Текст книги "Dude, Where's my Stethoscope?"
Автор книги: Donovan Gray
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Текущая страница: 8 (всего у книги 14 страниц)
“Sure Frieda, we’ll see you then.” She made the same request the following week. And the week after that. And the week after that, too… . Finally, one night I went in and asked Martha, “Didn’t you say that she’d only need a ride every second week?”
“Oh, yes, I did, but since then my husband’s schedule has changed. Now he’s away every Monday. I hope that’s all right with you.” No it’s not all right, it’s bloody inconvenient!
“Well, I guess so. When did you say your car would be repaired?”
“Um… we decided not to go ahead and get it fixed after all. We’ve put it away for the winter.” Wonderful.
So Frieda became a permanent part of our Monday evening routine. Kristen would fetch her at 5:45. Ellen would buckle her in and off we’d go. You just never knew what little misadventure Frieda was going to have. Most of the time she didn’t have her permission slips. She often forgot to wear her winter boots. On the days she did have her boots, she usually forgot to bring her indoor shoes. Once our automatic garage door surprised her and she screeched like a miniature banshee. I’m guessing she had never seen one before. Amish much? Another time her mother gave her $15 to bring to the Beaver troop leaders and she somehow managed to lose it during the 30-second walk from her house to ours. That night Jan and I fretted over whether we should pay it for her. Fortunately, Kristen found the missing money on the road the following morning. On one occasion Beavers was held an hour earlier than usual because the hall was going to be used for some other function between 6:00 and 7:00. I notified Martha of the schedule change weeks in advance. The pickup at 5:00 went smoothly. When I returned to drop Frieda off a few minutes past 6:00, her house was dark and deserted. I asked her where she thought her mother might be.
“Probably at church,” was her response. On a Monday night?
“Which church do you go to?”
“The one with the cross on it.”
I had no choice but to take her to the arena with us. Normally I read medical journals while my girls skate. Not that day!
“Excuse me, can I run over there?”
“Sure, Frieda.”
Two minutes later: “Excuse me, can I run over there again?”
“Sure.”
“Excuse me, can I hop down those stairs?”
“Go for it, Frieda.”
“Excuse me, do you think my mom will be home when skating finishes?”
“I sure hope so.”
“Excuse me, I’m getting cold.”
“Here, Frieda, you can wear my coat.”
“Thank you! My hands are cold, too.”
“Would you like to borrow my mitts?”
“Thanks!”
“No problem.”
“Um… .”
“Yes, Frieda?”
“I have to pee.”
Sigh… .
A couple of months ago Frieda set the record straight regarding the nefarious Harry Potter.
“Excuse me?”
“Yes, Frieda?”
“You know the Harry Potter movie?”
“Yes?”
“It belongs to SATAN.”
“What?”
“It belongs to SATAN.”
“Well, we sure liked it.”
“Oh. Was it funny?”
“Yes, it was.”
“Oh. I never saw it.”
Last week Frieda’s family pulled up stakes and left our small town in search of greener pastures. On the morning of their departure Frieda came over with a batch of freshly baked cookies and a homemade thank-you card. Inside the card was a crayon drawing of me and four little girls driving down the road in a minivan. The girls were all holding hands, and everyone looked happy. Even the sun was smiling.
We’re going to miss you, Frieda.
Chiaroscuro (Light and Dark)
What’s worse, preparing incessantly for a war that never comes, or maintaining a state of blissful ignorance and getting caught flatfooted when the bombs start falling?
Educating my children about racism may help reduce its sting when they finally encounter it firsthand, but it will also hasten their loss of innocence. I’ve always been of the opinion that if my kids have to learn certain unpalatable truths about race relations, I’d rather they get the facts from me than from some bozo on the playground. I can mete out the required information in carefully measured doses, which is obviously far superior to having someone unexpectedly dump the entire toxic payload on them in one fell swoop.
Gradual desensitization makes more sense than abrupt immersion, doesn’t it? Sure it does. Unless… . Unless the anticipated immersion never occurs. What if I’m preparing them for something that’s never going to happen?
I’m black and my wife is white. Although our three daughters are of mixed racial heritage, history tells us that society will view them as black. Jan and I aren’t sure about how best to prepare them to cope with racism. I favour taking a no-holds-barred, worst-case-scenario approach and teaching them everything up front. She prefers the concept of letting them gradually come to their own conclusions.
