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Sometimes a patient's reasons for leaving aren't as bad as we might imagine.

Fam Pract Manag. 2007;14(2):56

Dr. Brown is a solo family physician living in Mendocino, Calif., and a contributing editor to Family Practice Management. His “Practice Diary,” previously published in FPM, is now available on Medscape ( Author disclosure: nothing to disclose.

You know them when you see them. They're those little envelopes from other doctors' offices that contain signed, witnessed releases instructing you where to send your patient's medical records. I open them with dread and trepidation, wondering whose records I will be sending and what god-awful thing I've done to make my patient transfer physicians. Sometimes they're requests from patients I haven't seen for years and can hardly remember, while others are from current patients whose reasons for dissatisfaction aren't always apparent.

I sometimes find these missives a bit discourteous, especially after I've gone the extra mile for the patient. Maybe it's too much to expect people to be forthright or to care enough to explain themselves, but a while ago I received a records request along with a note from a patient that could be the model for how it should be done. It read:

“I want to express my appreciation and gratitude for your services over the years as my doctor and your support as a friend. However, therein lies the problem. Because of our friendship, there doesn't exist that ‘professional distance’ and I find myself feeling embarrassed at times. As I continue to get older, my medical issues will increase and so will the severity and personalness of my problems. I feel it would be better to establish myself with another physician at this time prior to needing that additional care. Again, this is no reflection on your abilities and I hope you understand. This has been a difficult letter to write.”

I hated to lose this patient, but I understood and appreciated her thoughtful words. It was a different story, however, when I recently received a medical records request from my patient John, with whom I had always had a good relationship and to whom I had always provided good care. What was up? I asked my office manager to pull his chart and confirmed that we hadn't even seen him for eight months. Our last visit had been amicable; I had gone over the recommendations of an ENT consultant I had referred him to for nasal polyps and chronic sinusitis. I had been refilling his prescriptions in a timely fashion. He had no billing issues. It was a puzzle. I was half tempted to call him up to find out what had piqued him to find another physician, but I chickened out.

A couple months later, John called for an appointment. My office manager diplomatically asked him if he was still our patient. “I'd like to be,” John said.

When he showed up at my office, he explained what had happened. “My wife has been after me for years to try her doctor, who's part of a big group. The new doctor had me do a bunch of lab tests, but then her nurse called me up to give me the results. The nurse didn't explain things very well and told me I was diabetic, which I'm not. I looked around on the Internet and found out that I'm prediabetic. Then the doctor sent me to a liver specialist because one of my liver tests was slightly high, but her office never sent the paperwork so the specialist couldn't figure out what I was doing there. You explain things really well, and I don't think you would have put me through this hassle. Will you take me back?”

I looked over the lab reports that John had brought with him. He had a minor elevation of his serum bilirubin that had always been there and could have been Gilbert's disease, and his blood sugar was 115 – not yet in the diabetic range. Besides, his A1C was only 5.4. I was happy to take him back, but I had one nagging question.

“John,” I said, “Why doesn't your wife like me?”

“She just doesn't like doctors,” John said.

I'm sure there was more to the story, but I didn't delve any further. We all have our fans and detractors. The important thing was that John was coming back to the flock after discovering that the grass wasn't greener on the other side. Later, I said to my office manager, “It's always nice to get a new patient who has heard good things and wants to give us a try, but to get a former patient to defy his wife and come back – now that's really special.”


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