Terminal Crankiness

It has been a tough week. If my staff ever decides to change careers, they should be well trained for work in a complaints department.

First there was Doris, a 50-something-year-old woman who's been my patient for years. Her rosacea flared up, so I wrote a prescription for doxycycline to help treat her face for her daughter's upcoming wedding. The next day I got a request that I fax another prescription to a mail-order pharmacy somewhere in Outer Darkness where rent and wages are low. Two days later the mail-order droid requested a clarification: hyclate or monohydrate? (Why does no other pharmacy ever ask me this?) I faxed back my answer.

Now here was Doris berating my secretary loudly and at length because the mail-order droid was still preparing her order. She demanded that we pay for overnight shipping to compensate for our sloppy incompetence. For good measure, she canceled her next appointment.

Asking us to pay for shipping was a new one. (A patient once did demand that I pay for dry-cleaning a dress when bacitracin from a dressing got on it.) I called Doris back, and left a polite voice mail message suggesting that she direct complaints of this nature to the mail-order pharmacy whose procedures were perhaps more pertinent than ours to her dilemma.

Later the same day Alfred came in, a slovenly and truculent man in his early 70s. His real concern was that we take off his facial keratoses. (You really can't tell a cosmetic patient by appearance.)

Alfred had a slightly raised patch on his right cheek that seemed at an earlier visit to be a vascular macule but had now developed a bit of texture. I explained that laser surgery would not work and suggested light curettage both to remove the spot and test it to rule out skin cancer.

Alfred would agree to this only if I guaranteed—in writing—that there would be no mark left afterward. I explained that I couldn't offer such a guarantee and why I felt it would be best to test the lesion (adding that leaving it there would guarantee that he would still have a spot). “Oh, so now we're just speculating,” he growled and walked out.

And you have a nice day too, sir.

The next day was even better. My PA, Megan, who has a soft manner and infinite patience, told me she had just endured a telephone tirade from a woman whose 21-year-old daughter had tinea of her toenails. We had actually diagnosed this 7 years earlier, offered the patient treatment with oral terbinafine, and asked her mother to arrange for liver function testing as a possible prelude to treatment.

They never got the testing done, and the patient had been back several times over the years for other issues without ever raising the fungal concern. Megan heard our mother patiently, spoke soothingly, and talked about treating with terbinafine when her daughter returned from school in May.

“In my family we don't use generics,” came her frosty reply.

I called Mom back. (At the time she was in Florida with her daughter, on spring break.) I explained that generic drugs can indeed be okay. (“I had a bad experience with one,” she reported.)

I told her that we could certainly start antifungal treatment after this semester, if her daughter wanted us to. And so on. She sounded mollified.

The question of course is: Why now? After having fungal toenails for 7 years, why did her daughter suddenly find it urgent to treat them? What about all those visits in between, spanning most of her adolescence?

People just get cranky, I suppose, and it was our misfortune to encounter three in a row. I guess I ought to make allowances for matrons aflutter in the run up to their daughter's wedding, or for gents who care deeply about their appearance, or for parents of excitable young ladies with acutely intolerable toenails, all of whom have decided to relieve their inner tension by beating up on me or my staff in full-throated arias of crankiness.

Only I'm feeling cranky myself just now, so I'm not in the mood for making allowances. You'll understand, won't you?

You won't? Too bad.

It has been a tough week. If my staff ever decides to change careers, they should be well trained for work in a complaints department.

First there was Doris, a 50-something-year-old woman who's been my patient for years. Her rosacea flared up, so I wrote a prescription for doxycycline to help treat her face for her daughter's upcoming wedding. The next day I got a request that I fax another prescription to a mail-order pharmacy somewhere in Outer Darkness where rent and wages are low. Two days later the mail-order droid requested a clarification: hyclate or monohydrate? (Why does no other pharmacy ever ask me this?) I faxed back my answer.

Now here was Doris berating my secretary loudly and at length because the mail-order droid was still preparing her order. She demanded that we pay for overnight shipping to compensate for our sloppy incompetence. For good measure, she canceled her next appointment.

Asking us to pay for shipping was a new one. (A patient once did demand that I pay for dry-cleaning a dress when bacitracin from a dressing got on it.) I called Doris back, and left a polite voice mail message suggesting that she direct complaints of this nature to the mail-order pharmacy whose procedures were perhaps more pertinent than ours to her dilemma.

Later the same day Alfred came in, a slovenly and truculent man in his early 70s. His real concern was that we take off his facial keratoses. (You really can't tell a cosmetic patient by appearance.)

Alfred had a slightly raised patch on his right cheek that seemed at an earlier visit to be a vascular macule but had now developed a bit of texture. I explained that laser surgery would not work and suggested light curettage both to remove the spot and test it to rule out skin cancer.

Alfred would agree to this only if I guaranteed—in writing—that there would be no mark left afterward. I explained that I couldn't offer such a guarantee and why I felt it would be best to test the lesion (adding that leaving it there would guarantee that he would still have a spot). “Oh, so now we're just speculating,” he growled and walked out.