I don’t want my daughters to develop an unnecessarily jaundiced view of the world, but I don’t want to see them get blindsided, either. What’s better, idealism or pragmatism? Should I hope for the best or plan for the worst? Tough choices. But then, no one ever said parenting was going to be easy.
Lost in Translation
“What we’ve got here is failure to communicate.”
– Captain, Road Prison 36, Cool Hand Luke
I have a patient named Irmgard who doesn’t speak any English. The first time I saw her in the office she brought her friend Roy to translate. The conversation went something like this:
“Hi, I’m Dr. Gray.”
“Roy.” He shook my hand, then pointed at his comrade. “Irmgard,” he said. She waved. I waved back.
“Could you please ask her what’s wrong today?”
They conversed in their language for a while, then Roy turned to me and said something like: “Hibida bibida pain hibida vonch stomach hibida shrek tang two weeks.”
“ What?”
“Hibida bibida pain hibida vonch stomach hibida shrek tang two weeks.”
“Um…She’s been having pain in her stomach for two weeks?”
“Yes.”
“Has she ever had this before?”
They spoke again. He looked at me and shook his head, “No.”
“Has she had any change in her weight or blood in her stools?”
They conferred. At length he told me: “Hibida bibida same stretch munch nona lollapalooza.”
“What?”
It was starting to look like I’d soon be needing a translator for my translator.
“Did anyone in her family ever have bowel cancer?”
They had an animated discussion that went on for a full minute. I fidgeted in my seat and waited. Patience, Grasshopper. Finally Roy swivelled around to face me and relayed her answer: “Purple.”
I made a mental note to never use Roy as a translator again.
Patients Say the Darndest Things!
“Yesterday I went to the hospital and they did a PAP test on my throat.”
“What’s your pain like?”
“It’s magnetic.”
“Does it hurt anywhere?”
“In bits and pieces.”
“How high are your blood sugars?”
“Anywhere from 4-foot-7 to 6-foot-5.”
“What’s your diarrhea like?”
“It’s kind of juicy.”
“How bad is your pain on a scale of one to 10?”
“Not too bad – about a nine.”
“Hey, doc, would you be able to fill out this welfare form for me?”
“Okay. What’s your medical reason for not being able to work?”
“Umm… I don’t really have one.”
“My vision’s blurry, doc.”
“Did you see an optometrist?”
“Yes.”
“What did they say?”
“She gave me some new glasses.”
“Do they help at all?”
“They work great, but I keep forgetting to wear them.”
“I was watching television the other day and they said those cholesterol pills you put me on do something to the lining of the wall.”
“The wall of what?”
“I dunno; I wasn’t paying that much attention.”
“What’s your last name?”
“Vogl.”
“Is that European?”
“No, it’s German.”
“Don’t inject me with that cortisone stuff, doc. Twenty years ago they injected some in my wrist and it stiffened up so bad I could hardly use it!”
“That’s odd. Why did they do the injection in the first place?”
“It was getting stiff.”
“Did anyone in your family develop heart disease at a young age?”
“Yes, my great-grandmother.”
“How old was she when she started having heart trouble?”
“97.”
Certified drug seeker:
“Geez, doc, I’m taking way too many Tylenol 3s. Can I get some morphine instead?”
Teenager who’s been slouching around the waiting room playing Game Boy, eating Cheezies and listening to his iPod:
“I have a stomach ache.”
“How bad is your pain on a scale of one to 10?”
“17.”
“The maximum possible score is 10.”
“Oh, okay, I get it. Um, let’s see… I guess it’s about a 12, then.”
“The number can’t be any greater than 10, and a 10 would be like someone cutting your leg off with a rusty chainsaw.”
“Oh. Well in that case it’s a 9½.”
… and sometimes sleep-deprived nurses say the darndest things!
“Mr. Bryant, since you're having trouble peeing I'm going to put this catheter in you, okay?”
“Does it go in my nose?”
“Do you pee through your nose?”
Let’s Get Physicals
“I’m here for my yearly complete examination.”
“I think the wife booked me for a checkup.”
“I’m fine, but I need a physical for my class A-Z driver’s license.”
“I want to be tested for everything.”
“Can you book me for one of those total body scan things?”
The complete physical begins with a series of health-related questions called the review of systems. The goal of these questions is to ferret out occult disease. In my experience, patients’ responses tend to be influenced by two main things – their personality type and the reason for the physical.
