On Wednesday, little Esmeralda's eczema took a turn for the worse. "It's infected," I told her mother, "so I'm prescribing this antibiotic syrup and topical cream. Here is my private extension. I need you to call me first thing Friday morning so I'll know how she's doing before the long weekend."
No message was waiting Friday, so I called at 9 a.m. and left one myself. I left another at noon. As I was preparing to leave at 2 p.m., Esmeralda's mother called, not to tell me that her daughter was improving, which she was, but to ask me to fax a report to Esmeralda's day care providers. I offered to call instead. "No," she said, "I need you to fax them what you recommended."
That same Wednesday, I got a call from a pulmonologist. A mutual patient, Fishbane, had come down with tuberculosis but was itching like crazy and refusing to take his medications. He needed to see me at once, but I was in my other office and he wouldn't come there. Could I see him Thursday? Sure. Arrangements were made, with thanks for my being so helpful. Fishbane never showed.
All this is familiar, of course: Patients follow through when it suits their needs.
"Hi, Henry. It's been 5 years. Are you back because you had that squamous cell, and I asked you to come annually?"
"Oh no, Doc. I have this new spot I'm worried about."
Nonhermits have many kinds of relationships. These relationships involve needs that each party satisfies to some extent. In the doctor-patient relationship, patients need us to diagnose correctly, prescribe properly, and behave with courtesy. We need them to show up, call back, and either cooperate with treatment or at least let us know why they can't.
Relationships flourish when people make allowances, but they founder when needs, duties, and shortcomings are aggressively spelled out.
"I've been waiting an hour," hissed Spencer. "I'm a professional like you, and I too have other appointments. It's clear that you care only about your own needs, not mine."
Maybe Spencer is just having a bad day, but suppose he's always like that. Imagine being married to him. His complaint is not without merit, but I have needs too. Spencer wants to get on with his day. I want to stay busy even when some patients don't show, others come late, and still others must be fit in right away (or, like Fishbane, claim they do).
Most of us know we'll get only some of what we need and decide to muddle through. Patients expect to wait a while. Doctors know that many patients won't remember which treatments didn't work. Some people, though, aren't satisfied with muddling and demand precision: yes or no, right or wrong, exactly how many minutes' wait is too many. That's how lawyers and bureaucrats think—an approach useful in its place but toxic to ordinary relationships, which are rife with fuzziness and ambiguity. Think of the difference between the arrangements a husband and wife make to pick up their kids versus those dictated by a divorce court.
"Thanks for taking off my wart, doctor," says Sue. "Would it be okay if I asked you one more question?" Well, sure, especially since you're asking so nicely.
But what about Phyllis, who has nine separate issues to discuss with magisterial deliberation and a sense of serene entitlement, and who catches you at the door trying to escape with, "And oh yes, doctor, my hair is falling out"?
How many questions does Phyllis have a right to ask? One? Three? Six from column A and two from column B? She needs to have her concerns addressed, but I have needs too. I need to get the heck out and see another patient. Sue is very considerate, but now and then the office serves up a Phyllis, just as life brings us bores who won't shut up or guests who won't leave.
Most people are considerate; others are endlessly needy. One way or another, we negotiate needs all day long. Considering how many people we deal with every day, it's a wonder how well things usually go. Sometimes a Phyllis or two shows up and throws things off. Then we can go home and crack open a beer. Whack a golf ball. Write a column.