Why Long John Silvers Will Kill You

It should be noted that this is shared with permission*


I saw an elderly gentleman for a recheck the other day.   He had a blood pressure of 190/110.  He denied any chest pain or shortness of breath and insisted that he felt fine.   I insisted that he get an EKG with his blood work.

About five minutes after he left I received his EKG in my inbox and gasped deeply when it became apparent that he was “tombstoning”.  As one might imagine, tombstoning is not a good sign.  It is a finding on an EKG that looks like a tiny little tombstone in multiple leads and leads to the patient acquiring a real tombstone of their very own.

I proceeded to call the patient in a panic, informing him that he needed to go immediately to the emergency room.

After a moment of hostile silence, he replied, “I am in the drive thru at Long John Silvers, and I am going to get my *&^%#@ fish!”

I calmly explained to him that if he stays to eat the fish, it will likely be his last meal.

He reluctantly agreed to go to the emergency room.

When I saw him back after his hospitalization and heart catheterization I joked with him about it, “Are you going to Long John Silvers today?”

He replied with a twinkle, “I went before I came this time.”


The Patients NO Doctor Likes

I love most of my patients. Most. Some of my patients are such a pleasure that I see them on my schedule and look forward to the visit regarding not just their health, but their lives and their families and their stories. (Stalker Nurse, you are my favorite, and you know who you are.) There are those other patients that annoy me to my bones.  When I see these people on my schedule, the anxiety starts to build in advance of what I know is going to be a highly unpleasant interaction. I start to hyperventilate and plan for the multiple contingencies of ways that I can minimize conflict (maybe I can fake a page, or have my nurse claim there is an emergency, or yell fire and run out of the room). In fact, after lengthy discussion with my colleagues, there are several archetypes of patients that almost all doctors cringe with repugnance and loathing to find on their schedules. So with no further adieu, I present to you the patients that ALL doctors despise.

The Hypochondriac– At best, this person is on your schedule every week for a “sinus infection”. This sinus infection is never really a sinus infection. It is usually an allergy or a virus which you can really do nothing about, because viruses don’t respond to antibiotics, even though they never believe you on this one, and the allergy is to the thirty-seven cats they insist on living with even though they are highly allergic. At worst, this patient is convinced there is something really wrong with them because they have done extensive research through the internet and Doctor Oz on the subject. Their fatigue cannot possibly be a result of their morbid obesity and two pack a day smoking habit. It must be some sort of mysterious “syndrome”, probably one that is going to make them eligible for disability.

The Rock Star- This patient knows they deserve special treatment. Let me be clear. I always try to do the best job I can with each and every patient. That will never be good enough for this patient. They will always find something wrong with something you or your staff does. It brings to mind one special patient of mine that was seen at the end of a clinic session and because I had no other patients scheduled for the morning, I spent forty-five minutes with her. She later spoke with my nurse on the phone and asked if I was leaving for the day, because it sure didn’t seem like I had any time for her. No matter how much you give, this patient will never be satisfied. They will tie your nurse up for hours on the phone with myriad special requests. They will write letters of complaint against you and your staff for the most minor of infractions.

**Even worse is that frequently there is the perfect storm of evil found in The Rock Star who is also The Hypochondriac. Because when that happens, you are going to be seeing this person a LOT.**

-The Abe Simpson– For those of you who are unversed in The Simpsons, grandfather Abe is a character who tells pointless stories, and these patients do the same thing. You will get sucked into a ten minute diatribe about something that you assume is relevant only to find out that they have lured you down a rabbit hole into a vortex of nothingness. THEY don’t even remember the point to their story. I once listened to a fifteen minute account of a women’s relationship with her Welsch Corgi. I incorrectly assumed this was going somewhere with her medical condition, maybe flea infestation, or worms or something, but NO, it went nowhere.   Later I found out that the Corgi had been dead for six years, and we still hadn’t discussed anything about her medical condition.

The Crier – The crier starts crying the moment you walk in the room. At. Every. Visit. I understand that people disclose many things to their physicians that are deeply personal, and frequently people shed a few tears at the doctor’s office when recounting some particularly traumatic, frustrating event, and that is normal. But, breaking down into snot-driveling, ugly crying to the point that I cannot even understand the words you are saying and it takes you ten minutes to collect yourself at every office visit is not normal.

I think there is the capacity in each of us to be a hypochondriac, a rock star, an Abe Simpson, or a crier from time to time (I don’t know when this turned into the essay from TheBreakfast Club). I think furthermore it is probably normal that people assume these different personas throughout different periods in your life, but if you find yourself consistently being one of these people with your healthcare provider, you are probably not realizing a satisfying therapeutic relationship. Your doctor and their staff will be much better able to care for your medical needs if their energies are not spent on how to avoid your phone calls and office visits.  Thankfully, these are not frequent encounters.  Please help your physician to exercise their practice in the greatest compassion possible by realizing we and our staff are also human beings with feelings and respecting the time and needs of other patients as well in a time of dwindling healthcare resources.

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