Apr 1999 Table of Contents

Practice Diary

Excerpts From a Family Physician's Journal



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Fam Pract Manag. 1999 Apr;6(4):44.

Mistaken first impressions

Pearl was a wizened, 87-year-old woman who appeared at our office one morning looking for a doctor. Hers had hurriedly left town, and, although she claimed to be healthy, she didn't want to be without one. I was hesitant. Little old ladies usually have fairly thick charts and a multitude of medical problems, and our practice was rapidly approaching critical mass. I told her we'd set up a consultation, go over her records and see what we could do for her. “By the way,” I said, “what do you do with your time now that you're retired?”

“I'm not retired,” she replied, “I'm a gardener.”

A week later she returned with her medical records. They were remarkably sparse. She took no medications, and her only contact with the medical establishment had been years before for a ruptured appendix. A cursory exam, however, disclosed severe rheumatoid changes in her hands. “Those hands ever bother you?” I asked.

“Nope.”

“Take anything for them?”

“Nope.”

“By the way, Pearl, I'm looking for a gardener. Interested?”

“Yep.”

Pearl came back that afternoon and started weeding and trimming the garden in front of our practice and returned the next morning to finish the job. She worked slowly but never stopped, and she wouldn't let me get her anything. She left the garden immaculate.

A few days later, I did a complete physical on her, and when I tried to get her to make a return appointment for her results, she balked. “Too busy. Got 40 customers. Just call me up.”

An office manager with connections

I find that by employing Isabel, not only do I have an office manager who doubles as an interpreter, but through her I am connected to nearly every Hispanic family in our town, many of whom have become my patients. If they aren't Isabel's aunts, uncles or cousins, they are her godparents. In Isabel's culture, anyone who helps with a young girl's coming out, or Quincenera, becomes a godparent. Isabel has 20 sets.

If, by chance, our Hispanic patients are not family, they still know Isabel because her father, Cuco, works in the woods where nearly every worker is Hispanic and her mother, Gloria, works in the courts and knows absolutely everybody. It was Gloria, in fact, who made me deliver Isabel's younger sister, Melissa, 11 years ago when I was trying my hardest to give up OB. (“But Dr. Brown, you have to deliver this baby!”) For years, Gloria and Cuco have cleaned my office, using the extra money for a variety of expenses, including orthodontist bills. They've since shucked those expenses to Isabel, who has beautiful teeth (and another 24 payments to make!) and whose contributions to my practice are priceless.

Getting into med school

I was a nontraditional premedical student. I graduated from college in 1968 with an English major, a 2.96 GPA, no MCATs and no medical course requirements, yet I matriculated into medical school one year later. Since then, I have felt an obligation to help other atypical students.

One of my advisees, Sara, is a 45- year-old professor of religion and humanities. She is bright and compassionate, has six pages of publications in her CV, is qualified to teach university courses in history, literature and several ancient languages I haven't even heard of, and would make a terrific physician. But Sara isn't good at taking standardized tests. Despite attaining a 3.5 GPA in her premedical sciences, she bombed the MCAT.

Medical school admissions criteria (high GPAs and MCAT scores) have not changed substantially in over 50 years. To be a doctor, you must be a good test taker; it's the one characteristic we all have in common. Whether we have any of the other attributes our patients demand of us (i.e., compassion) is a matter of pure chance. I wonder what sort of admissions criteria we might use if we were truly interested in turning out humanistic physicians.

Relaxing

We all find our personal comfort levels when it comes to work and play. Some of my friends are workaholics while others have already retired; I'm something in between. I have pursued semi-retirement, working two whole and two half days a week for many years. I'm not together enough to know what to do with nothing but free time, but I have enough interests to keep me busy on my days off. My favorite activity for pure relaxation is dirt bike riding.

Living next to Jackson State Forest in northern California, I can get home at 4 p.m. and, in 15 minutes, be properly accoutered and on my way out to do a trail ride through the woods. There's usually never anyone around, and I can be alone with my thoughts. An hour and a half, 40 miles, and I'm back before dark, totally refreshed. If I'm lucky, I'll catch a glimpse of a wild boar, porcupine or brown bear. And all the while I'm thinking it really doesn't get much better than this.

Dr. Brown is a family physician in solo practice. He lives in Mendocino, Calif.


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