Lessons From a Visit to the Doctor…

Recently, my friend Nick told me a story that I feel compelled to repeat, because it contains some valuable lessons for all of us. A few weeks earlier, Nick had undergone an emergency procedure for a detached retina. He had returned a week later for his first follow up appointment. As he started telling me his story, I asked him how things went at the first follow up visit. “Hmm, I really don’t remember anything, except that the doctor was happy with my progress” he replied, clearly a little embarrassed. The day before our conversation, he had been back to the doctor for his second follow up visit to make sure his retina was healing properly.

Because he had been told not to drive, a friend took him to his second appointment. Nick and his friend had arrived a few minutes early for the appointment, and within a short time they were in the exam room with his doctor. Looking confused, the doctor asked Nick whether or not he had taken his medications before he arrived, as he had been directed. Nick replied that he had not taken any medications, and said that he had not been given any directions to take any medicines.

At this point, the doctor became visibly annoyed with them. He snapped at Nick, saying that he had told him the directions himself, so he was sure that he had been instructed on what to do. He told them that he would have to give Nick the medicines now, and then they would have to wait at least 30 minutes for the drugs to take effect. He made sure to point out that this was a huge waste of his time, and that he could have simply sent them out to return at another time. He gave Nick a pill to swallow and put some drops in his eyes, and sent them to sit in the waiting room.

…it was clear that Nick was high and feeling no pain or concern about anything…

About thirty minutes later, he called them back into the exam room. As they got up, it was clear that Nick was high and feeling no pain or concern about anything. The pill had been a sedative, and it was working all too well. Nick’s friend held him and guided him through the doorway, trying to keep him from swaying too far in any direction. Somehow, they got Nick into the complicated chair and kept him from spilling out of it.

A few minutes later, the exam completed, his doctor explained that everything looked good, and he would see him again in a week. He also told Nick to take one of the pills and place the eye drops in his eyes an hour before his next appointment. At this point, Nick was appearing rather chameleon-like, focusing on two different parts of the room at the same time.

Nick’s friend casually asked the doctor if these were the same instructions that he had given him the previous week. He said that they were. Looking at Nick, the friend replied, “Do you realize that he is high right now, and won’t remember a word of what you just said?” The doctor was a bit too shocked to reply immediately, so he used the brief silence to add, “Could you write the instructions down, so that he can read them when he sobers up? I think this is why he didn’t follow your instructions the last time”. With a withering look, the doctor scribbled the instructions on a piece of paper. “Can you write the date and time of his next appointment also? I don’t want him to miss it”.

The friend managed to steer Nick back to the car and get him home without incident. The three of us spoke the next day, and as expected, Nick remembered almost nothing of his visit with the eye doctor. I was disappointed to hear about his experience, but not altogether surprised. Although he meant well, Nick’s doctor didn’t have very good communication skills. He also had unreasonable expectations. Giving someone verbal instructions after they’ve taken a sedative is really not a great way to communicate. Expecting them to remember the instructions is expecting a little too much.

For both his and his patients’ sakes, this doctor could have provided written instructions, so that his patients would know how to prepare for their visit. He or his staff could also phone, email, or text a reminder the day before the appointment to confirm that the patient understood the instructions. A little extra effort can make the difference between a satisfied patient and an angry one, or the difference between a safe treatment and dangerously misunderstood one.

My friend Nick also learned some valuable lessons. He will always take a trusted family member or friend with him, to listen in on the plan and help him remember what to do. He now asks for all instructions in writing, rather than trying to remember them.

Most importantly, he is no longer embarrassed about not remembering much about his earlier appointments. He had blamed himself, thinking that he hadn’t understood his doctor, when in reality he had been under the influence of a pretty potent drug at the time of his office visits. A drug that had been prescribed by his doctor, who should have known that it might interfere with his ability to remember detailed instructions. The doctor’s scolding tone had reinforced Nick’s guilt about not remembering the instructions, and it has taken him some time and coaching to gain back his confidence when dealing with doctors and the health care system.