Impatient Medicine

I could say I never feel frustrated at work. I could say I cruise through every day with a warm smile and an open heart. I could say I feel nothing but love and compassion for every patient all the time. I could say I never get angry at a patient, never wish they would just shut the heck up or go away and leave me alone.

I could say all those things, but I'd be lying like a rug.

The truth is, doctors are just as human as anyone else. We have bad days. We have buttons. We get tired. We get PMS. We feel anger, frustration, annoyance and fear. We don't treat all patients equally all the time. We don't even like all patients equally all the time.

Now, I'm hardly one of those crusty curmudgeon docs. You know, the ones who bang in, barely look at you, bark orders, scribble in the chart and bang out. I'm usually quite nice to my patients. And I usually DO feel love and compassion. I truly enjoy my work, and feel honored to do it. But there are those times...

I'm going to describe a few patient "types" that predicatably get my dander up. If you recognize yourself here, cancel your appointment and find another doctor! Just kidding. My goal here is to add data to my "doctors are people too" hypothesis, and to raise awareness in people who might inadvertently be pushing their doctor's buttons. I'll alternate gender to be fair, because any of these can come in the male or female variety.

First there's The Late Mr. X. No matter how far in advance this one made his appointment, he always rushes in late, in a panic, almost too late to be seen. He drops stuff everywhere. He apologizes profusely every time, citing various plausible causes of his tardiness, none of them his fault. He charms his way into the exam room, backing up the whole line behind him. He honestly doesn't mean to be a pain. He was trying to be on time. He was planning to be on time. He probably has Adult ADHD. He's probably late to everything, bless his heart. Bless his heart, but curse his timing!

Laundry List Lily is the patient who schedules a brief appointment for "follow up" or "single problem" or "to discuss something with the doctor; it'll only take a few minutes." Then, when I ask her to tell me about her problem, she pulls out her list. A litany of complaints, none of them brief or simple. She really needed a long visit. Or three. If I address all of these today, it's going to delay everyone after her and make me late. And grouchy. In residency, I was told to Just Say No to the Lily's. Tell her we can deal with ONE problem only, and she'll have to reschedule for the others. This is easier preached than practiced. It might take weeks for her to be able to get back in. She's here now, she's already listed her problems, and oh, what the hell, let's just do it. Lily honestly doesn't mean to be a pain either. She probably thinks problems are easy for me. I think she might have low self esteem, might be unsure that she is worthy of much attention. When in reality she's worthy of much more than she asks for.

The Drama Queen is one of my personal least faves. I always imagine this one with her hand against her forehead, palm out. You know, the old "woe is me" pose. Her highness speaks in dire pronouncements. "I can't breathe." (This is while she is speaking clearly and calmly, thus obviously capable of breathing.) "I can't walk" (after strolling into the clinic with no assistance). "I haven't slept in a year" (blatantly impossible). Doctors are scientists, remember? We don't like broad sweeping exaggerations. We like data. We like precision. "I often cough when I breathe." "It hurts right here when I walk." "I've been having trouble falling asleep for 3 months." Patent impossibilities tend to lose you respect. Perhaps The Drama Queen would be more aptly named The Boy Who Cried Wolf. Remember what happened to him?

Thankfully rare is Eric the Entitled. In my Student Health Walk In Clinic, this one is often a medical student, I'm sorry to say. He is terribly, importantly busy, and really deserves to be seen quicker than anyone else. He absolutely can't get away from his essential role to make an appointment. He must be seen now. Oh, and he knows exactly what he needs. Don't ask him all these unnecessary questions. Just give him the precise medication he wants. And, of course, call him on his cell the minute his results are in. If you don't, he'll feel entirely free to just drop in and interrupt you so he can have the information at his convenience. Does Eric know he's a pain? Probably, but he just doesn't care. How do I feel about Eric? The truth is I just wanna wring his righteous little neck.

The Ventriloquist is actually not a patient, but a spouse, partner, or family member who comes with the patient and answers all the questions directed at the patient. "So, Mr. Smith," I say, making eye contact with the patient, "Tell me about your rash." Before Mr. Smith can open his mouth, The Ventriloquist pipes up. "He's had it since we went in that hot tub at the hotel." I listen politely, turn back to Mr. Smith, and, when he doesn't offer anything further, I ask my next question. "Does it itch?" Again, The Ventriloquist. "It itches like crazy! He's scratching a hole in his pants!" Etc, etc. (The extreme version of the ventriloquist is The Controller, who might be an abuser in thin disguise and who is not one bit funny). The Ventriloquist can only be silenced by Banishment to the Waiting Room.

Drug-seeking Dan is one that all doctors know. He comes in different shapes and sizes, he uses varying strategies, but his goal is always the same. Only the story changes. " Someone stole my meds. I lost my prescription. My regular doctor is out of town so I can't ask her for a refill. I accidentally dropped the bottle in the toilet. The dog ate it." and other variations on this theme. The strangest ones are sometimes true ("my ex-wife threw all my stuff on the lawn and burned it"). The other clue that you might have a Dan on your hands is when he says something like, "I have this recurrent pain problem [with no physical findings] and it's back again and ONLY Percocet [or other specifically named medication and dose] works for me."
Dan is looking for a gullible, kindly practitioner to sucker. This used to be me, but I've toughened into a cruel bitch over the years (or so Dan has informed me). To avoid being mistaken for this miscreant, get your meds filled on time by your regular doctor, and keep track of them!

Roundabout Robin has never met a question she didn't like. And she never answers with a single word. You ask Roundabout Robin one of the open-ended questions that work so well with other patients, and you soon wish you hadn't. The answer to "How's your breathing?" might go something like, "Well, I remember back when we lived on the ranch, and my daddy had that old pickup, and we used to ride in the back when he went out to count the herd, and that dust would just blow up in our faces and make us cough like crazy, and I couldn't hardly breathe, it was so awful, but I could never ride up front in the cab because Daddy always saved that seat for his stupid dog..." Get my drift? As a doctor, you learn quickly not to ask Robin open-ended questions. You stick to simple, yes or no questions, figuring you can't go wrong with those. "Have you ever been hospitalized?" That oughta work, right? Only two possible answers to that one. You have, or you haven't. Right? WRONG! Roundabout Robin is incapable of speaking in one-word sentences, remember? "Oh, one time, I was so sick, and my sister, she kept telling me I oughtta go to the hospital, but I didn't want to go because I had a roast in the oven, and I knew I was really sick because every time I opened the oven to baste that roast, I threw up on the new linoleum floor we just laid the week before, so..." Roundabout Robin is the only patient I am rude to on a regular basis. I can't help it. If I don't interrupt her, we'll be there all day, or else I'll end up in the clink for strangling a patient, and then I wouldn't be there for her next time. So I have to be rude, right? Right?

Last (always last), By-The-Way Bill. Also known in the medical world as the Doorknob patient. This is the guy who, as you have your hand on the doorknob ready to leave the exam room, says, "Oh, by the way, I have this crushing sensation in my chest, like an elephant sitting there...." Screech! About face. Why didn't you SAY SO IN THE FIRST PLACE?! It's always something potentially horrible, this last-minute problem. And sometimes it's more than a potential. In fact, medical folklore is full of "doorknob disasters", where that tossed-off comment sets off an avalanche of major workups and often hospitalization. Like a little Smart Bomb. Bill doesn't actually annoy me as much as worry me.

I'm sure I'm leaving some out, but I'm starting to feel like Whining Winona here so I better quit and think about something more pleasant (like..... flowing myrrh!) before I get really grumpy. I can't afford an Attitude Adjustment on my government salary.