"My friend took your elective," read the e-mail from Adam, a medical student I didn’t know. "I need one more rotation before I graduate and would love to get some dermatology experience, which I expect I’ll need for Family Medicine. Could you possibly accommodate me?"
Sure, no problem.
The day before he was to start, I e-mailed Adam with the time and place to show up, along with parking suggestions.
"Oh, sorry," came the reply. "I found another elective. Hope this causes no inconvenience."
Thanks, pal.
People, you may have noticed, are not always considerate. This includes patients. Take Irene. Please.
Irene is 28 years old. One of my associates diagnosed pyoderma and gave Irene oral antibiotics. She called Friday afternoon to report headaches and vomiting. Because of a scheduling mix-up, not one colleague – but both of them – thought they were covering and called her back. They each phoned Friday night and left messages on Irene’s home and cell numbers. And again on Saturday, twice each. Ditto on Sunday.
Irene finally did call back. Tuesday. She said she was fine.
Gee, thanks, Irene.
Or consider Zoe. Or more precisely, consider Zoe’s mother, Hildegard. Their family had just returned from Panama, a rain-forest jaunt being just the thing for a 2-year-old. Zoe had returned with a souvenir collection of bizarre, bull’s-eye–shaped plaques all over her face and torso. I had never seen anything like them. Perhaps bites? No one else in the travel party had them.
Because the child did not seem ill, I suggested to Hildegard that we spare Zoe a biopsy and see what happened over the next few days. I photographed the spots and said I would share the pictures with an academic specialist I know. Perhaps Hildegard would send me an e-mail update in 2 days? She would.
My academic friend looked at the photos and also had no idea. And from Hildegard? Radio silence. Was Zoe OK? Was she in an ICU?
I e-mailed Hildegard. No response. Not a good sign. I called and left a message, referring to the e-mail. No response. I wrote the referring pediatrician. No answer there either.
Three weeks later, Hortense, a nurse practitioner from the pediatrician’s office, came in as a patient. With some trepidation, I asked whether she was familiar with Zoe’s condition. She wasn’t. She would check and get back. She didn’t.
But I did, when I called Hortense a couple of days later with her own biopsy results. Had she perhaps checked on Zoe? Oh, right, she had. Zoe was fine. The spots had just gone away. Must have been bites or something.
Think I’ll just up my Valium.
Of course, more prosaic examples of this sort of thing happen all the time. Like the patient who calls for an emergency appointment. He has to come in. Right away.
"9:00 o’clock?" Not convenient. Staff meeting at work.
"2:00 o’clock?" Sorry, can’t make it then.
"5:30?" OK, I’ll be there! Thanks!
Then he doesn’t show. The rash went away. Or he got a better offer. Who knows?
After all these years, I should be used to this behavior by now, but sometimes, annoyance still gets the better of me. There are people – many, actually, and not just in the office – who really need you. Really, really. Their needs are urgent, overwhelming.
Your needs, less so.
There is no point in being cranky about this. We are in the people business, which means taking people as they come. It may mean following through when we worry about the consequences of not doing so, even if the patients themselves seem oblivious. It also means not taking it for granted when people do act with consideration.
Adam’s e-mail that he hoped I was not inconvenienced really steamed me. Then I thought, "I never met this guy, and I never will. He may find this kind of behavior unhelpful in his future professional dealings. But that will be his problem, won’t it?" So I decided not to respond.
Then I changed my mind.
"Inconvenience, no," I e-mailed back. "Inconsideration, for sure."
He apologized again, and I left it at that. There’s no emoticon for a Bronx cheer, anyway.
Dr. Rockoff practices dermatology in Brookline, Mass. To respond to this column, e-mail him at our editorial offices at sknews@frontlinemedcom.com.