How are you feeling?

"So,  Can I ask... how do you feel?"

Meeting New Patients.  The ultimate  wild card, blind date, wild ride.  Anything can happen.   You meet someone new,  who knows  if they need pain medication, anti psychotics, an air tight alibi?

These folks need a new doctor, their old doc is retiring. Two rules in modern medicine:
 1) The best psychiatrists take only  cash and 2) The best internists don't accept  new patients.   I sympathize  with the psychiatrists.  Insurance does not reimburse the talking cure.


"Your  staff says you've been (  beat)  sick and you're back part time. How do you feel?"

Boundaries.  My staff has been overly  protective.  I appreciate it, but  really,  is my medical history  pertinent?  Of course it is.

I'm caught off balance. I should ask the questions.

" How do you feel?"  I flash on an old girlfriend,  who would reply " I have a mild headache" whenever asked about her health.

Turns out, I have a mild headache

 More to the point what's an appropriate  answer?
I try out responses :

"Its none of your Goddamn business"
" I'm great! how are you?"

They have a right to know. They have a right to know if I am  in the big fade, they need to know if their doctor is a ghost  slowly  slipping the surly bonds of a 15 minute office visit.

 it's none of their business.

Aren't  there laws about this? Aren't there laws that   keep ones medical  history a secret, isn't the state of my health privileged  information?
On the other hand, I ask  the most  intimate, complex questions of strangers   so  it  seems fair to give an honest, non sarcastic response
I answer  accurately, if not a wee bit curt:  "I have good days and bad days."

"So.... is this a good day?"
It is not.  It is not a good day.  I glance at my arms,  now covered with purple, livid  splotches, the  result of  taking an anti fungal along with coumadin. The  fungal mediation has  shorted my liver, leaving me unable to produce  clotting factor.
This is , in itself, not critical, unless of course, the bleeding is in my brain

Did I just say I had a headache? Uh oh.

Quick, do serial 7s.... 100-7 is...93.. 93 minus 7 is... is what?

No ifs ands or buts

Spell world backward

Draw a clock, make it 10;30

You are not dying

That would be bad.

I am worried.  Am I bleeding into my Pons?   I call  Jim, my cardiologist to adjust my coumadin dose.  His advise disorients me.

"Don't have rigorous sex" is his advice.


He's not joking.
Do I mention this to my patients ?

 ' I'm OK as long as I avoid vigorous sex?" I'm OK if I avoid the  Gym, sharpening  axes and the  Venus butterfly?

I'm clearly flummoxed.

The patient smiles sympathetically .

"DO you think you;re getting better?"

I haven't the vaguest idea.

"Better?"  Any pain free day  is better
Now I'm just whining.
But I need to see new patients.

There arent many GPs out there any more.  When our  children contemplate med school, we  sing some version of " Mommy don't let your babies grow up to be internists."  Isn't that what we tell Jeff?    He'll emerge from state  med school a quarter million in debt. That's an awful lot of sore throats or one knee replacement
I smile, stalling for time.

 "I have every intention of  increasing my hours, returning to work, hanging around here" as I struggle to  add a note of sincerity.


I just received  a memo "Dr Weinreb is not taking new patients" Why?    Something I did? said? didn't do? I am grateful, actually. Although my salary increases when my patient numbers increases, making money is not on my mind today.


 The patient looks doubtful.   Maybe she can find a  Doctor who isn't covered with Gin Blossoms.

I ask a few more questions, make sure they  see my diplomas from Cornell and SUNY upstate to prove Im not a fraud.

Perhaps the headache is starting to resolve.

Great. ask me again..... how am I feeling?