Comfort Zone

Chapter 16

A weekend is for slowing down and smelling the roses, indulging in simple pleasures like lying in bed with the shades closed until noon reading free medical magazines—the "throwaways" that piled up in the mailbox. Not for studying articles with titles such as "Nephrosclerosis in the elderly," but rather:

"I volunteered in Kenya and learned the true value of healing,"

"Charged with Medicare fraud? Here's how to fight back,"

"How to transform your struggling practice into a multimillion dollar franchise,"

"EHR privacy: Is the government tracking all?"

"Is our medicine safe? The worrisome rise of counterfeit medicines –10% of prescribed medicines globally!"

"How to manipulate your social media presence," and, most perplexingly,

"Seven minutes is enough! How to boost productivity and include everything for everybody into the new, supercharged seven minute visit!"

When she was just starting out in practice, Miriam made a cheat sheet listing all the things a primary care doctor was supposed to cover. There were ongoing medical issues like diabetes to discuss, new problems to address, medication lists to update and specialist visits to review. There was screening for matters like depression, domestic violence, risky sex, smoking, drugs and alcohol, even seatbelts!, and counseling when necessary. There were routine health measures such as PAP smears and colonoscopies to talk about, a physical exam to perform, and prescriptions and lab work to order.

Every visit was a combination of these elements, varying as per the needs of patient and doctor. The EHR could make it easier to remember the questions, but harder to avoid the appearance of a bloodless cross-examination.

In the past, Miriam had also routinely asked about gun ownership safety, until some NRA-happy lawmakers in Florida muzzled doctors from doing so. Even though they had eventually lost their gun fight, the damage was done and Miriam had yet to put it back into her routine. She made a mental note to check her electronic record to see if there was a prompt for it, or if they'd stayed out of the fray.

Even without gun safety, it was challenging enough to include everything needed in thirty minutes, and this doctor author had found a technique that allowed him to get and give all the information necessary in under four hundred eighty seconds? Miriam pictured herself speeding through the necessary questions, listening for exactly the recommended length of time to show empathy.

Whew! Four hundred seventy three seconds, triumphant click closing the electronic note and hand on the door, seven seconds from a clean getaway, just enough time to say "Do you want fries with that?" and--

"Dr. Got—t—lin," the patient says, bursting into tears. "My husband just left me."

Miriam tossed the magazine into the recycling bin and poured another cup of coffee.

The weekend was also for remembering Tati's words and going out to hear music at a local bar with a friend.

She looked around carefully in the dim lighting, hoping none of her patients were there. She hated when that happened. The last time it did, she was alone at a matinee showing of a chick flick, and was balancing a large popcorn and diet Coke. She tried to paste on her professional face but it wasn't easy with popcorn kernels between her teeth.

Miriam relaxed; no one looked familiar, just the usual crowd of siliconed, airbrushed-appearing women, and men with no chest hair.

"What's your name?" one of them shouted to her over the music, his arm brushing against the bar toward hers.

"Miriam."

"Hmm. That's biblical." He veered into her personal space and she could smell his breath. Beer, but not unpleasant. Even looked a little like Josh, had the pharmacist's mouth.

"She had leprosy."

He veered away toward another prospect.

The music was too loud, and had a driving beat. Good for beating my head against the wall, Miriam thought. Why am I even here?

"He was cute," her friend said. "Why do you blow them off so soon? I bet that blind date guy was better than you said. He even texted you after. Why don't you try to engage them a little? It wouldn't kill you. Smile, say something nice."

"I did."

"You implied you might have leprosy."

"It was a joke. Anyway, it's curable now."

"You looked mean."

"I always look mean. It's something with my eyebrows."

"I know a good place you can get them waxed, or plucked or threaded."

"Just one of the many fun things women do to feel good about themselves."

Her friend just shook her head and went off to chat up an attractive man. Miriam sipped her drink and sighed, closed her eyes for a minute and bobbed her head to the beat.

She wondered how Ms. V was doing, and just barely managed to keep from running outside the bar and calling Tati to ask. It was almost midnight. She pictured her reaction.

"What kind of shit is this?" she'd sputter.

The woman had more ways to use shit creatively than a two year old.