On the one hand are healthy people who are seeing me solely because they need to have their mandatory job-related physical examination forms filled out. On the rare occasion that they actually do have an active medical problem, they go to great lengths to hide it from me. It’s not too difficult to figure out why – their livelihood depends on my giving them a clean bill of health. In these patients, the system reviews are shockingly brief:
“Have you been having any chest pain?”
“No.”
“Shortness of breath?”
“No.”
“Weight loss?”
“No.”
“Wait a minute – according to our scale, you’ve lost 40 pounds over the past three months.”
“Really? I hadn’t noticed. Probably just that stomach flu I had last week. Hey, how about those Winnipeg Jets!”
Neurotics who are in for “a good physical” represent the other side of the equation:
“Have you been having any chest pain?”
Mr. Somatoform gets that far-away look in his eyes. He strokes his chin thoughtfully as he contemplates the question.
“Now that you mention it, I did have an episode of chest pain not that long ago.”
“When?”
“Last Christmas.”
“Nine months ago?”
“Yes.”
“What sort of pain was it?”
“It felt like a bolt of lightning.”
“Where did you feel it?”
“It shot from my right armpit to the centre of my chin.”
“How long did it last?”
“About three-quarters of a second.”
“Has it ever come back?”
“No, it hasn’t. What do you think it was, doc? Could it have been a heart attack? Should I be seeing a cardiologist?”
“I don’t know what it was, but I’m pretty sure it wasn’t anything too serious. Let’s move on. Have you had any shortness of breath?”
“Funny you should mention that… .”
Ramblers are a breed unto themselves:
“Have you been having any chest pain?”
“Chest pain, chest pain… . I’m not quite sure how to answer that, doctor. I haven’t had any chest pain lately, but back in the winter of ‘64 old doc Tilley had to admit me to the hospital for two days on account of the fact I was getting a mighty peculiar discomfort – I can’t really say it was a pain, mind you, because it was more of an ache than an actual pain, sort of like a nagging toothache, if you know what I mean – right above this here rib. At first they thought it might be pleurisy because plenty of folks in our neck of the woods had been coming down with it right around the same time I took sick, but in the end doc Tilley figured it was just…uh…doctor?”
“ Zzzzzzz… .”
And let’s not forget the Chronically Vague:
“Have you been having any chest pain?”
“Uh-huh.”
“How long have you been getting it?”
“Huh?”
“How long have you been getting the chest pain?”
Mr. Isidore gazes at me with the eyes of a chicken. After half a minute of deep thought he responds, “Quite a while.”
“How long is ‘quite a while’?”
“Oh, I dunno. A long time.”
“Weeks? Months? Years, perhaps?”
“I dunno. Been quite a while, though.”
After I’ve completed the review of systems I usually leave the room while my patient changes into a gown. If I return to find they’ve put the gown on with the gap facing the front instead of the back, I automatically deduct two points. The same applies to people who still have their T-shirt on underneath the gown.
I start every physical by asking my patient to turn their wrist over so I can palpate their radial pulse. Due to the location of the artery, it’s easier for me to check the right wrist than the left. Inexplicably, 98 percent of patients offer me their left wrist. Why is that? I’m sure there’s a research paper for some starving university student in there somewhere. Similarly, when I examine patients’ necks I usually ask them to tilt their heads downward slightly to make it easier for me to feel the glands. Most people immediately hyperextend their neck, which results in them staring up at the ceiling. Go figure.
Some people have more earwax than Shrek. Every so often I come across an unexpected surprise, like the time I discovered a bunch of uncooked spaghetti noodles wedged into a young man’s ear canal. As it turned out, earlier that week he had used them in an unsuccessful attempt to curette out some earwax. Epic fail! Once I had to flush a fly out of someone’s ear canal. How the frak do you get a fly in your ear?
When the ear exam is finished, I’m ready to inspect the throat. I stand in front of my patient, aim a flashlight at their mouth and ask them to open wide. Three-quarters of people open their eyes widely instead of their mouth. Research paper!
Occasionally a detailed eye exam is required. Some people are unbelievably calm when it comes to having their eyes checked – irritating drops and dazzling lights shone directly into their pupils don’t faze them in the slightest. Others are eye wimps – the instant the ophthalmology tray is brought out they reflexively scrunch their eyelids shut so tightly a crowbar couldn’t pry them open. It usually takes a fair bit of cajoling before these folks will allow me to proceed. Years of examining eyes have taught me that there are four cardinal directions: up, down, left and the other left. “Okay, Ms. Knowles, please look to your left. No, the other left.”
