Playing Doctor

Initial Visit?

Tuesday, August 16

The Teaches of Peaches

In my clinic this morning, I saw a patient who usually argues with me about her care, arguing that my approach was wrong, no matter what problem she had.

This isn’t the typical, ‘Is there some way I can take fewer/cheaper medications?’ or ‘How important is this test/medication?’ It’s complaining about the approach to the problem. If I recommend a test, she wants therapy without any workup at all. If I suggest a therapy, she wants a battery of tests before taking so much as an aspirin.

She approached her health care the way persnickety people approach a menu. ‘I want the Cobb salad, but with no lettuce, and a double helping of ACE inhibitors, no x-rays, but I’d like a pulmonology referral and an MRI. And I want the dressing on the side.’ It’s tricky explaining to a patient why the treatment plan they came up with from reading the internet is inappropriate. It’s often like explaining to a teenager why they can’t have a flame thrower.

This woman was fairly sick when I met her, uncontrolled diabetes and high blood pressure as well as a few other miscellaneous unresolved problems. (Her last physician allowed her to dictate the treatment plan. Which is, admittedly, much easier than trying to actually control her illnesses)

Over the past year and a half, we made progress on her problems, even she admitted that. But every time I saw her, she would give me these exasperated sighs to let me know she thought of me as an incompetent fool who was simply a tool to get to her prescription drugs.

Today, even though I was over an hour late for her appointment, she was peaches with me, smiling and agreeing with everything I suggested.

I couldn’t figure out why things were going so smoothly, but at the end of the visit she explained the difference. She had been in the ED two months previously.

‘They asked me if I had some illness and I told them that I didn’t know, complaining that my doctor had never tested me for it. They asked me who my physician was. When I gave them your name, they chastised me. They said I had a good physician and that I was lucky to have you.’

I wasn’t sure what I was happier about, the compliment or the lack of argument.


Blogger dan writes:

Diddle my skittle.

That's an awesome compliment. Your contemporaries dig you. I had a similar yet more awkward experience when I was drunk this weekend and bumped into my boss. It's amazing the praise and compliments that a little tequila will knock loose. Sincere? Who knows, but I'm taking them at face value.


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