*A fictional column. All patients are composites. This is reflection, not medical advice. Full disclaimer at the end.*
—
Thursday. 9:23 AM. Clinic was supposed to start at 8.
The patient is convinced she has been misdiagnosed. She has been told this by two doctors, three websites, and one nephew who is in his second year of dental school. She has come, finally, to me, and she has brought, in a clear plastic envelope, what she calls “the evidence.”
The evidence is six lab reports across two years. She lays them out on the desk in chronological order, the way a detective lays out photographs. I have not drunk my coffee. I look at the reports. I look at her face. She is watching me the way you watch a man you are about to hand a verdict to.
The first thing I notice is that the reports are not telling the story she thinks they are telling.
The second thing I notice is that I am about to become either the seventh person to disappoint her or the one person who took her seriously.
I read slowly. I make small noises, which I have learned patients interpret as professionalism and which are, in fact, just me making noise.
The reports do not show what the previous doctors said they showed. They also do not show what she thinks they show. They show, instead, a third thing entirely, which is mild and slow and easily missed, and which has been quietly sitting in the data for two years like a small, polite guest no one offered a seat.
I tell her this.
She does not speak for a moment.
Then she says, “So I wasn’t crazy.”
“No.”
“So they missed it.”
“They didn’t look the right way.”
“But you saw it.”
I want to tell her that any reasonable person looking carefully would have seen it. I want to tell her I am not the genius she now suspects I am, that two of the previous doctors are competent people who had a busy clinic that day, that the difference between missing something and catching it is sometimes seventeen seconds of attention.
I do not tell her any of this.
She is going to tell the story for the rest of her life. In her telling, it will be about a doctor who finally listened. I am, today, that doctor. Tomorrow, somewhere else, I will be a doctor who missed something. That is the trade.
I write the plan. I order the next test. I send her home with a follow-up in three weeks. She will, in three weeks, be slightly disappointed that the treatment is boring. It mostly is.
I drink the coffee. It is, by now, room temperature. The room temperature of this room is not what most rooms would call temperature.
—
11:39 AM. The patient is a woman in her thirties. Her husband has booked the appointment. He sits beside her with the kind of small notebook people bring when they have decided, in advance, what the doctor is going to say.
“She’s been tired,” he says. “For about a year. We think it might be her hormones.”
She says nothing.
I ask her what she has been feeling. I ask the question to her, not to him.
She looks at the floor.
He answers.
I do not interrupt him. I let him talk. He is the kind of man who has not been listened to in his own life and has, with no malice, decided to do the listening for both of them. He tells me about her sleep, her energy, her appetite, the time she fell asleep at the table at her cousin’s birthday, the night she cried in the car for no reason he could identify.
She watches her shoes through all of it.
When he stops, I look at her. I wait.
She says, “I’m fine.”
I do not believe her. I do not say so. I order a small panel of tests. I write down “follow-up in four weeks.” I add, at the bottom, “alone if possible,” and I underline it twice.
Her husband does not see the underline. He thanks me. He gathers their bag. She follows him out, and at the door she turns, just for a second, and looks at me. The look is not gratitude. It is something quieter than that. The look of a person who has noticed that one other person in the room noticed.
The door closes.
—
At 1 PM I sit at the desk. The detective patient has, by now, told four people about me. The quiet patient has gone home and is, somewhere, washing dishes.
I think about how thin the line is. Between a doctor who is paying attention and a doctor who has, on a particular day, a slightly longer attention span. Between a patient who says everything and a patient who says nothing. The reports on the desk look the same. The patient in the chair never does.
The coffee is finally cool. I drink it anyway. The afternoon clinic begins at 2.
—
**Disclaimer**
Doctor’s Diary is a work of fiction. All patients, conversations, clinical findings, laboratory values, treatment decisions, and outcomes described in this column are invented composites. They do not depict any real individual, living or deceased. Any resemblance to a specific person, encounter, or institution is coincidental and unintended.
This column is published for reflection and literary purposes only. It is not, and is not intended to be, medical advice, a clinical opinion, a diagnosis, a treatment recommendation, or a substitute for professional medical evaluation, examination, or care. Nothing in this column establishes a doctor-patient relationship between the author and any reader.
Do not start, stop, change, or interpret any medication, test, diet, lifestyle measure, or clinical management on the basis of anything written here. If you have a clinical concern, consult a qualified healthcare professional in person. In an emergency, contact your local emergency services immediately.
The author writes anonymously. The views expressed are personal literary reflections and are not official guidance from any institution, regulatory body, hospital, university, professional society, or government agency. Information may not reflect the most current medical consensus, guidelines, or evidence and is provided “as is” without warranty of accuracy, completeness, or fitness for any particular purpose.
The author, Hormone Insight, and its operators accept no liability for any action taken, or not taken, on the basis of content published in this column. By reading this column you acknowledge and accept these terms.
