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The air in the exam room felt thick when I walked in.
"Are you John?" I asked.
"Yup," he replied, never looking up from his cell phone.
"Nice to meet you, I'm Dr. Malebranche."
I put my fist out for a #COVID19
fist bump.
He gave me a half-hearted tap in return.
1/
"Are you John?" I asked.
"Yup," he replied, never looking up from his cell phone.
"Nice to meet you, I'm Dr. Malebranche."
I put my fist out for a #COVID19
fist bump.
He gave me a half-hearted tap in return.
1/
Still not looking up from his phone.
I sat in my chair and looked at him.
He was a thin, young brother in his upper 20s or early 30s. Baseball cap nestled tightly over his head. Mask blanketing his nose and mouth.
Unassuming.
And completely unbothered with me.
2/
I sat in my chair and looked at him.
He was a thin, young brother in his upper 20s or early 30s. Baseball cap nestled tightly over his head. Mask blanketing his nose and mouth.
Unassuming.
And completely unbothered with me.
2/
I began anyway.
Me: "You usually see the nurse practitioner, right?"
Him: "Yup."
Me (joking): "She's on vacation this week, so you're stuck with me."
Him (not amused): *
Me: "And this follow up? Just a regular check up?"
Him: "Yup."
Still not looking up from phone.
3/
Me: "You usually see the nurse practitioner, right?"
Him: "Yup."
Me (joking): "She's on vacation this week, so you're stuck with me."
Him (not amused): *
Me: "And this follow up? Just a regular check up?"
Him: "Yup."
Still not looking up from phone.
3/
I changed course.
Me: "Where you from?"
Him: "Atlanta."
Me: "What do you do for a living?"
Him: "I work."
Me: "And what #HIV medications are you taking?"
I guess he had had enough of the small talk. He put his phone on his lap, finally looking up at me.
4/
Me: "Where you from?"
Him: "Atlanta."
Me: "What do you do for a living?"
Him: "I work."
Me: "And what #HIV medications are you taking?"
I guess he had had enough of the small talk. He put his phone on his lap, finally looking up at me.
4/
Him: "You should know all that, right? It's in the chart. Why you askin' me questions like 'where I'm from?' I'm not here for all that. I'm here for you to get my labs so I can be on my way."
He was over it.
I was beginning to get there too.
5/
He was over it.
I was beginning to get there too.
5/
"Every time I come in here I see a different doctor," he continued. "I hate coming to this place. Only reason I come is because I don't have insurance and it's the closest clinic to me."
I listened.
When he finished, "fair enough" was the only response I could muster.
6/
I listened.
When he finished, "fair enough" was the only response I could muster.
6/
He returned to his phone.
Silence joined us in the room and lingered long enough to make me uncomfortable as I looked up his labs:
- undetectable viral load 3 months ago
- positive rectal and oral gonorrhea 2 months ago
- treated with antibiotics
- no labs after that
7/
Silence joined us in the room and lingered long enough to make me uncomfortable as I looked up his labs:
- undetectable viral load 3 months ago
- positive rectal and oral gonorrhea 2 months ago
- treated with antibiotics
- no labs after that
7/
Me: "So let's get your labs today."
He looked up again.
"I'm here to get my lab results. I did all that last month and no one ever let me know what they were."
I glanced back at the medical record.
He was right.
There were orders for labs and cultures a month ago.
8/
He looked up again.
"I'm here to get my lab results. I did all that last month and no one ever let me know what they were."
I glanced back at the medical record.
He was right.
There were orders for labs and cultures a month ago.
8/
The results, however, were nowhere to be found.
Sometimes lab results don't populate in the electronic medical record until the ordering provider signs off on them.
Yeah, maybe that was it.
Me: "Gimme a minute. Let me see what's going on."
I left the exam room.
9/
Sometimes lab results don't populate in the electronic medical record until the ordering provider signs off on them.
Yeah, maybe that was it.
Me: "Gimme a minute. Let me see what's going on."
I left the exam room.
9/
After speaking to the nurse manager, we found out a few things:
- he came in a month ago for labs
- they were ordered
- he had cultures and blood drawn
- but no results
Like it never happened.
He had called the clinic back 11 days after the labs to get results.
10/
- he came in a month ago for labs
- they were ordered
- he had cultures and blood drawn
- but no results
Like it never happened.
He had called the clinic back 11 days after the labs to get results.
10/
He was told they weren't in yet and to call back in 2 to 3 days.
He got frustrated and never called.
The clinic didn't follow up either.
So here he was today.
Seeing another doctor.
Telling the same story again.
Discussing gonorrhea with another stranger.
11/
He got frustrated and never called.
The clinic didn't follow up either.
So here he was today.
Seeing another doctor.
Telling the same story again.
Discussing gonorrhea with another stranger.
11/
And here I was telling him that not only were the labs not back, but that somehow they never made it to the lab at all.
He had every right to make the air thick in the exam room.
He had every right to study his phone instead of answering my questions.
12/
He had every right to make the air thick in the exam room.
He had every right to study his phone instead of answering my questions.
12/
He had every right to utter one word answers.
We did that.
We dropped the ball.
We didn't follow up.
We didn't earn his trust.
I returned to the exam room.
Me: "OK, so I know what happened."
He put his phone down and looked me in eyes. I had his attention now.
13/
We did that.
We dropped the ball.
We didn't follow up.
We didn't earn his trust.
I returned to the exam room.
Me: "OK, so I know what happened."
He put his phone down and looked me in eyes. I had his attention now.
13/
Me: "First off, I apologize on behalf of the clinic. We messed this up. You came here and got the labs and the cultures a month ago. Somehow they didn't make it to be analyzed. That's our fault. We'll have to repeat them all today."
His eyes never left my face, studying me.
14/
His eyes never left my face, studying me.
14/
Him: "You mean I need to do it all over again today?"
Me: "Yup. The cultures, the bloodwork, everything."
He paused.
"OK."
I was surprised how easily he agreed to do it all over again. I handed him the cultures so he could go to the bathroom and self swab.
15/
Me: "Yup. The cultures, the bloodwork, everything."
He paused.
"OK."
I was surprised how easily he agreed to do it all over again. I handed him the cultures so he could go to the bathroom and self swab.
15/
When he returned, I labeled the samples and told him I would personally call him when the labs came back in a few days.
I thought I saw his eyes squint ever so slightly, and imagined a wry smile cracking under his mask.
He knew I meant what I said.
16/
I thought I saw his eyes squint ever so slightly, and imagined a wry smile cracking under his mask.
He knew I meant what I said.
16/
Our visit took much longer than the 20 minutes we were allotted.
It was worth every minute.
The air was more breathable now.
17/
It was worth every minute.
The air was more breathable now.
17/
