The author describes what he does when one patient visit morphs into two, or three, or more.
2005 DOCTORS' WRITING CONTEST - YOUNG DOCTOR AWARD
At 10:15 I went in to see 9-year-old Ronnie, who was complaining of headache. This complaint in someone so young is unusual enough that I knew I'd spend a fair amount of time sorting through personal, family, and social history, as well as conducting the most thorough neurological exam I can muster-which, admittedly, would probably have most neurologists rolling their eyes and/or reporting me to the board of medicine. Often disposition planning is complicated, requiring radiological studies, referrals (so the patient can get a real neuro exam, for one thing), and the like. What I'm trying to convey here is that this is a clinical problem that requires a lot of concentration by me.
WHEN I WENT INTO THE ROOM, MY RADAR TURNED ON. Ronnie's mother, grandmother, older sister Rachel, and younger brother Thomas were all there. My first thought was, "It's 10:15; don't you kids go to school?" My next thought was, "Uh-oh, someone's planning a sneak."
The sneak is a scenario where, in the course of a visit, another person in the room hits you up for a separate physician-patient encounter. I first learned the term "sneak" in this context in one of my wife's parenting magazines. The article in question addressed the "sibling sneak," in which a parent brings one child to the pediatrician and asks for care of a sibling, too.
If someone is caught with several pounds of heroin, the authorities automatically assume that he or she was intending to traffic. Same deal here: Patients who load the exam room with more than three people can be charged with conspiracy to commit a sneak.
MY EYES NARROWED AS I SURVEYED THE SUSPECTS. I quickly dismissed Rachel and Thomas; kids are usually unsuspecting victims of a sneak, never the perpetrators. Is it Mom? Maybe. She looks a little fidgety, like she's planning something. Or perhaps she's fidgety because Grandma insisted on coming in so that she could commit the sneak. Maybe it's even more sinister: Grandma wants to sneak one of the siblings, but is forcing Mom to execute her evil plan while she sits by looking innocent. I'm watching you, Grandma.
Despite my certainty that I was in the midst of a transgression, I acted nonchalant. I took the pertinent history, but as I began to ask Ronnie to say "ahh" I heard the magic words: "Dr. Switzer, when you're done looking at Ronnie . . ."
AHA! I thought. Caught ya! I placed my penlight back in my pocket and turned to Mom. "After I'm done looking at Ronnie . . ." I said, waiting for her to complete her sneakin' sentence.
"After you're done looking at Ronnie, could you look in my throat? It's been sore for a couple of days." Well, whaddya know. Grandma and the siblings were just decoys. This was a run-of-the-mill mom sneak. Oh, sure! I thought. No problem! You must have seen our coupon in the newspaper, the one that reads, "Buy one office visit, get one free." I'll have to see the coupon before I can look in your throat, of course; it's office policy.