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The Art of Medicine

A distant close encounter

Maurer, Brian T. PA-C

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Journal of the American Academy of Physician Assistants: October 2016 - Volume 29 - Issue 10 - p 66
doi: 10.1097/01.JAA.0000496969.93548.dd
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“When the pursuit of self-interest and self-realization turns into self-absorption, other people can lose their intrinsic value in our eyes and become mere means to the fulfillment of our needs and desires.”

—P.M. Forni, The Civility Solution

“When a phone call competes for attention with a real-world conversation, it wins.”

—Lynne Truss, Talk to the Hand

It's Saturday at the after-hours care center, and the clock is ticking down the last 5 minutes of the morning before we close at noon.

I pull my stethoscope off my neck, drop it into my valise, reach for my coat from the hook on the back of my office door, and slip my arms through the sleeves. Suddenly, I hear the front door open and shut, a very distinct, unmistakable sound.

Shortly, the medical assistant escorts a man and a boy down the hallway to the freshly cleaned examination room.

I pull off my coat, return it to the door hook, open my valise, fish out my stethoscope, and wait.

“Sore throat,” the medical assistant intones. He hands me the clipboard with the attached patient encounter form, dropping his gaze to the floor.

“You didn't lock the front door after that last family left?” I ask.

“Ah, I did,” he says. “But they opened it when they walked out.”

I glance at the encounter form and step into the examination room. A young boy sits on the examination table. A man, presumably his father, stands off to the side by the back window, chatting on his smartphone.

“Yeah, that's right,” he's saying, gesturing with a large Styrofoam cup of coffee in one hand. “No, I checked the radiator fluid level before I left the house. I'm telling you it was okay.” He slurps a sip from the cup. “The thermostat shot up on the drive over here....” Another short slurp. “Well, I'm about 25 minutes away; I mean, no way can I make it down there by 12:30 p.m....”

I stand in the middle of the room and wait in silence, but the man keeps on talking as though I weren't there.

Another minute goes by, and he's still at it.

Finally, I turn my attention to the boy. “Are you sick?” I ask him. He nods his head. “What's the matter?” I ask.

“I have a cough and a sore throat and my ears hurt,” the boy says.

“Let's have a look at you,” I say, pulling my otoscope out of my pocket.

Amazingly, the boy cooperates. I peer into his ears, look up his nose, scan his throat, feel his neck, and listen to his chest. “I'm going to swab the back of your throat to do a test,” I say. The boy nods his head. The father continues to chat on the phone, slurping his coffee, oblivious to my presence.

“Look, it's like I said before...that's right, yeah...I already told you...”

I can still hear his muffled voice droning on from where I stand in the laboratory as I watch the digital display on the timer descend: 5, 4, 3, 2....the timer sounds, and I raise the test strip to eye level to verify the presence of a thin blue line just below the red control mark.

I pull my prescription pad from my pocket and transcribe the boy's name from the encounter form. I write the script, sign it, and step back into the examination room. The boy greets me with expectant eyes while the father continues his cyber-conversation.

“Your son's got a strep throat,” I announce above the verbal fray, waving the prescription slip in the air before the father's face.

“What's that? Strep throat?” Seemingly mesmerized, as though he were coming out of a mystic spell, he finally acknowledges my presence. “Oh, a prescription—that was fast!”

“Call his pediatrician in 2 days if he's not feeling better,” I instruct him. I step out of the room and stride back to my office to finish writing my note.

Once more I toss my stethoscope into my valise, once more I don my coat and wait—wait for the boy and his father to depart, wait for the front door to snap shut and lock securely, wait for the pent-up emotion in my chest to subside, as I stare out the back window over the stark and barren winter landscape at nothing in particular.

Copyright © 2016 American Academy of Physician Assistants