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She wanted me to call in an antibiotic.
My sister, a lawyer, often tells me how the ethics of her profession govern even her extra-professional acts. She feels that when she was sworn into the New York State bar, she lost the freedom to bend the truth. She would never, for example, attempt to smuggle a Cuban cigar into the country for our father, because she might be required to falsely represent herself to a customs official.
Given this, I am perplexed that she does not see the irony in asking me to bend medical ethics to diagnose and treat my nephew over the phone.
I should explain—my mother is a pediatrician. When we were growing up, all of our medical care came in the form of house calls. The downside? I would have needed an oxygen requirement to skip a day of school. The upside? No waiting rooms. All of our medical care was prepared à la minute. When my mother retired and turned in her prescription pad, the role of family doctor fell to me.
My nephew seems to have inherited the family impatience with the medical ritual. When I tried to conduct a medical review of systems over the phone, my nephew interrupted—Uncle Phil, why are you asking so many questions? Just concentrate on the throat.
I decided he was right. He probably had strep throat. In truth, I wasn’t sure if an antibiotic would help. From what he described, it sounded like his symptoms were already starting to resolve. That said, I thought a short course of amoxicillin was not unreasonable and, almost as important, would satisfy my avuncular obligations, so I could return to the work for which I am paid.
I called his local pharmacy and asked to speak to a pharmacist. It was a bit of a novelty. As a trainee, I spent a good part of my life listening to Vivaldi’s The Four Seasons, or some equally inoffensive piece of music, while waiting for a pharmacist to pick up the phone. Now, I largely communicate with pharmacies electronically, sending prescriptions with a few clicks of the mouse.
This brought back old memories, however. I spoke to someone at the front desk, to let them know I was a physician who wanted to call in a prescription. I was dutifully transferred to another line, but after about six or seven minutes of listening to Spring, my call, again, rolled back to the front desk, where I, again, explained that I was the same physician wanting to call in the same prescription.
Someone finally answered the phone in the pharmacy, who then asked if I would mind being placed on a brief hold to speak to a pharmacist. I actually had objections to several parts of that sentence, but I assented. I was just starting to listen to the first few bars of Summer when the pharmacist picked up.
I knew immediately that she was having a bad day.
She spoke in the clipped tones of someone who did not have time for this conversation. I tried to communicate the information as efficiently as possible, using the lingo sig and dispense to linguistically reassure her that I was a physician. She still wanted my bona fides, starting with my office phone number, then my office address, then my NPI number. At some point, I wanted to point out that all of that information should be in her system from prescriptions I had called in previously. But I know what it’s like to be in the weeds, and I did not think that now was a good time to ask whether she could be using her computer system more efficiently. I thought the greatest kindness I could show her would be to answer all of her questions, quickly, so she could return to the work for which she was paid.
After I got off the phone, I did find myself thinking, I wonder if she has enough time to make sure my nephew is receiving the right drug?