A never-ending encounter

There are times when keeping your patience is the hardest task of all

Mrs M is not happy. She says she must have her repeat prescription today, always gets her repeat prescription without a separate appointment, that it is imperative I send a repeat prescription to the pharmacy right now. Her expression is expectant, fixed, frowning, disapproving, demanding. It is the expression of a woman who gets what she wants without delay, no questions asked. Her voice, a voice I would recognise anywhere, resonates in my acoustic canals like a nail on a chalkboard, reverberates in millions of nerve endings, even after she falls silent. I can detect no openness, no empathy, no patience, no tolerance. If she does possess such qualities, she will not waste them on me. 

We face each other, doctor and patient, in the sanctity of the consulting room, and in the brief and merciful silence, I ask a higher power to fill me with restraint, to send it to me in the in-breaths I notice getting longer and deeper as I face my ‘foe’. I am a professional, I remind myself. I run a business, I try not to keep people waiting. I try to complete important tasks in a timely manner. I only have so much time and she has already consumed more than her share. For over 20 minutes I have listened, clarified, examined, listened, explained, and listened again – old aches, new pains, stiffness, headaches, sleeplessness, cough – until finally, believing we have a plan, a conclusion, she requests one more thing (“While I’m here, Doctor”). It is a request that requires even more time, concentration, and decision-making. 

I repeat that she needs to make an appointment for blood tests and then come back to me for her prescription. I am restrained. I remind her that she has enough medication for a few weeks, that this is good medical care. She remains seated.

I push my chair away from her and swivel towards my computer and tap and click and tap and click and browse and sigh, and click and tap until I hear her ask a question, her tone a little softer.

“Can I go now?”

I answer: “Yes, of course, we are done here for now,” and return to my clicking and tapping. I hear her chair scrape the floor, hands rummaging in her handbag, keys jangling.

“Are you writing my prescription, Doctor?,” she asks, hesitating, halfway to the door. Ah, I wasn’t done yet, it seems.

I turn in her direction, her expression enquiring now, less certain, a slight tremor of her lip.

“No, we have dealt with a lot of important issues today,” I say. “I don’t have any more time to give you right now. I must see to the others in the waiting room. I’m sure you understand.”

“You could have said that,” she says. “Instead of having me sitting here.”

“I did,” I say, “you obviously didn’t hear me. Now, if you don’t mind, I have quite a lot to do.”

Her face grows dark, dark as a thunderous cloud, darker than that, the evening darkens as the sliver of light between the hedge and sky narrows and disappears. I get up and walk to the door.

“I’m not being awkward,” I say. “And this is not about money. I get paid the same no matter how many times I see you. But I must practice safe prescribing, make sure you are on the best possible treatment, avoid repeating medications that you may not need, that may cause you harm. I will not make excuses for doing things right. I will not be pushed into taking shortcuts that may have negative consequences.”

I try to speak kindly, convey concern, compassion, but hear my frustration, irritation, my need to be done with this consultation. It has been a long day and it’s not over yet. I hold open the door.

“I’ll see you soon,” I say, not sure that I will ever see her again, “and will sort your medications. Just make appointments on your way out.”

“Fine,” she says. “I’ll be back and I hope I won’t be kept waiting like I was today. I can’t understand why doctors are always running behind.” She has one foot in the corridor, and will soon be gone, so I let this remark go, refuse to rise to the bait. I even attempt a smile.

“I’ll do my best,” I reply. “That’s all I can do.”

She leaves without saying goodbye, disgruntled, brisk footsteps click-clacking on the waiting room floor.

While I have never sworn the Hippocratic Oath – a venerable document that dates back more than two millennia – like most doctors, I aspire to abide by its principles: Maintain patient confidentiality, do no harm, and uphold the integrity of the profession. These are lofty goals, that, for me, require minute-by-minute decision-making, Herculean efforts at emotional regulation, and up-to-date knowledge and competence. Expecting to keep everyone happy can be a step too far.