Editorial

THAT $5 HOT DOG GETS STUCK INMY THROAT EVERY TIME

Each patient is unique. What excites one may thor-

oughly antagonize the next. Psychologists have said

that patients expect ‘‘a lot’’ and can ‘‘suck you dry

emotionally.’’ Yet, we stay focused and try to do our

best. The doctor and the staff must muster patience

and learn to cope with the myriad of personalities

that cross their doorstep in search of treatment. Every

now and then, in walks the completely unreasonable,

hostile, and demanding patient. Everyone has some

private mental baggage which they carry around with

them. Some hide their issues well, while others make

everyone else pay dearly. If you look deep into their

soul, you just may find their psychological trigger.

An optometrist working in our practice is one of

the most pleasant and likable people you could meet.

One day he came running to the front desk completely

red in the face. He exclaimed, ‘‘These people are

impossible!’’ In his exam room, the daughter of the

patient continued to shout, ‘‘I can prove to you that

my mother�s glasses are no good!’’ She proceeded to

pull the eyeglasses off of her mother�s face and put

them on her own face. ‘‘See! I can�t read anything on

that chart with these glasses, so how can you expect

my mom to do any better?!?’’

At this point, you just begin silently counting to ten

very slowly. Ultimately, these types of patient make

for a very long day.

Then there are the family confrontations. Family

members often cannot accept the ‘‘mental baggage’’

of another family member. A good example was a

visit by Mr Jones and his daughter. Mr Jones*

walked into the eyeglass dispensary heading directly

for the wall display marked ‘‘$39 Clearance Frames’’.

Following a few steps behind, the daughter quipped,

‘‘Dad, no! You deserve a designer frame.’’ She looked

to the staff for support and continued, ‘‘For heaven�ssake, he worked seven days a week and now owns

the largest commercial electrical contracting busi-

ness in this part of the state.’’ Mr Jones turned and

quietly replied, ‘‘Honey, let me look around a bit.’’

With a sigh, she said, ‘‘Okay, dad. I�ll be back in

30 minutes.’’ Once she left the building, Mr. Jones

said very somberly, ‘‘There goes one of my beautiful

children. They bring me to the ballpark to sit in $75

seats and then buy me $5 hot dogs. They don�tunderstand when I tell them that the $5 hot dog just

won�t do down my throat! I take a bite out of those $5

hot dogs, but can�t swallow them. No kidding...they

get stuck in my throat. So, I give �em to the grand-

kids.’’ Looking out the window of the office,

Mr. Jones smiled softly and continued, ‘‘When I was

a kid, my mother would go to the store and buy a bag

of two-week-old bread and a package of five hot dogs

that were just about turning sour. It was the

Depression and you took what you could get, you

know? I mean, my dad worked for a few dollars a

week and with five kids––well, the money just didn�tgo that far. Once they turned off the electricity for

one month in the middle of winter...’’ His voice trailed

off and he sighed. Slowly, Mr Jones turned toward

the display of frames and began again. ‘‘Anyway, us

five kids would watch my mom coming out of that

little grocery store with a small bag. She would only

buy five hot dogs for us...one for each of us kids. Oh

boy, we could just taste those 2-cent hot dogs. It was

the best tasting meal I ever had in my life. None of us

ever realized that my dad and mom weren�t eating

with us until we were a little older. It was a real

sacrifice for them to take care of us like that. God, I

wish I had a time machine to go back and really

splurge on my parents.’’

Then there are the ‘‘good guy, bad guy’’ couples. It

doesn�t take long to realize their modus operandi of

manipulating the people around them. Be smart and

don�t get sucked in! If one maintains focus by doing

their job in a professional manner, hopefully a

smooth exit can be made.

One of the hardest decisions is when to get rid of

a patient. Often times, these patients come around

and end up as one of your most grateful patients.

It�s like a difficult customer in the business world,

win them over and they will probably become your

greatest supporter. But, a small percentage is the

making of your litigious patients. So, be careful and

don�t let a patient�s antics distract you. Document

uncooperative and unreasonable behavior. Don�t letthis type of patient make you careless or sloppy. Be

assured that their attorney will be most careful and

effective.*All names have been changed to protect the privacy of those

involved.

ANN OPHTHALMOL. 2007;39 (2) ................................................89

The physician is being pulled from all directions by

the myriad of patient demands, the financial con-

straints of the insurance industry, and greedy mal-

practice attorneys. Physicians are stretched to the

limit by a mountain of paperwork, an insurance

industry that pressures one to do as little as possible,

and a legal system that sues doctors even when the

physician saves the patient�s life. Usually this has

nothing to do with right or wrong; the motivation is

that 20% of the financial settlement is handed over to

the malpractice attorneys. So now, more than ever,

the physician requires maximum energy to stay

focused. All of these extra headaches are more fre-

quently pushing physicians to burn out quickly.

While saving lives, the physician must deal with all

forms of personalities along with insurance and legal

distractions. When one completes medical school, no

one tells you the really big secret about the guy who

has $5 hotdogs that stick in his throat. We often feel

sorry for this patient type, but often they will prob-

ably be angry with you, the doctor, for prescribing

those ‘‘expensive eye drops’’ that just happened to

save his vision. If such a patient fails to use the drops

except for a few days before his office visit, then

subsequently goes blind, what is the physician�s legalliability? Absolutely, you would have moral as well as

legal liability in such a case. But, that is a discussion

for another editorial on another day.

The moral is that the life of the physician is ever

more complicated. So, you need to stay focused,

document your activities, and develop as good a

dialogue with your patients as is possible.

Richard J. Fugo

ANN OPHTHALMOL. 2007;39 (2) ................................................90