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Fam Pract Manag. 2000;7(8):53

Auto mechanics

Bobby, my car mechanic, has a style I'd like to emulate. First off, he's a great diagnostician; tell him what's wrong, he'll give you the differential diagnosis. But you have to be specific. “You say the truck's not starting. Does the engine turn over, or do you just get a clicking sound?” After a few more questions, he concludes that my engine's not getting any gas and narrows the possibilities to either the high- or low-pressure fuel pumps.

The second thing I like about Bobby is that he always manages to teach me something. For example, although the high-pressure pump can't be seen, it can be heard just before you turn on the ignition. “If you don't hear this sound,” he demonstrates a high-pitched whirring noise, “the pump that primes the system is probably bad. Hit it with a screwdriver, and it should work until we can fix it.” (That's another thing I like about him: He's practical.)

Sure enough, the screwdriver did the trick, so I made an appointment to have the defective part replaced. That morning, as I left my car, keys inside, parked alongside all the other cars, keys also inside, I thought to myself, “Why do car thieves hang out at airport lots when there are easy pickings between 8 and 9 a.m. at places like this?” Somehow, Bobby never has trouble. And although he always has time to answer his own phone, run to the auto-parts store and talk to passers-by, customers and cronies that hang out at his shop, by 5 p.m. all the cars are fixed and gone. This has fascinated me for years.

Perhaps what I appreciate most about Bobby is his honesty. He is sure to tell me that if it isn't right, bring it back. And if it looks like he might make things worse before he makes them better, he'll warn me about a potentially negative outcome and ask my permission to proceed. These worst-case scenarios never actually happen, and they always make me wonder how he manages to skirt disaster.

As a physician, I only wish I had his combination of courtesy, proficiency and productivity — and, of course, his magic.

Signing out

Betty, an elderly patient of mine, wanted to leave my practice but had been too emotional to tell me. Instead, she asked Kathy, a patient representative, to intercede. “When it comes to doctor preference, the patient is always right,” I told Kathy. “I never try to dissuade a patient from leaving, but I do try to understand their motivations. How did she happen to see you anyway?” I knew Kathy was hospital-based.

“Well, her husband, Earl, has been here for a week recovering from a broken hip. Didn't you know?” she asked.

No, I didn't. Not only had one of my orthopedic colleagues fixed Earl's hip without telling me about it, but then he left town for two weeks and signed him out to me to boot. No wonder Betty wanted to change doctors; she thought I didn't care enough to visit her husband. I couldn't blame her.

When my colleague returned, he was extremely apologetic, but said so many doctors didn't seem to care. “Look,” I said. “I have to know what's happening to my patient. I know you can take care of him well enough without me and would have called me if things went south, but I should have visited him.” I could see he felt badly, so I added, facetiously, “And if you ever sign a patient out to me again without giving me a report, I'll break your legs.”

Revisiting Julia Butterfly

Julia Butterfly Hill ended her historic tree sit on Dec. 18, 1999, after wood tree named “Luna.” Recently, she spoke at a local auditorium, where she also autographed copies of her book. Having made the pilgrimage to Luna the previous summer, my family was up for hearing Julia speak and seeing her at eye level.

Julia is a sincere, spiritual, gentle person who exudes a serenity that borders on saintliness. When our turn came, my wife, Sue, asked her to inscribe “To Sandy, Sue, Gabe and Margot, who made the marvelous trek in the summer of '99,” which she graciously did. I had sent Julia a copy of the piece I wrote about her for the October 1999 issue of FPM and asked her if she recollected it. Despite having gotten hundreds of pieces of mail weekly, she said, “Oh, do you mean the one about physicians needing to have a spiritual side? I really enjoyed that perspective.”

She also had sent me a letter last November, reusing my envelope and paper, in which she thanked me for sharing her story with my medical colleagues. She corrected my impression that she had an exercise bike and laptop computer in her perch 180 feet above the forest floor; she did, however, have a radio phone powered by solar panels, a digital and video camera, an emergency cell phone, a tape recorder, walkie-talkies and a pager, the latter of which she accidentally dropped to the ground. It shattered, and she relished the few days of reprieve that it brought. I understood completely.

On the outside of the envelope Julia had written, “Respect, Rethink, Reduce, Reuse, Recycle. It's a precious planet.”

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