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"Patient was very angry about this.  Are you going to break protocol?"

The nurse's flag came across my desktop this morning on a patient who was last seen 13 months ago.  He has hypertension and our protocol is to see all hypertensive patients every 6 months, 12 months if stable.  When patients call and are due for an appointment, then nurses will call in one month with no refills and require an office visit to be scheduled.  If they still don't schedule one, they get only one week at a time until they come in.

"No.  I am not breaking protocol," I responded.

I may get an angry patient coming in to the office this week, but I don't really care.  I am prescribing a medication that has some risk and the person has a disease that needs to be monitored.  What bothers me, however, is the anger this patient expressed to my nurse.  The implication is that I am manufacturing business by bringing in people in unnecessarily.  The implication is that I should prescribe his medications like a Pez dispenser without being paid for my service.

I work for a living.  I use my education and experience to make sure my patients stay as healthy as possible.  I take a risk with every prescription I give.  I cost less than a monthly cable bill.  I am not greedy; I've got lots to do.  I just want to do my job and be paid for it.

The best-case scenario is that he will come in with perfect blood pressure and no complaints.  The problem with this is that he will then feel justified in his consternation at being "forced" to come in.  He will think to him self: "I was right.  I told you so!"

I don't care.

Then my first patient this morning was a woman who I saw for a routine visit last year.  She has high cholesterol and hypertension, and was "feeling fine" when I saw her last year.  On my routine examination I noticed an irregular heart beat.  The EKG showed atrial fibrillation (a potentially dangerous heart arrhythmia) and I sent her to the cardiologist.  She was electrically cardioverted back to normal rhythm - we call that a Georgia Power consult - and is back in normal rhythm.  "I didn't realize that I didn't feel as good as I could.  Thanks." she told me today.

Case closed.  Be mad as you want, but I won't let your unreasonable expectations make me become your vending machine while being on the legal hook for anything bad that happens.

When I listened to the heart of the woman in the office today, the heart beat regularly.  We both smiled.

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