And you have a nice day too, sir.

The next day was even better. My PA, Megan, who has a soft manner and infinite patience, told me she had just endured a telephone tirade from a woman whose 21-year-old daughter had tinea of her toenails. We had actually diagnosed this 7 years earlier, offered the patient treatment with oral terbinafine, and asked her mother to arrange for liver function testing as a possible prelude to treatment.

They never got the testing done, and the patient had been back several times over the years for other issues without ever raising the fungal concern. Megan heard our mother patiently, spoke soothingly, and talked about treating with terbinafine when her daughter returned from school in May.

“In my family we don't use generics,” came her frosty reply.

I called Mom back. (At the time she was in Florida with her daughter, on spring break.) I explained that generic drugs can indeed be okay. (“I had a bad experience with one,” she reported.)

I told her that we could certainly start antifungal treatment after this semester, if her daughter wanted us to. And so on. She sounded mollified.

The question of course is: Why now? After having fungal toenails for 7 years, why did her daughter suddenly find it urgent to treat them? What about all those visits in between, spanning most of her adolescence?

People just get cranky, I suppose, and it was our misfortune to encounter three in a row. I guess I ought to make allowances for matrons aflutter in the run up to their daughter's wedding, or for gents who care deeply about their appearance, or for parents of excitable young ladies with acutely intolerable toenails, all of whom have decided to relieve their inner tension by beating up on me or my staff in full-throated arias of crankiness.

Only I'm feeling cranky myself just now, so I'm not in the mood for making allowances. You'll understand, won't you?

You won't? Too bad.

It has been a tough week. If my staff ever decides to change careers, they should be well trained for work in a complaints department.

First there was Doris, a 50-something-year-old woman who's been my patient for years. Her rosacea flared up, so I wrote a prescription for doxycycline to help treat her face for her daughter's upcoming wedding. The next day I got a request that I fax another prescription to a mail-order pharmacy somewhere in Outer Darkness where rent and wages are low. Two days later the mail-order droid requested a clarification: hyclate or monohydrate? (Why does no other pharmacy ever ask me this?) I faxed back my answer.

Now here was Doris berating my secretary loudly and at length because the mail-order droid was still preparing her order. She demanded that we pay for overnight shipping to compensate for our sloppy incompetence. For good measure, she canceled her next appointment.

Asking us to pay for shipping was a new one. (A patient once did demand that I pay for dry-cleaning a dress when bacitracin from a dressing got on it.) I called Doris back, and left a polite voice mail message suggesting that she direct complaints of this nature to the mail-order pharmacy whose procedures were perhaps more pertinent than ours to her dilemma.

Later the same day Alfred came in, a slovenly and truculent man in his early 70s. His real concern was that we take off his facial keratoses. (You really can't tell a cosmetic patient by appearance.)

Alfred had a slightly raised patch on his right cheek that seemed at an earlier visit to be a vascular macule but had now developed a bit of texture. I explained that laser surgery would not work and suggested light curettage both to remove the spot and test it to rule out skin cancer.

Alfred would agree to this only if I guaranteed—in writing—that there would be no mark left afterward. I explained that I couldn't offer such a guarantee and why I felt it would be best to test the lesion (adding that leaving it there would guarantee that he would still have a spot). “Oh, so now we're just speculating,” he growled and walked out.

And you have a nice day too, sir.

The next day was even better. My PA, Megan, who has a soft manner and infinite patience, told me she had just endured a telephone tirade from a woman whose 21-year-old daughter had tinea of her toenails. We had actually diagnosed this 7 years earlier, offered the patient treatment with oral terbinafine, and asked her mother to arrange for liver function testing as a possible prelude to treatment.

They never got the testing done, and the patient had been back several times over the years for other issues without ever raising the fungal concern. Megan heard our mother patiently, spoke soothingly, and talked about treating with terbinafine when her daughter returned from school in May.

“In my family we don't use generics,” came her frosty reply.

I called Mom back. (At the time she was in Florida with her daughter, on spring break.) I explained that generic drugs can indeed be okay. (“I had a bad experience with one,” she reported.)

I told her that we could certainly start antifungal treatment after this semester, if her daughter wanted us to. And so on. She sounded mollified.

The question of course is: Why now? After having fungal toenails for 7 years, why did her daughter suddenly find it urgent to treat them? What about all those visits in between, spanning most of her adolescence?

People just get cranky, I suppose, and it was our misfortune to encounter three in a row. I guess I ought to make allowances for matrons aflutter in the run up to their daughter's wedding, or for gents who care deeply about their appearance, or for parents of excitable young ladies with acutely intolerable toenails, all of whom have decided to relieve their inner tension by beating up on me or my staff in full-throated arias of crankiness.

Only I'm feeling cranky myself just now, so I'm not in the mood for making allowances. You'll understand, won't you?

You won't? Too bad.