical work, he has written two books and worked as a Senior Clinical Content Specialist and freelance writer.

His current book Medical Metamorphosis: The three step cure for America's health care crisis is available at

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