Next comes the throat. When I push down on someone’s tongue with ye olde glorified Popsicle stick and ask them to say “ah,” it’s not because that’s how I get my jollies. Saying “ah” makes the soft palate rise, which makes it easier for me to visualize the back of the throat. Half the time I ask patients to say “ah,” they either straight-up don’t do it or else they try to fake it. What? Do they think I won’t notice? Hel-lo, McFly, I’m right here! I notice! Say “ah!”
I just love it when someone a foot and a half away from me spontaneously ejects their dentures to show me a lesion in their mouth. Isn’t there some sort of unwritten rule of social conduct that stipulates prior to popping out one’s false teeth, a person is supposed to give innocent bystanders fair warning? I’m still waiting for the day somebody asks me to hold their drippy dentures for them.
Chest auscultation is always interesting. When asked to take deep breaths, many people take one deep breath and hold it. How is that supposed to help me? Sometimes I’m tempted to sit back and wait to see how long they’d last. And then there are the times when patients seem to forget how to breathe and I end up having to remind them to exhale after each inspiration. “Deep breath…exhale! Deep breath…exhale!” When I get tired of repeating myself I say, “That’s good! Just keep doing that, okay?” Seems to work.
While I’m on the topic, what mysterious force compels people to start talking to me while I’m auscultating to their chest with my stethoscope? At least once a day I’ll be straining to decipher a subtle heart sound when suddenly “My great-grandmother died of a heart attack when she was 98!” explodes into my eardrums. Now that’s annoying. Minus 10 points.
The umbilicus is the centre of the abdomen. Heck, it’s practically the centre of the entire body. You’d think people would make an attempt to keep it clean, right? Maybe even treat it to a little soap and water once in a while? Don’t count on it. I’m here to tell you that the hygienically-challenged walk among us. Some belly buttons are so full of dirt, you could plant an oak tree in them. Others contain enough lint to fill a Beanie Baby. Wash your belly buttons, people! This has been a public service announcement… .
Centuries ago, when I needed to evaluate male patients for groin hernias I would insert my gloved finger into their inguinal canal and ask them to cough. This inevitably resulted in them coughing all over me. Nowadays I say, “Please cover your mouth and cough.” My patients often look a little baffled when I make this request. Maybe they’re thinking, “You mean I don’t get to cough on you anymore? Bummer!”
Sooner or later all good things must come to an end. Once the examination is over we discuss my findings as well as any recommended investigations and treatments. When we’re finished most people say thanks, walk out and shut the door behind them. I’m never quite sure why they close the door. Perhaps they think I plan to teleport out of the room. Fortunately, I’m not claustrophobic. I finish my charting, reopen the door and mosey on down the hall to see what new challenges await me.
Survey Says…
My desk is littered with surveys. We rural physicians are a hot research topic these days – everyone wants to know what makes us tick. I imagine the brainiacs in their think tanks across the nation scratching their heads, vexed and perplexed.
“What makes them venture beyond city limits?” they ask one another. “And more importantly, what keeps them out there?” More fruitless head-scratching. Suddenly one of them leaps to his feet. He looks excited. Head Boffin arches a bushy eyebrow in the direction of his impulsive young colleague.
“Yes?”
“Sir, I’ve got it! Let’s send them all surveys!”
“Surveys?”
“Yes! We’ll ask them each a few hundred questions and then have our quantum computers analyze their responses!”
Head Boffin nods; slowly at first, then with increasing enthusiasm. Finally he breaks into a wide grin.
“Splendid idea, Dilton! First class! We’ll start immediately.”
And so it begins.
My receptionist unceremoniously dumps the morning mail onto my already overflowing desk. Junk, bills, test results, insurance forms, more bills… and two objects that look suspiciously like surveys. Shoulders sagging, I open the first one.
“Dear doctor, we truly appreciate you dedicating your life to rural medicine yada yada yada and we hope you won’t mind filling out the enclosed survey. Please review the following 200 items and rate their importance in terms of the impact they have on your desire to continue practicing rurally. We estimate this survey should take you no longer than 45 minutes to complete.” What?! 45 minutes? Are they nuts? I’ll be lucky if I get 10 minutes for lunch today! I wad the oversized monstrosity into a ball and three-point it into the recycling bin across the room. The crowd goes wild… .
Item two is a follow-up letter from a group whose survey I completed a few weeks ago. As I recall, this particular survey had asked more personal questions than most, but its authors had gone to great lengths to assure that all responses would be held in the strictest confidence. They also promised names would not be linked to the forms, so it would be impossible for them to trace answers back to the individual respondents.
