Friday, January 16, 2009


When I arrived at my office this morning, I had a walk-in patient waiting for me. In the winter months, it’s not unusual for a parent to try to “jump the line” and want to be seen first thing, and I try my best to accommodate parent and patient. I had promised to do a medicine re-check for my nurse’s child after I made morning hospital rounds today so that we could get her child to school, and my nurse back to work. My partner saw the walk-in who had stalked Lori, my scheduler, at the back door forty-five minutes prior to my arrival, while I saw my scheduled re-check.

Sometimes parents believe that medicine is a club – one that you can join if you have the right political affiliations or money or a very important job. Membership in this club gets them exclusive bonuses –kind of like frequent flyer miles or box tops – bonuses that include a physician’s home phone number or pager and the right to call them any time of day or night. Occasionally a parent will ask for my direct number- sometimes with a smile or a giggle as they promise not to call me at 2 AM for a diaper rash or spit-up. Acceptance into this club also allows members to talk about their child’s sex education in Starbucks, or ask for antibiotics (just in case) whenever they are leaving the country for Turks and Caicos for the next two weeks.

Being truthful with myself, I accept that I am part of a club of sorts. When my triage service calls about a family friend who bit his tongue and needed advice about whether to go to the ER or not, I call the family because they‘re friends, and they would show the same concern for my children. I’ve also referred my brother-in-law with appendicitis to Dr. Ileum because he’s a friend and I know he’ll take good care of my relative. I’ve also met a fellow partner and her child in the middle of the night when she suspected her daughter had new onset Type 1 diabetes. (She was right!) My family and close friends (I can count the number of families on one hand) are default members, and they know there are rules about membership.

The notion of an exclusive membership or concierge medicine doesn’t sit well with me. As humanly possible, I try to treat my patients as well and equally as I would treat my own family or friends regardless of socioeconomic status. There are boundaries, though, and limit pushers that make me put my foot down. I won’t write prescriptions on the fly for administrator or staff’s children anymore when I’m trying to make hospital rounds. It’s not fair to my patients to get distracted like that. I cannot prevent a patient with lice showing up on Sunday morning on my front porch, but I won’t let them expose my kids. My phone has caller ID, and we screen the calls heavily, so when I’m not on call, I’m focused on my family, and my personal time. It’s all part of a balancing act that I’ve had to learn bit by bit.


  1. You are smart to set limits. I have been very bad at that and then I feel abused and resentful and it is my fault to begin with. I have made the mistake of being the doctor for "friends" because there is a shortage of primary care doctors and I want them to get the best care (me!). This is faulty thinking. There is no way to separate the friendship from the professional arrangement. They do abuse me and there are no boundaries. I have learned the hard way and it is impossible to get out of the arrangement once it has begun.

  2. Anonymous is correct that limits must be set. Because friends will abuse you, but worse yet, neighbors who are barely acquaintances. They call on weekends because "my doctor is off today and I don't want to bother his on call coverage partner". And what am I? The most useful excuse I have found is to tell them that my malpractice people absolutely forbid me to give advice or write scripts for anyone not an officially registered patient. Obviously, I will respond to a true emergency, but most of the afterhours stuff from neighbors is trying to avoid a visit to their physician's office. Even more irritating, is after you go through a thorough explanation of their options on given Dx or Rx, you find out that you are simply the fifth physician from whom they're get 1-2-3-4.... opinions. Kind of like advice on buying a car or picking a vacation spot. So - set limits at first request.

  3. Maybe the test of membership is whether you get special treatment when you need to see a physician or something?


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