Maria Yang, MD
November 11, 2012
It had been about two years since I last saw a primary care doctor. I was still living in New York City. My initial—and only—appointment with that physician lasted nearly an hour.
The front desk clerk had a round, pale face. Behind her was a textured wall over which ran a thin sheet of quiet water. Lush leaves spilled over the brim of the planter onto the marbled countertop.
“I’ll let the doctor know you’re here,” she nearly whispered.
He was a family practice physician. He was friendly. He smiled at me. He asked me if I lived in the city. When he learned that I worked as a psychiatrist, he commented, “Wow. That’s hard work, Dr. Yang.”
It was professional courtesy to address me by that title, though it didn’t feel right to me. I looked down to mask my discomfort. My feet dangled off of the examination table.
“Do you have a private practice?”
No, I said. I worked primarily with people who were homeless.
“Oh,” he said. “That’s even harder work.”
He asked me about my medical history, then my family history. He went through the major components of a physical exam.
He told me about his work as a primary care doctor. As a physician in primary care, it was getting more difficult to stay in business. He previously worked in New Jersey, but had been practicing in New York for a few years. He didn’t think he would leave the city. He was established now.
His technician then put square stickers on my chest and the EKG machine printed out my heart rhythms. Next, I took a deep breath in and held it as another technician took a chest X-ray. And then, another technician, who apparently worked as an anesthesiologist when he was living in his native country, told me not to worry too much when he drew my blood.
“It won’t hurt at all,” he snickered.
The physician called me two weeks later. He said that everything looked fine.
My primary care appointment in Seattle was one of the first visits of the physician’s day. I walked into the medical center and looked at the directory. I must have looked perplexed. A portly man with glasses asked, “Can I help you find something?”
“I’m looking for Dr. X’s office.”
Dr. X wasn’t a physician in private practice. Are there even family practice doctors in private practice in Seattle? I wasn’t sure how long the appointment would be. Not long ago, I was working with primary care physicians who had appointment lengths of 20 minutes. I envied them. I only had 15 minutes with each patient. A lot could happen in those extra five minutes.
The medical assistant was wearing a plaid shirt and black high-top sneakers. I couldn’t help but think that no medical assistant would dare wear anything like that in New York.
He left me alone in the exam room and I waited. It was a cold room and the gown was thin. I hoped that my doctor wouldn’t be harried and rushed.
After the physician knocked on the door, she quickly entered and gently shut the door behind her. She was about my age. She wore a long white coat and her stethoscope was around her neck. I immediately thought of the snarky comment one of the surgery residents had made about internists when I was a medical student:
“They wear their stethoscopes like they’re dog collars.”
“Hello, Ms. Yang—Dr. Yang? Dr. Yang, right?”
“Yes,” I said. There was that professional courtesy again.
She didn’t ask me many questions. I had filled out the general health questionnaire prior to the visit; she reviewed my responses. She typed some notes on the computer while we talked.
With what seemed like some sheepishness, she provided counsel on vitamin D. Maybe she thought that I was already aware of this. Maybe she thought that she shouldn’t go on about it because I had resources to look it up myself. Maybe she didn’t want to seem condescending. I couldn’t help but think, Don’t worry about me—just do your job. I don’t follow vitamin D as closely as you do, just as you don’t follow schizophrenia as closely as I do.
She went through the major components of a physical exam. We soon were talking about her job.
“Yeah, I went to a Prestigious Residency, but it really was malignant,” she said, pushing on my abdomen. “I’m so glad that I have this job here.”
“Do you mind if I ask about any productivity requirements you might have?”
“You may not believe this, but my schedule is built so that I only have seven patients scheduled in the morning and seven in the afternoon. I can add more on, but that’s the general schedule. That gives me time to call patients, return e-mails, and spend more time with geriatric patients, since, you know, they often have a lot of health problems and need more time.”
I was silently doing the math in my head. Seven patients for an entire morning! There were days when I had seven patients scheduled in two hours!
“Yeah, I can’t imagine working like that,” she said.
She spoke quickly after she completed the exam. “If you have any questions, you can call me or send a message through the website. It was nice to meet you.”
As I was getting dressed, I found myself wondering about all the tests she could have done, but did not. Wouldn’t it have been nice if she had baseline studies for me? What if I developed an arrhythmia in the future? Wouldn’t a previous EKG be useful for that? And what about basic labs? What if my kidneys start to peter out? Wouldn’t it be nice to know that they were fine in 2012?
And then I caught myself. Most women my age are healthy and without medical problems. I hadn’t endorsed any symptoms that would warrant further intervention. Tests had their risks, too.
Doctor as patient. I considered myself lucky that I was able to leave without new diagnoses or the need to return within a few weeks.
And I remembered again what it was like to be a patient.
Maria Yang, MD, works as a psychiatrist and first published this article on her blog, In White Ink , a collection of commentaries and stories about human behavior. Some of them are related to psychiatry and medicine; others take place in non-clinical settings. These narratives often do not appear in textbooks or medical charts. It’s as if these stories are written in white ink.
In White Ink offers insights into the behaviors of people and systems. These insights can help us learn more about the world, other people, and ourselves.