An Open Letter to the Woman at the Supermarket

Dear Neighbor/Patient,

It was very kind of you to inquire after the state of my garden when we bumped into each other at Safeway this morning.  We haven't seen much of each other lately and I was pleased to hear your early peas are already flowering.  We waved good-bye to each other and went about our business.  Or so I thought.

Moments later, you cornered me as my food items were being scanned and asked me "What do you think about all this stuff they're saying about Fosamax?  Should I stop taking it?"  I was unprepared for such a question, because my navel oranges were bumping into the large globe artichokes and threatened to clog the upstream progress of the red seedless grapes onto the rubber rolling mat that conveys the groceries inexorably towards the bagging platform.   

You see, when I go to Safeway, I go not as a family doctor, but as an ordinary citizen in need of some vanilla soymilk and a package of Wasa crispbread.  At the supermarket, I do not bring the analytic mind that accompanies me to the hospital or to the clinic, but the harried householder's mind, concerned about bank balances and the dire possibility of running out of orange juice before the weekend.

In other words, I do not like to be asked medical questions when I am conducting my everyday errands.  I do not like to be cornered in the supermarket, or at the coffee stand, or when I am out to dinner on a rare night off.  I do not enjoy being told about the nagging pain in the back of your left knee when I am trying to decide which 12-pack of toilet paper is the best value this week.  I find the intimate details of your vaginal discharge a bit too much to stomach when I'm waiting in line at the salad bar.  And if you decided, several weeks ago, to stop taking your ACE inhibitor because it "made you feel funny," then surely further discussion on the subject can wait until your next appointment, and need not take place in the parking lot outside Radio Shack, where I ran in to buy a replacement battery for my cordless phone.

Perhaps you were not aware that dread of running into patients at the supermarket is one of the major reasons why I occasionally consider moving back to a more populous area, where I could walk into a shoe store and try on some sneakers without having the wife of a man whose buttock abscess I incised and drained last week sit down next to me and ask whether they could be doing more to take care of his diabetes.  Certainly there is no way for you to have known that I feel compelled to drive several hundred miles out of town to have my hair trimmed, and even when seated in the barber's chair at some distant SuperCuts, I lie about my profession.  Sometimes I say I'm an accountant, sometimes a freelance writer.  I am running out of plausible lies, so I will have to turn to the implausible:  What do I do?  Oh, I'm a snake charmer.  I need to keep my hair short so my anaconda can't do too much harm when he's feeling frisky.

I do not expect you to be a mind-reader.  I only ask you to obey the simplest social niceties, and refrain from asking me the risks of postponing your screening colonoscopy the next time we run into each other in line at the post office.  You would not want me to discuss the intricacies of your mucosal atypia in the hallway of the hospital, so why would you expose yourself to such scrutiny in the Just Released aisle of our local Blockbuster?

I look forward to hearing about the progress in your lettuce beds, about the first peppery radishes you pull from the loamy earth.  If you must corner me at the checkout stand to tell me of these developments, however, I would appreciate your help in bagging those new red potatoes that have escaped their plastic sack and are rolling down the rubber conveyor belt, perhaps my only line of defense against your well-intentioned questioning.

Sincerely,

Rural Doc

Comments

[Penelope]

I'm curious to know how you, as a rural physician, handle your own personal health care.

I imagine also that anything you put in your shopping cart in a small town is likely to be seen as "doctor endorsed" - I can see why you might want to take your business to the next closest big city.

With privacy being so challenging, how do you navigate your own medical appointments, prescriptions, etc...?

[Trebor]

Perhaps you should move back to the larger city... so you don't really have to be a part of other's lives and don't have to live in fear that they need you as much as they think they do.

[Martin]

Guess what, every professional is confronted with this situation from time to time! Most of them don't complain about it like medical professionals do though. They view it as an opportunity. They say something like, that is a good question, but I don't have your chart in front of me, so it is difficult to answer. Give me a call next week and we can set aside some time to discuss it! Why is it that medical professionals view this as an aggrevation instead of a selling opportunity?

[Bianca Castafiore]

I'm a patient and found this a wonderful post. My doctor recently left his group practice to open a so-called "boutique" practice with one partner. It's been about 5 months now...

