Anything else?

Do you always feel comfortable asking your doctor all of your questions?  I thought I did, until late one summer, when my legs suddenly started to itch.  It began on the lower aspects of both shins and spread steadily, up to my knees, then my thighs, and then my arms, with little pink bumps.  The itching was moderate, I could still get through my day, but I didn’t know what it was.  After a few weeks I made an appointment with dermatology.

I was a model patient—told my story in chronological order, all the pertinent details laid out neatly for the resident who saw me first.  I made his job easy; he appreciated that.  We both surmised that it probably wasn’t anything serious, maybe viral, and would likely resolve with time and some steroid cream.  The attending entered several minutes later, having heard the story outside of the exam room.  We all agreed on the diagnosis and treatment, easy-peasy.  I felt proud for keeping their clinic on schedule.

Then I suddenly remembered other bumps on my hands that I had always wanted to ask a dermatologist about.  Present for years, there were just a few—pinhead or smaller, round, translucent nodes on my palm, which would always grow back a few days after I pinched them off.  I showed them to the attending doctor and asked what they were.  He said they were nothing, and that I could just live with them.  And that was that.  I only realized later how unsatisfied I felt.  What were they?  What caused them?  What should I expect, would they ever go away?  I just wanted to know, to learn.  He didn’t really answer my question (though I suspect he thought he did), and I felt too sheepish to ask anything more, as if I were wasting his time.  I can’t blame him entirely—he was not intentionally dismissive or rushed; actually he was perfectly pleasant.  But something made me shut up when I really wanted to engage him.  It fascinates me to this day: I am a doctor; I gave my doctors what they needed from me, and could not get what I needed for myself.  The rash resolved with ointment and my hand bumps persist.  I still regard them with annoyed curiosity, and remember that encounter.  It was humbling, to be sure.

By contrast, my kids’ allergist regularly invited me to ask questions.  He knew my background, and explained things to me in a collegial way.  He would then speak to my kids in language that they could understand.  I always came prepared for his appointments, a list of events and questions in hand.  Toward the end of every visit he always asked, “Anything else?”  No, we’re good.  Some more small talk, follow up plans…  “Anything else?”  Umm, no, thanks, I think we got it.  Prescriptions, parking validation…  “Anything else?”  Really?

At first I started to wonder, ‘Am I missing something?  Is he hinting at me?  What else, there must be something else, think, woman!’  And, ‘Does he have some kind of tic?’  Then I realized: He made an intentional practice of making it safe for patients to ask questions. He understood how patients got tongue-tied in his presence, and made repeated, conscious efforts to untie us.  Brilliant!  Maybe it cost him a few extra minutes each visit, maybe not.  His sincere interest in my concerns, though, earned him my trust and respect.  As a fellow physician, I know the value and rewards of that.  And now I ask my own patients often, “Anything else?”

10 thoughts on “Anything else?

  1. Funny, my kid’s allergist is the same way, talks directly to my son, yet makes sure that mom has all the info she needs, too. (I suspect you do the same.)

    I read somewhere on the interwebs a discussion of why we often say “no problem” when someone thanks us rather than “you’re welcome.” I think your post speaks to this as well. As if we don’t want someone else to feel bothered by us, whether we are asking questions or even, strangely, when we have done a nice turn for them. It’s a cliche but we are so hassled and frenzied by daily life that the last thing we want is to be a hassle to someone else. Perhaps repeatedly asking, “Anything else?” may be one way to break through that barrier and emphatically remind others that no, you are not bothering me. Really. It truly is “no problem.”

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    • That’s so interesting, “No problem,” vs “You’re welcome.” If I say “You’re welcome,” does that make you feel like you still owe me something, even though I said it? “No problem,” feels like, “it was nothing, it doesn’t matter,” and in a way invalidates the, “Thank you.” It absolves both parties of any further connection–is that our pattern these days? I think I will try to say, “You’re welcome” from now on, and mean it. You are welcome, it was my pleasure. You don’t owe me anything, and I’m happy to be connected to you now and hereafter.

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      • I don’t frequent fast-food places, but I do stop by Chick-Fil-A for their hand-squeezed lemonade from time to time. Their order takers always response, “My pleasure.” It’s so charming and old-fashioned, and it always makes me happy to hear it. Now, I look for opportunities to use the phrase.

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      • “It absolves both parties of any further connection–is that our pattern these days?” I think you’ve hit on it. Too often our encounters are transactions and once completed, no further obligation exists. It reflects our independence, but also is sadly alienating. I am going to consciously go back to saying “you’re welcome” and “my pleasure” too. Because sometimes it is a problem to help but I still ultimately enjoy doing so. 🙂

        Liked by 1 person

  2. I recently had cataract surgery. The first procedure went well, as did the second. But one day after the second surgery, after a day of perfect vision and a perfect follow-up visit, it was as though I had walked into a cloud of zero visibility fog. It came, and it went, and I was panicked. As I said later, if all hadn’t been perfect in the beginning, I probably would have accepted the fogginess as natural, and let the healing process take its time.

    In any event, I ended up back at the clinic to see my surgeon a second time. After he’d checked everything again (still 20/20, with a little inflammation, add antibiotic drops to the routine) he sked how I was feeling. I said, “Nervous.” He reached into his pocket, and took out a card. He wrote something on it, then handed it to me. It was his cell phone number. He said, “If you have any problems over the weekend, give me a call.”

    Of course I had no problems, and my anxiety level went down to near zero. I’m not saying every doctor should do that — in fact, I suspect most shouldn’t — but he knew me well enough to know that a little security blanket was all I needed — one about 3″ x 2″!

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    • Expectations. Reassurance. Connection. There is so much potential for meaningful relationship in every medical encounter! What a privilege to do this work, really. Too bad for so many it just doesn’t feel that way… Maybe I can contribute to changing this? As patients, how do you see your doctors? Do they love their work? Do they empower you to take charge of your health? Do you feel like part of the same team? What would it take to achieve these things?

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      • I once saw a specialist for what was potentially a very scary condition that turned out to be nothing, thankfully. But as he was delivering the good news, he was walking backwards out the door and on to the next problem, I mean patient. The good news was nearly cancelled out by his dismissive attitude, leaving me wondering, had I been overly worked up, creating a mountain out of a mole hill? Did he see this as a case of female hysteria? And also, sometimes good news takes a moment to sink in too, to turn off the worry. Better doctors give you time and their undivided attention. My internist is learning my style, that I don’t want to rush right to drugs, but understand what the root cause is and make lifestyle changes first. But that takes time. Somehow she manages to make me feel like I’m her sole concern for the duration of my encounter.

        I would say, yes, if you feel the calling, please work to bring about change! Wouldn’t it be great if real-life docs were like the ones we see scripted on TV who converse at length with their patients in nice offices and act as trusted advisors/champions?

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      • What’s sad is that when we docs cut the encounters short like that, we cheat ourselves out of the key connections that give us joy in our work. It’s a steep downward spiral of deeper and deeper isolation. Fascinating…

        Liked by 1 person

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