“Dear Dr. 655, thank you very much for taking the time to fill out our survey. We notice, however, that you neglected to answer questions 19 and 99. Please complete them and return the form to us in the enclosed self-addressed envelope.”
Okay, this I can handle. I quickly finish off the questionnaire and drop it in the outgoing mail tray. Several hours later the penny drops – if they claim to be incapable of tracking the doctors filling out their surveys, how did they know the incomplete one was mine? Egads! I’ve been duped! With my luck the study will turn out to be the product of some nebulous federal intelligence-gathering agency. Good thing I didn’t mention my fluffy pink slipper fetish in the “deviant tendencies” section… or did I?
Although surveys can be a real nuisance, I’ll probably continue to fill out the shorter ones for years to come. Why? I figure those poor research eggheads need all the help they can get in their noble quest to decode the enigma of the rural physician. If they eventually succeed, perhaps one day we’ll be featured on a segment of Hinterland’s Who’s Who. First will come the familiar, haunting flute melody, followed by that unnaturally calm voiceover: “The Canadian rural physician is a peculiar beast that appears to thrive on challenge and adversity. Only recently have scientists come to understand why this curious creature voluntarily makes its home in the underpopulated nether regions of our great land… .”
Prescription for Parenting Skills
A few months ago one of my patients brought her three-year-old son in to see me. Although little Genghis had only recently begun attending daycare, the workers there were so alarmed by his pervasive aggression and impulsiveness they insisted he be assessed by a physician ASAP.
I walked in to find the rambunctious little fellow gleefully dismantling my examination room. His mother seemed oblivious to the crime scene unfolding around her. After reining him in a bit I obtained a history and wrestled my way through a physical. By the time I was finished, ADHD and suboptimal parenting were highest on my list of potential diagnoses. I spent several minutes reviewing my findings with his mother, gave her some reading material and made arrangements for a follow-up visit.
As I was about to leave I remembered Genghis had a five-year-old brother who had always struck me as being excessively busy. The last time I saw him I had suggested we schedule an appointment to explore the matter further, but his parents hadn’t taken me up on the offer.
“Did Anakin start school this year?”
“Yes, he did.”
“How’s he making out?”
“Super!”
“I’m glad to hear that.” I began leaking towards the door.
“At first we were getting a lot of notes from his teachers about his behaviour, but a few weeks ago I figured out a way to stop that.”
“How?”
“I just give him some Gravol right before he leaves for school every morning. It works great – he hasn’t brought home a single note since!”
Introspect/ Apologia
Lately I’ve been reviewing my medical narratives. Some are autobiographical, others reflect patient encounters, and most of the remainder relate to parenting. One thing I’ve noticed is that a few of the narratives depicting my interactions with patients are slightly cynical. Usually it’s just my warped sense of humour at play, but once in a while there's a bit of an edge to it. Some of this can probably be attributed to representational bias. I'm no neurobiologist, but I suspect difficult experiences engender higher rates of memory protein synthesis than neutral events. In addition to that, stories involving conflict are intrinsically more interesting to write about and analyze than their more peaceful counterparts. Who wants to read a book about unicorns frolicking in the sunset? For the purposes of discussion, though, if we suppose that I do in fact have an embryonic case of misanthropy gestating, is it being nourished by my patients, my job, or me? I think it’s probably a combination of all three.
For starters, I am definitely not the touchy-feely type. I tend to favour a linear, problem-solving approach to medicine. Within the first few minutes of most interviews I’ve usually assigned my patient’s presenting complaint to one of four categories:
1) I can fix this.
2) I can’t fix this myself, but I know someone who can.
3) I’m not exactly sure what’s going on here, but I get the impression it’s something fixable.
4) Jesus and Gandalf combined couldn’t fix this.
The instant I realize I’m probably not going to be able to help the person I’m seeing in any meaningful way, I start getting fidgety. The way I see it, every morning I arrive at work with a finite amount of expendable energy. Once it’s used up, I’m pretty much done for the day, psychologically speaking. This means I have to ration my resources wisely in order to try to do the greatest good for the greatest number of people. There’s nothing esoteric about this – it’s basic Utilitarianism 101. Unfortunately, a small percentage of patients are like black holes – they’ll pull you over their event horizon and suck all the energy out of you in a single sitting if you allow it. Trying to help them is akin to watering the Sahara with a garden hose. Over the years I’ve treated a number of these unusually needy people. It’s been my experience that no matter what I do for them, no matter how much time I spend, they never seem to get significantly better. Working with this challenging subgroup requires a lot of patience. Unfortunately, patience is not one of my strong suits. In fact, some days it seems I have none at all. This regrettable character flaw of mine undoubtedly contributes to the frustration felt on both sides of the desk from time to time.