Last week, I asked him whether things were turning out as expected. During the long pause that followed the query, I said, "As a patient? Being able to reach you after hours, right away and in-person, is a great anxiety-reducer, so much so that I find the need to actually reach you after hours goes away!"

To which he replied, "Probably the most difficult part IS that after hours phone call. There's a fair amount of inappropriate use of that... um... privilege. That and the fact that I am not getting home as early as I thought I would... But I think things will change as people get used to the new set up."

I don't understand why people cannot treat their doctors as just plain people -- with attendant rights to free time, family time, foolish time, whatever-the-heck-I-want time, away from needy patients or family members? (Which are worse, actual patients or relatives? People with an actual doctor/patient relationship or those who want your official opinion on The Study Of The Day?)

I'm in a big-ass city! Do you really think this problem is worse because you're in a rural area? [read: incredulity]

Is my doctor's new practice model a "rural" design in the urban soup of anonymity?

What my doctor doesn't know is that I receive intel from his nurse. She says that she shields him from many calls -- particularly from people who *actually* say:

"I paid my X dollars! I want to talk to him, now!"

(I paid my X dollars... so I own him?)

Jeez.
Regards,
La Bonne et Belle Bianca Castafiore

[DocRobbs]

I'm a rural general surgeon and sometimes I would like to send out a similar letter.

There is nothing worse than having some one pull there pants down in the dairy section to show you a new mole or a scar they don't like.

What makes it worthwhile is when someone thanks you for saving their neighbor, brother ect. I never got that in the "big city".

[tom]

I'm a family doc in the small town I grew up in and there is no quick trip to the store. Even if my kids are with me and pulling at my arm, people are incredibly demanding and want to engage in a discussion in the produce aisle. I plan my exit from church on Sunday morning by the highest concentration of "talkers" in the quadrants of the sanctuary. I've actually faked a page so I could leave during the last hymn, because a particularly voluble fellow was standing behind me! The general "what do you think of the Vitamin E study in the news this morning" questions aren't too bad, but when someone asks about that pain in their chest yesterday, I have to do something about it! My favorite story is the old guy who learned my morning routine was to go to the ymca at 6 and shower around 7:30. He came to the Y one morning at 7:30 specifically to see me and sat in the locker room until I had finished showering, and asked me to look at his rash while I stood there in my towel! I wish I had set some better boundaries when I moved back. Every time I try to get tough or at least have a good deflecting response to medical questions, I feel terrible, like I've done something wrong. Pat answers like "call me at the office about that" never seem right when talking to a former teacher or fellow church member.

[HawgGuy]

I can relate. Small town doc in geographically isolated area. I have switched barbers 6 times in 10 years. That's the worst predicament; trapped in the chair providing free medical consultation while someone with sharp objects buzzes around your head. When out of town getting a trim I've been tempted to fib and claim to be a motorcycle mechanic but, alas, I am pathologically honest and cannot lie.

[Xavier Emmanuelle]

When I lived with my parents in a rural area, I actually had this problem, despite the fact that I was a mere first year student at the time.

You see, there are not enough doctors where I'm from, and there is a waiting list that is so long they've stopped putting people on it. (I think they stopped once the waiting list reached 10 years).

I'd get stopped for medical advice in the general store, or while I was out walking the dog... it was hard to tell people that they needed to see an actual doctor, knowing how hard it is to get in to see one there.

[Marta]

I sympathize with you, but for a different reason. I live in a rural area, yet we are overrun with physicians. Anyway, I stand out in my community because it's 98.02% white and well, I'm not. My doc, who is awesome, is pretty well known for treating lots of GLBTQ patients (I am none of those things) and very beloved. I have seen him out in public and when he smiled I froze and scooted past him because this town is too small and people are entirely too backward.

So my problem is with doctors who don't know how to pretend I don't exist if they encounter me outside the office.

[Theresa]

Hi Shauna--I think I would draw the line at performing a genital exam in public. People would talk.

I know all the staff at my clinic/hospital get approached by patients. This is a teeny community and everyone knows everyone else, it seems, which makes enforcing firm boundaries difficult. I'm a private person--despite the blog!--and I really prefer not to have such public encounters.

Thanks for stopping by!

