Saturday, October 11, 2008

"Oh, and Doctor, One More Thing..."

It's the line no doctor wants to hear at the end of their examination, but it's the line that cuts to the chase:

"Oh, and doctor, one more thing..."

Doctors plan on adding at least 30 minutes to their clinic visit time for that line.

My favorite instance of this line came many, many years ago. I was in my internal medicine residency.

He was 82, a stalwart, congenial gentleman who was always prompt and a pleasure to manage. He decided to bring his wife to the appointment, since she knew all of his medications, dosages, and procedures that he could never recall. Plus, he needed a walker and she helped open the doors.

They shuffled into my office and were situated in their chairs. I reviewed his overall condition, addressed his concerns, and reviewed his extensive medical problem list: diabetes, hypertension, hyperlipidemia, coronary disease, osteoarthritis, and hip replacement. He had no significant complaints that day, so we refilled his prescriptions, ordered some basic labs to assure his diabetes and renal function were monitored and was ready to send them on their way, when his wife said:

"Oh, and doctor, one more thing..."

I braced myself. I couldn't imagine what would come next. I sheepishly asked: "Yes?"

"Well, I'm worried about Herbert." (not his real name.)

"Why's that?"

She looked down at her feet, then stared at me with conviction. I could tell she was struggling.


Her face was a bit red, but she was worried and bound and determined to make sure I knew her concern:

"Well, Herbert doesn't want to have sex with me each night any more. Is that okay?"

Now it was my turn. I was speechless. Dumbfounded. I glanced over and saw Hercules Herbert smiling.

"Uh, seriously?"

(God what a pathetic response, but it was all I could muster at the time.)

"Seriously. He just keeps wanting to fall asleep."

I looked at Herbert's med list again. Beta blockers, ACE inhibitors, statin, aspirin, angiotensin receptor blocker, glucophage. Nothing new. I couldn't help but wonder how this man had been so lucky. God, every night? Heck, I'd have to rest, too! I considered calling my wife. "Honey, I just wanted you to know that there's a guy here, well, you know, every night!" But I reconsidered. She was obviously concerned about Herbert. I asked to see his medications.

She pulled out a handful of pills.

I arranged them on the table and paired them with his med list:

"Now which is the beta blocker?"

She pointed to atenolol.

"And the glucophage?"

She pointed to the pill.

And on and on it went, until there was one left over.

"What's this?" I asked.

"Oh, that? Just a little medicine I gave him for his arthritis that bothered him at night."

"What's it called?"

"Serax. It worked great for me."

I reminded her that Serax was an anxiolytic and could cause drowsiness. She blushed, realizing her mistake.

She thanked me profusely as they left the office. I struggled to catch up with clinic and rushed home. When I got home I told my wife the story in confidence.

Needless to say, she wasn't impressed.