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Miscellaneous thoughts and ramblings
Wednesday, June 29, 2005
 
You Should Know Better Than That
(This is a fictionalized account fabricated around a kernel of truth. The kernel is small enough and surrounded by enough lies that the true patient who inspired this story and the details of his medical problems are unrecognizable. I’ve also altered two somewhat graphic words by changing the letter “e” to “3” so that search engines don’t bring people here for all the wrong reasons.)

John Smith is 78. I've been taking care of him for years. His urologist called me a few days ago after receiving some worrisome test results about him. The urologist asked me to tell Mr. Smith about the abnormal results during his visit with me the following day. The reason he didn’t just give him the results over the phone is that Mr. Smith is quite deaf and phone conversations with him are difficult. So it was left to me to give him the bad news.

Doctor Bean: Good to see you, Mr. Smith.
John Smith: Heya doc.
DB: I have some news I have to give you about the tests Dr. Roberts ordered.
JS: Wha?
DB: I GOT THE RESULTS FROM DR. ROBERTS.
JS: Oh good. What's it say?
DB: YOU HAVE SYPHILIS.
JS: Huh?
DB: [screaming] SYPHILIS. YOU HAVE SYPHILIS.
JS: Oh, Lord! Syphilis!? Am I gonna die?
DB: [quietly] Eventually, but not from this; probably from failing to hear a car horn.
JS: Speak up, doc!
DB: YOU'LL BE FINE. I NEED TO GIVE YOU SOME ANTIBIOTICS TO TAKE.
JS: Oh good. I'm so embarrassed. How did I ever get syphilis?
DB: Don't be embarrassed. Well, um, how long have you had the sore on your p3nis?
JS: Eh?
DB: HOW LONG HAVE YOU HAD THE SORE ON YOUR P3NIS?
JS: Oh. That. It comes and goes. Doesn't hurt though. You think that's how I got syphilis?
DB: THAT IS THE SYPHILIS. HOW LONG'VE YOU HAD IT?
JS: Oh, 'bout a year, a year and a half.
DB: IT WOULD HAVE BEEN OK FOR YOU TO TELL ME ABOUT IT SOONER.
JS: I shoulda told you, doc. I didn't know it was syphilis. I'm so embarrassed. How could I have gotten syphilis?
DB: Well, when's the last time you had s3x?
JS: Wha?
DB: WHEN IS THE LAST TIME YOU HAD S3X?
JS: Oh. S3x. It's been many many years, except for once about a year and a half ago.
DB: WAS IT WITH A PROSTITUTE?
JS: Yuh.

So we had a good, long, loud talk about condom use. I tried to reassure him, and I prescribed his antibiotics. When I left the exam room to let him get dressed everyone in the waiting room looked at me and smiled. I stared at my shoes and rushed into the next room.
----------------------------------------------------
My previous reflections on doctoring:

I Really Appreciated This Visit
If I could be a doctor...
If I could be an astronaut...
Gawsh, You’re Awful Purdy!
Going Around
What Is It?
The Secret To Longevity
Thank You, Doctor
Senior Sadness
Comments:
This story is an argument for both condoms and soundproof exam rooms.
 
Well, good for him! Still going strong (syphilis aside!) That's what I call "loving" life to the fullest!
 
That's OK, my wife's OB for our first two kids was a frum guy (we actually knew him socially too) and his practice was in a very religious section of Brooklyn. My wife is VERY ticklish and shrieks with laughter if anyone touches here... anywhere! You can imagine how most of the exams went. He told her (only semi-jokingly) that even though there was a nurse in the room, the patients in the waiting room were likely to get the wrong idea of what was going on.

One of his best lines was when we went in to hear our oldest's heartbeat for the first time and my wife shrieked each time he got near her with the ultrasound probe. He turned to me and said, "Explain to me exactly how you managed to get her pregnant?!"
 
Ralphie: and an argument for prompt reporting of symptoms related to your how-do-you-do.

Irina: I'm not sure he thinks in retrospect it was worth it, though I didn't ask. I can imagine that conversation: SO, WAS SHE HOT?

David: Very very funny! If I ever have the pleasure of meeting you both I hope not to be thinking of this story as I greet Zahava. I don't think I'll be able to keep a straight face.
 
Great story! And all too familiar (though not necessarily syphilis). It seems that there is some correlation between the level of embarrassment of the condition and the degree of deafness.

"YOU HAVE HEMMOOORRRRHOOIIIDDDSSSS!!!!!"
 
By the way, have you ever had to change your advice based on an inability to communicate?

"I want you to double your Lasix."

"WHAT?"

"I WANT YOU TO DOUBLE YOUR LASIX."

"You have trouble with latex?"

"NOOO! I WANT YOU TO DOUBLE YOUR LAAASSSSIXXX!! TAKE TWO!!"

"What about my shoe?"

sigh "CAN YOU COME INTO THE CLINIC?"

"I Can't understand you doc! I think I'll come see you."

Maybe he's on too much lasix already.
 
Psychotoddler: Very funny. Changing my plan because I can’t communicate happens all the time. When I had more non-English speakers I would find myself ordering more tests to compensate for the fact that I couldn’t get a very detailed history. It’s the same thing with patients with deafness or dementia. Whatever the cause is, if you can’t communicate, you’re forced to practice veterinary medicine: examine the horse / patient, do tests on the horse / patient, give the prescription to the owner / relative and explain to the owner / relative how to give the medicines. That’s why Mr. Ed always got such great healthcare; he could report his symptoms.

[Explanatory note for non-physicians: Lasix is a diuretic that at very high doses causes hearing loss. Now you get it!]
 
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Thanks!.
 
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