I also have some difficulty dealing with the fraction of patients I classify as canaries. What's the story behind the term? Coal miners of yesteryear often brought caged canaries underground with them for use as low-tech early warning systems. Canaries were known to be disproportionately sensitive to methane and carbon monoxide. This made the birds ideal harbingers – if a canary suddenly stopped chirping and belly-flopped off its perch, the miners knew it was time to get the hell out of Dodge. Poor canaries. Always the first to keel over whenever the environment is anything less than perfect.
Another obstacle stems from the fact that although I’m always hoping to receive a reasonably concise, coherent history, sometimes all I’m offered is a vague mishmash that meanders all over the place. At the end of some of the more tangential interviews I leave the room wondering if I just went through the looking-glass again. I need to work on not getting so bent out of shape when the story being related to me is more circuitous than I’d prefer.
According to the True Colors personality test, I’m off the scale at the gold-green end of the spectrum. This means I’m analytical and organized to the max. The good news is that these are both useful traits when it comes to things like running an efficient office practice or maintaining control of an ER that’s trying to go nuclear. Unfortunately, my high scores in these areas come largely at the expense of the orange-blue characteristics, namely impulsivity and empathy. I can manage just fine without the impulsivity, but a little more compassion would certainly be a plus, especially considering my chosen profession.
What else am I guilty of? Misdemeanours, mostly. I’d probably quit my job tomorrow if I won the 6/49 jackpot, so I’m guessing that means I’m no Mother Teresa. I’m chronically late. I biorhythm down to zero at about 10:00 every morning. I get crotchety when I’m tired. I’m set in my ways. I’m a tad OCD. I get antsy when I can’t logic things together. I have a tendency to display exit-seeking behaviour during futile patient interviews, particularly those of the asymptotic variety. And sometimes I can’t help but wonder if my helping keep certain individuals healthy and reproducing is a direct violation of Darwin’s law of natural selection.
Lastly, there’s the matter of my smouldering cynicism. For the past couple of years it’s been quietly modifying my worldview. I don’t think cynicism is chic. I agree with Bruce Mau, founder of the Massive Change Network, when he says that anyone can be cynical, but it takes guts to be optimistic. Nevertheless, I suspect I’m losing the battle. I think part of the reason I’m getting jaded stems from the fact that every day I observe people taking advantage of the system. To make matters worse, not only do I have to witness it, I’m often conscripted into helping them do it. How does this happen, you may wonder? Due to the nature of my job, I have the power to grant certain things. I never asked for this privilege – it comes with the title and there’s no way to divest myself of it. Modern-day family physicians have somehow been transformed into living cornucopias expected to generate an infinite supply of sympathetic off-work slips, welfare letters, disability pensions, tax credit papers, insurance forms, subsidized housing recommendations, accessible parking permits, travel grants, etc. This, of course, is in addition to the usual prescriptions, tests, referrals, and so on. After a while the endless stream of requests starts to wear you down. Usually the things I’m asked to provide are fair and reasonable. Sometimes…not so much. I try to be as accommodating as possible, but I do have to draw the line somewhere. Whenever I say no, conflict ensues. Here are some of the less reasonable requests I’ve had to deal with over the past few months:
1. A patient asked me to provide her with a prescription for foot orthotics. She had been seeing an alternative health care professional for sore feet for several months and in the end he fashioned her a $400 pair of shoe inserts. Her insurance company refused to reimburse the money unless the inserts had been ordered by an MD, so she dropped in to inform me I needed to write a prescription for them. The catch is she had never seen me for that particular problem before. She ended her request with “…and make sure it’s dated before June 5th, because that’s when I submitted the claim.” What should I do? If I agree, I’m participating in a low-grade swindle. If I refuse, I’m labelled mean-spirited and difficult. I guess you could say the money’s not coming out of my pocket, so why should I care, but it just doesn’t seem right.
2. Someone with mild quasi-depressive symptoms who has repeatedly eschewed offers of counselling asked for a note stating it was medically necessary for him to take a paid six-month leave of absence so he could “rest up a bit.”
