Counseling Patients On What Not To Bring To The Office

Author(s): 
By John H. McCord, DPM

   I have a small list of items that I prefer patients not bring to the office when they come for care. What is on the list?

   • Supersized 32-oz. soft drinks
   • Guns
   • Pets
   • Cell phones

   The problem with 32-oz. soft drinks is obvious. I manipulate the painful heel. The patient lets out a screech and the Cherry Coke bounces off the ceiling before cascading onto my bald head.

   Guns are a unique and challenging problem. I live in a rural community where many are aware of the Second Amendment of the Constitution and mistakenly assume it extends past the entry door to my office. It does not.

   A few years back, a portly old gentleman was squirming his way into a comfortable position on my exam table. Poking between rolls of his belly was the barrel of a big pistol in a clamshell holster. I remembered the old Mae West line, “Is that a gun in your pocket, buster, or are you just glad to see me?”

   I did not quote Mae. I stepped to the door and asked the patient to take the gun out to his car. He gave me a lecture on his Second Amendment rights and asked what I had against guns. “Nothing against guns,” I answered. “It is the bullets that make me nervous.”

   The gun problem seems to come up a couple of times a year. Another patient, a legally blind lady with diabetes and some dementia issues, asked me to hand her purse over. It weighed a lot so I asked what was in it. “All my medications and my gun,” she responded.

   She showed me an old military style .45 automatic. I finished her care and sent her back to the nursing home, warning the senior citizens dial-a-ride driver that she was packing heat. I also called the nursing home and recommended that they disarm her before her next visit. She switched podiatrists.

   Pets are another interesting challenge. We cannot deny admittance to certified helper animals such as seeing eye dogs. I would prefer that the other pets stay in the car.

   One of my patients is a bird hoarder. He has over 100 parrots, cockatiels and canaries flying loose in his small house. He likes to bring several with him for his visits to my office. It is unnerving to peel away layers of his ulcers as birdseed drops to the floor and a little green parrot pops out of his shirt. The parrot eyes the spilled birdseed while a mangy looking cockatiel observes all this from the patient’s shirt pocket.
We finally had an understanding. There will be a surcharge added to his bill for each bird he brings. He doesn’t know that Medicare would never allow this even with a modifier.

   Another patient showed up with a “helper” dog. He claimed it was certified and trained. It was to help him feel safe. The dog was a Bull Mastiff about the size of a Buick. It took up half of the exam room and glared at me while I was debriding the patient’s nails.

   The patient told me that the dog would go into action if he perceived that someone was trying to hurt his master. I was very gentle with his care. The dog must have trusted me because he looped his massive frame around the base of the table and settled down to slurp on his privates. I decided not to challenge the legitimacy of this dog’s certification.

   I have just added cell phones to my annoyance list. I was about to remove a cast from a businesswoman’s leg when Beethoven’s Fifth started beeping from her purse. She held a hand up to signal me not to turn on the cast saw.

   I waited and waited and waited. Then I put the saw down and went to the next room to see a patient. I saw three other patients, caught up on some dictation and then went to the break room for a Pepsi.

   I returned to the cell phone lady 45 minutes later. She was not amused. I explained my office policy that cell phone calls should be private and I did not want to disturb her important business transaction. I also explained that if a patient accepts two calls during a visit, I am willing to concede that the calls are more important than the appointment, which can be rescheduled to another week. She promised to keep her phone turned off for future visits.

   Supersized soft drinks, guns, pets and cell phones. Am I getting too picky?

Dr. McCord is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.

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