Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Sunday, September 23, 2007
    Conversations with V.

    So last Friday night I sat in V.'s office rehashing the events of the workweek, as we often do. Call it a debriefing session: It allows us to dump our angst for the week and go home to relax.

    "So did I tell you we had a ghost in the office today?" she said dryly after a few minutes' chat.

    "Um... no," I answered, puzzled.

    "A patient of mine came in asking me to write her a letter. She lost her Medicare benefits because the government says she's dead. And I am writing this letter going, I have known this woman seventeen years. Trust me, she is not dead."

    I gaped at her for a second. "Are you serious?"

    "Yes. I've known her longer than I've known B [her husband]. So I felt her and I said, 'Well, you're warm... you have a pulse... I'm guessing you're not dead.'"

    "Geez." I thought for a second. "That might be the least of her problems. She's gonna lose her Social Security benefits."

    "She already has." V. is very good at keeping a dead pan, no matter how pissed off she is. I knew she was more than just annoyed.

    "Did I mention this is why you should never depend on the Feds? For, like, survival?" I demanded, unleashing my libertarian side (which V. is used to by now).

    "Yeah. It sucks."

    "Well, she's got you. And you know her," I said, hoping it would help. "You're willing to stand up for her. I'm sure that will take care of it." And it will. Eventually. But it probably will mean a lot of extra work for V., as it would for me were it one of my patients. This falls into the class of those "annoying but necessary" jobs we have to do. Except it's more annoying but unnecessary - it's due to some bureaucratic foul-up.

    V. sent me a copy of the letter she wrote for the patient, brilliant in its understatement. In it she documented the woman's vital signs at her visit this week and stressed the fact that she had known the patient for seventeen years. Subtext: Do the math, you idiots.

    We anxiously await the result.




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