[Shauna]

Hi, interesting post. I'm not a physician, but I am a nurse (I work as a rounding nurse for a cardiac electrophysiologist and have been with him since 2004). I find that I get stopped sometimes too! (and I agree, it's VERY annoying). In fact, I just got stopped in the grocery store about 3-4 weeks ago by one of our more special/needy-ish patients in front of the milk cooler as he told me that he has groin pain and then pointed and pushed around on his groin. Speaking NOT in hushed tones he told me all about his groin pain and that he thinks it's from all his cardiac caths and he wants an MRA, yada yada yada.... I was pleasant of course, but thinking...geesh...I just wanted a gallon of milk and now I have to decide what to do with/and remember your vascular concerns until Monday when I can do something about it. (My coworkers teased me and asked me if I did a groin check in front of the skim milk......nice). I have to wonder what all the people passing by me thought when they saw an 83 year old man showing me his groin!

[Peggikaye]

My eye doc and I just had a discussion about her. (she treats his dad) He asked me if I liked her. I said yes, but kind of hedged before I said anything else. He said "she is *interesting*
I looked at him and said "I was thinking kind of 'tornado...ish' .."
He busted up laughing and said "that is the best description I've ever heard of her. You should tell her, she'll like that!"

Evidently, she knows she's a bit ..um, unique.

Can you imagine the chaos that goes on inside her brain if she can keep that kind of information? Name, diagnosis, recognition?
shudder to think!

[Theresa]

Wow, PK, that's the opposite of how I act when I run into patients outside the office. I feel that, if I value my privacy, I should value the patient's as well.

Example: I ran into a patient who is actually a clerk at my Safeway. I'd delivered her baby about 2 months earlier and she'd had an appointment with me the day before, but missed it. Did I go up to her an say, "Hey, you missed your appointment, what gives?" No! I said hello and went about my business.

Interesting.

[Peggikaye]

I rarely run into my docs (I've got several) I keep it social.
I was very shocked recently when I ran into (or rather she ran into me) a new doctor ..dermy ..and she not only came up to me and called me by name and asked "what is my lupus patient with a history of skin cancer doing running around without a hat on?"

Um ..er ..uh ...um ...gulp.

She informed me she lived in my area and is quite social, and it is her stomping grounds. I promptly ran into walmart and grabbed about 8 hats.

I'd stubbornly refused to wear one in the 5 years since my lupie dx and and the 3 years since I had the melanoma. So I guess it was a good thing. But rather shocking since most docs don't like outside the office contact.

GEESH.

[Theresa]

Yup. And your family members might turn out to be the worst offenders. It is an occupational hazard but I find it draining....

[Dragonfly]

That is difficult.
I ran into a patient (well, patient of the doctor I was attached with) at the shops, and was told "he put me on this new drug, I'm not sure about it, so haven't started it. Can you email me and let me know whether it is any good?" I didn't email (or phone, or take out for dinner, but thats another story) this patient, but did dob him in to his doctor (because of the nature of his condition).
I tend to get more people coming to my place for medical advice (at least, until I moved to a rural place with 16 of my classmates who all live in the same street), but I spose I have that to erm..look forward to.

[Theresa]

Good advice for extricating oneself from these awkward moments.

Another good one, from a former lawyer who now runs a yarn store: "Well, here's my advice, and it's worth exactly what you're paying for it." I haven't gotten up the nerve to use it, though.

Thanks for dropping by.

[Doc]

As a small village (suburban) solo psychiatrist, it is especially embarrassing to run into patients at, say, a bar while having an adult beverage. (A place where I'm likely to lie to the bartender/server about my profession)
The information and advice requests are common, and I view them as occupational hazards. They could always be calling me on my cell phone, instead!
I usually politely say to patients that I'll be happy to discuss these things at the office. To family members (my personal pet peeve of public case discussants), I usually mention privacy and confidentiality, etc. And to strangers, I usually tell them I'm not on the clock.

[Theresa]

Yes, I wish I had an information buffer. I get more general inquiries like this one. It could be worse: a colleague once had a patient approach her at the gas station, where she was checking tire pressure, and ask her to sign a disability form. She said no.

[Vijay]

I sympathize. But this sort of thing doesn't usually happen to me. I do get an occcasional scan related question in an out of hospital setting, but those are handled easily because of the non-availability of the scan or the inability of the person to remember the exact details of the report.