Dear patients, please abide the current issue limit
Dear patients,
I regret to inform you that the clinic’s one issue per visit policy has been amended, effective immediately, to half an issue per visit.
Time for the other half is needed to enact two factor authentication so I can access the clinic desktop, your electronic medical record, the diagnostics log-in and the secure clinic messaging platform containing fourteen urgent notes from you. Each subject line is a variation of “urgent!”, “extremely URGENT!!”, and “sorry to bother (frowny face emoji) but This. Is. An. Emergency.”
I use the clinic desktop because my laptop, bless its ancient CPU, is burning out in solidarity. Admittedly, I do have 69 tabs open in Chrome. I know I should use a less demanding browser but I’m afraid to close my tabs—I might lose the minuscule progress made on three mandatory learning modules, a partly completed doodle poll with 26 dates/times, seven of which have already passed, and an email drafted last year outlining the reasons for my early retirement. Plus, I‘m superstitious about shared Google Docs. When you close them, where do they go and—even scarier—what do they take with them?
But don’t worry! Your doctor’s got you. While you, dear patient, recount IRL what you assure me is a half-issue totally unrelated to your fourteen urgent emails (Oh, you say, that wee chest pain, all cleared up now!), I skim your lab results and try to guess the significance of the radiologist’s report. As you pull up your shirt to show me a rash, my brain short-circuits. I surrender: tilting the screen out of your view, I type “interpret CT scan” into ChatGPT. Ignoring a sensation not unlike the feeling of my mother catching me smoking at age 15, I cut and paste the radiologist’s cryptic message (this opacity may possibly but not necessarily represent slight fibrosis which could, in specific contexts, indicate likely progression but seems unlikely; clinical correlation required) into the magical search box. Then, I cut and paste the result—in my own words of course!—into your chart, cut and paste the chart note into a referral letter, .pdf (verb form) and zip the whole damned thing. Next, I (you guessed it) cut and paste the referral into an encrypted message to the office person in charge of referrals. She only accepts double-spaced 12-point font messages, so I unzip, un-pdf and reformat. Per privacy protocol, I send the encryption password (FUNGUSFOOT) by regular email decoupled from data that could reveal your identity. First though, I must re-log into the timed-out desktop.
While I’m waiting for some kind of validation authentication code, up pops a time sensitive notification. It is the medical college, that pesky licensing entity. The message declares that, within the next six months, I shall evaluate my practice, identify five areas for improvement and implement three changes to avoid practice audit. In addition to regular annual educational credit requirements.
Meanwhile, dear patient, you recount to me all your daily stressors and bodily functions. The rash is eczema.
All of this is important to me; however, I’ve no time to counsel. Instead, while prescribing a tablet or two to treat your stressors/body functions, I recite a memorized fight-flight-freeze script meant to alleviate everyone’s baseline anxiety. Writing the prescription with a pen (the printer is haywire), I offer a half-promise to follow up at your next truncated appointment. Hand on the door handle, I advise you to speak with a pharmacist about any possible side effects. You scratch at your dyshidrotic abdomen. My own blood pressure palpable, I quickly instruct: steroid ointment, over the counter, twice a day, 10 bucks. Fourteen years of post-secondary education right there.
Later, after loading the dishwasher and tucking in my kids and the dog, I sit down with my lazy laptop and open tab #70. The computer crashes in digital fight-flight-freeze and so, for yet another day, I don’t submit any billing or finish any learning modules. Falling into bed exhausted, I then lay awake half the night worrying about you, 20 other half-problem patients, and how to pay my bills.
I hope you’re all finding the help you deserve, and I’m sorry I couldn’t do more. On the bright side, I take it all as a sign I should pivot, as trending leadership literature espouses, and become what I always dreamed of: a writer.
Sincerely,
Your Doctor
Dr. Bonnie Larson is a clinical assistant professor of Family Medicine at the University of Calgary who practices in Calgary's inner city.