I also have some difficulty dealing with the fraction of patients I classify as canaries. What's the story behind the term? Coal miners of yesteryear often brought caged canaries underground with them for use as low-tech early warning systems. Canaries were known to be disproportionately sensitive to methane and carbon monoxide. This made the birds ideal harbingers - if a canary suddenly stopped chirping and belly-flopped off its perch, the miners knew it was time to get the hell out of Dodge. Poor canaries. Always the first to keel over whenever the environment is anything less than perfect.
Another obstacle stems from the fact that although I’m always hoping to receive a reasonably concise, coherent history, sometimes all I’m offered is a vague mishmash that meanders all over the place. At the end of some of the more tangential interviews I leave the room wondering if I just went through the looking-glass again. I need to work on not getting so bent out of shape when the story being related to me is more circuitous than I’d prefer.
According to the True Colors personality test, I’m off the scale at the gold-green end of the spectrum. This means I’m analytical and organized to the max. The good news is that these are both useful traits when it comes to things like running an efficient office practice or maintaining control of an ER that’s trying to go nuclear. Unfortunately, my high scores in these areas come largely at the expense of the orange-blue characteristics, namely impulsivity and empathy. I can manage just fine without the impulsivity, but a little more compassion would certainly be a plus, especially considering my chosen profession.
What else am I guilty of? Misdemeanours, mostly. I’d probably quit my job tomorrow if I won the 6/49 jackpot, so I’m guessing that means I’m no Mother Teresa. I’m chronically late. I biorhythm down to zero at about 10:00 every morning. I get crotchety when I’m tired. I’m set in my ways. I’m a tad OCD. I get antsy when I can’t logic things together. I have a tendency to display exit-seeking behaviour during futile patient interviews, particularly those of the asymptotic variety. And sometimes I can’t help but wonder if my helping keep certain individuals healthy and reproducing is a direct violation of Darwin’s law of natural selection.
Lastly, there’s the matter of my smouldering cynicism. For the past couple of years it’s been quietly modifying my worldview. I don’t think cynicism is chic. I agree with Bruce Mau, founder of the Massive Change Network, when he says that anyone can be cynical, but it takes guts to be optimistic. Nevertheless, I suspect I’m losing the battle. I think part of the reason I’m getting jaded stems from the fact that every day I observe people taking advantage of the system. To make matters worse, not only do I have to witness it, I’m often conscripted into helping them do it. How does this happen, you may wonder? Due to the nature of my job, I have the power to grant certain things. I never asked for this privilege – it comes with the title and there’s no way to divest myself of it. Modern-day family physicians have somehow been transformed into living cornucopias expected to generate an infinite supply of sympathetic off-work slips, welfare letters, disability pensions, tax credit papers, insurance forms, subsidized housing recommendations, accessible parking permits, travel grants, etc. This, of course, is in addition to the usual prescriptions, tests, referrals, and so on. After a while the endless stream of requests starts to wear you down. Usually the things I’m asked to provide are fair and reasonable. Sometimes…not so much. I try to be as accommodating as possible, but I do have to draw the line somewhere. Whenever I say no, conflict ensues. Here are some of the less reasonable requests I’ve had to deal with over the past few months:
1. A patient asked me to provide her with a prescription for foot orthotics. She had been seeing an alternative health care professional for sore feet for several months and in the end he fashioned her a $400 pair of shoe inserts. Her insurance company refused to reimburse the money unless the inserts had been ordered by an MD, so she dropped in to inform me I needed to write a prescription for them. The catch is she had never seen me for that particular problem before. She ended her request with “…and make sure it’s dated before June 5th, because that’s when I submitted the claim.” What should I do? If I agree, I’m participating in a low-grade swindle. If I refuse, I’m labelled mean-spirited and difficult. I guess you could say the money’s not coming out of my pocket, so why should I care, but it just doesn’t seem right.
2. Someone with mild quasi-depressive symptoms who has repeatedly eschewed offers of counselling asked for a note stating it was medically necessary for him to take a paid six-month leave of absence so he could “rest up a bit.”
3. A fellow who bumped his head at work two years ago and hadn’t mentioned any problems related to the accident since it occurred came in to see me. He had recently been laid off, so he’d decided to launch a Worker’s Compensation claim over the incident. He wanted an MRI of his head, neck, shoulders and back as well as a referral to a neurologist “right away.”
4. A few people with no particular musculoskeletal disorders asked that letters be sent to their insurance companies informing them that in my opinion it was medically necessary for them to have prolonged courses of massage therapy at their chiropractor’s office. “It’s covered under our plan, so we might as well get our money’s worth.”
5. A fit senior who hikes and rides his mountain bike all over the place insisted I sign a form stating he is too disabled to walk in order to allow him to qualify for an income tax disability credit. He was surprisingly irate when I declined.
6. A patient wanted me to send a letter to the town’s subsidized-rental housing administrator saying I felt it was imperative she and her equally able-bodied spouse be given the next available ground floor apartment. Why? “We don’t like stairs.”
7. A squadron of shady transients drifted into town looking to score prescriptions for OxyContin, fentanyl patches, sedatives and other goodies. Don’t even get me started on those con artists – in the Periodic Table of Society, ER drug seekers are plutonium!
8. One of my patients showed up at the office saying he’d missed the preceding week of work due to a bad cold. He assured me he was fine now, but he needed a return to work note to present to his employer in order to collect his sick pay. Neither I nor any of my colleagues had seen him during the week he was off, so there was no objective way to corroborate his story. This isn’t the first time he’s pulled this stunt. How do I know he wasn’t out moose hunting with his buddies?
9. Another patient had some money locked into a GIC. In order to withdraw the funds prematurely without incurring the standard financial penalties he wanted me to advise his bank that it was medically necessary for him to get his money right away. The reason he needed the money in such a hurry? He wanted to buy a new snowmobile.
And the grand prize winner:
“Can I get a letter saying you feel it’s necessary for my health for me to have carpets installed in my apartment?”