Occasionally patients who haven’t seen me for years will return to the office and say things like, "Gee, doc, you haven’t aged at all!" As nice as it is to hear such comments, I know that they are only true if you don’t count gray hairs or wrinkles. Despite that, I am usually happy to accept the compliment and get on with the visit. I usually return the compliment by telling patients that I haven’t visibly aged because my patients are so nice to me. One nice bit of flattery deserves another.
When patients comment on my personal appearance or other nonmedical aspects of the encounter, I know they feel comfortable enough to engage in a little banter with the doctor. Some patients feel so comfortable that they tell me jokes or anecdotes. Occasionally, patient’s remarks are a little bit off the mark, and may indicate mental illness or early dementia. Some of these people even go so far as to laugh at my jokes. If that happens too much, I usually have them complete a Mini-Mental Status Exam.
By Dr. Larry Greenbaum
Perhaps these patients are amazed that in a society where obesity is endemic, my weight has stayed about the same. One man weighing more than 300 pounds told me, "Now Larry, I’m sure you get a lot of this, but the truth is that I don’t eat that much." A small number of my patients feel more at ease calling me by my first name. Most of these patients are considerably older than I am, and I never felt that my role as physician was threatened by this small familiarity. My 300-plus–pound patient described his skimpy breakfasts and added that he doesn’t eat lunch. His evening meals seemed pretty Spartan, too. I didn’t have a ready explanation for the marked discrepancy between his weight and the little bit that he admitted eating. I made some lame remark that some people are just more "fuel efficient" (meaning that they only eat a little bit, but still manage to get fat).
Some of my patient’s off-the-cuff remarks and observations about me are quite accurate and, at times, mildly disconcerting. One lady told me that my glasses were dirty. I held them up to the light and found that she was quite right. I don’t know if I rose in her esteem by using my necktie to polish my lens. Perhaps I should have asked.
On another occasion, I strode confidently into the exam room sporting my freshly dry-cleaned white coat. A new patient was waiting to meet me, and I gave her my standard hearty greeting: "Hi, I’m Dr. Greenbaum. How are you today?" My patient was pleased to meet me, and she politely let me know that the dry-cleaner’s pink tag was still attached to the bottom buttonhole of my splendid white coat. Perhaps if I buttoned all the buttons I would have noticed this detail, too.
Some patients make wardrobe inquiries. One woman told me that my shirt was a really good color for me. She followed up on this comment by asking if my wife had picked it out for me, and she acted impressed when I told her I had managed this feat on my own. Another time, almost everyone in the office was dressed in green for St. Patrick’s Day. One lady asked me why I wasn’t wearing green. I replied casually that with a name like mine, I was green every day, so I felt exempt from this social requirement.
A number of older patients have asked me where I buy my shoes. My work shoes are usually boxy-looking walking shoes with thick rubber soles. I remember one of my professors exhorting patients to wear "practical shoes". If the patients failed to assimilate the message, I surely absorbed it. I usually pass this clinical pearl on to trainees. "Practical shoes" I tell them. "The first organ to fail in an intern is the feet, followed rapidly by the mind."
Another touchy point for me has to do with my hands, or more accurately my dry skin. One winter while I was examining a patient’s hands, she took one look at mine and exclaimed, "Your poor hands!" She told me what kind of hand lotion she thought I should buy, and for a moment our roles as doctor and patient were reversed. Since then, I’ve been more zealous about applying lotion to my hands after washing to avoid eliciting any more embarrassing exclamations of pity from my patients.