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Am Fam Physician. 2021;104(6):644

Author disclosure: No relevant financial affiliations.

8:05 a.m.

I received four messages from a patient requesting a medical exemption from the COVID-19 vaccine. The patient has no contraindications to the vaccine, and I have repeatedly counseled her to get vaccinated, especially given her comorbidities. I called the patient, and she shouted, “Doc, I need you to call my employer! They're going to fire me because I don't want to get the shot… I saw my family get beat up by cops when I was five. The government has been killing my people for 400 years. You know about Tuskegee, right? I don't trust what they're saying.”

9:00 a.m.

My first patient was a 32-year-old man who was recovering from gunshot wounds. He has a colostomy bag and has difficulty walking because his sciatic nerve was partially severed. He made significant progress with mobility and wound care, so I congratulated him for sticking with his treatment regimen. He said, “You know, doc? I almost died three years ago when I OD'd on heroin. The ambulance girl did CPR on me for 30 minutes. I still smoked crack after that. This is the second time I almost died. I know I won't have a third chance. It's going to be different from now on.”

12:30 p.m.

During lunch, a message popped up on my screen, “Seiji, a patient of yours needs a letter for immigration ASAP.” I called the patient, and he said his wife would get deported unless I wrote a letter. He couldn't give me more detail, so I called his immigration lawyer. After discussing the case, I wrote a letter stating that my patient has diabetes and end-stage renal disease, and that without the help of his wife, my patient would not be able to get to medical appointments or take care of himself at home. The lawyer responded, “This is perfect. I think I can get a work visa for his wife.”

2:00 p.m.

Toenail removal was the chief complaint for my next patient, who was referred to me by a colleague. I introduced myself and said, “So, I hear you need your toenail removed.” The patient looked at me nervously and showed me his discolored and thickened nails on two fingers and seven toes. I asked whether he had taken any medicines for fungal infections before, and he shook his head no. I didn't see any paronychia or ingrown nails, so I suggested that we try an antifungal medicine. With a sigh of relief, the patient thanked me. Pointing to the procedure tray, he said, “I thought you were going to rip off all of my nails!”

3:30 p.m.

I reviewed laboratory results between patients and saw an A1C of 6.7 for a patient whose A1C was 11 when I met her one year ago. I excitedly called the patient. “Ms. D, your A1C is 6.7. I'm so proud of you!” She responded, “You and [the nurse] were so kind that I didn't mind coming to the clinic. You know I lost 20 pounds just by walking 30 minutes a day like you told me.”

5:40 p.m.

Before leaving the clinic, I saw another message from the patient who requested a medical exemption from the COVID vaccine. “Doc, they fired me… I almost got the shot... But, at the last minute, I had a panic attack, and I just couldn't...”

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This series is coordinated by Jennifer Middleton, MD, assistant medical editor.

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