Mr. Alexander, a retired cop, was 73 when I became his doctor. His previous physician had left our practice.
The diagnoses listed in his chart included high blood pressure, type 2 diabetes, and high cholesterol; all were well managed on appropriate medication.
Masks can fool us all.
“Any problems?” I asked.
“Nope. Feeling good,” he replied.
I asked about his medications; whether he had an adequate supply and if he thought any of them were causing side effects. We discussed exercise, sleep, his diet, and hobbies. He was an early morning mall-walker, part of an exercise group. To me, this was a good sign physically and socially.
I asked how his wife was.
“She made me promise to give this to you.”
He unfolded a piece of lined memo paper with neat cursive handwriting. On it was a list of his medications and their doses; the ones that needed refilling were starred. There was also a question about pain in his right knee, and a suggestion to check his hemoglobin A1c, a test used to monitor blood sugar control in diabetics.
This all seemed reasonable enough, but I wondered why if Mr. Alexander had knee pain, he needed a note from his wife to tell me about it.
“What’s going on with your knee?”
“Not much. I guess sometimes it’s a little stiff,” he offered.
I liked Mr. Alexander. He was affable, and somewhat typical of my older male patients: Stoic about all things medical, and unlikely to complain in response to an open-ended question. If it ain’t broke, don’t fix it.
He benefitted from a wife who took charge of his medical care. She made sure that he attended his appointments, took his medications, and followed my recommendations. Mr. Alexander was all too willing to relinquish control over his medical care this way, in my mind, to his benefit.
Other patients aren’t lucky enough to have a spouse take such an active interest in their health. If they are, often they’re resistant to being “babied.”
I made a mental note about Mr. Alexander: Not forthcoming with medical complaints. In his chart, I documented that he’d brought a note from his wife and what the issues were that she’d hoped I would address. This was to serve both as record of the visit and to remind me about this dynamic at subsequent appointments.
At this point, you either identify with this story in relation to your own life and loved ones, or you’re thinking, “What kind of guy needs a note from his wife to remind a doctor about his knee pain?”
I saw Mr. Alexander a half dozen more times over the next two years. Each visit followed the pattern we had established: I’d ask him how he was; he would always answer “just fine.” A note from Mrs. Alexander might indicate a minor complaint but also thoroughly detailed his medications, necessary refills, and questions about routine testing for tracking his chronic conditions.
I looked forward to having Mr. Alexander on my schedule. Each time he’d come, we’d have an exchange of pleasantries and then “take care of business” as outlined by his wife.
His visits were a model of efficiency. Mine.
A doctor has a sixth sense, or should, that when things are going too smoothly there’s probably more to the story.
