The never-ending office visit

"The secret of boring people lies in telling them everything."

– Anton Chekhov

Missy closed the door and smiled at Dr. Fremont. The smile was a long, strained affair as she tried to mimic the Cheshire cat from "Alice in Wonderland". The smile vanished as she rolled her eyes and moved into the next room.

Now with knowing trepidation, Dr. James Fremont entered the exam room and looked down at "Milo" Erickson, a scrawny half-nourished Boxer owned by Amanda Erickson. He looked at the chart and the nearby motley pile of mismatched papers and tried to make sense of the presenting history.

Missy Franklin, the morning technician, had been in the exam room for what seemed like eternity. She had made a valiant attempt to write Milo's subjective chronological history for Dr. Fremont.

Mrs. Erickson was a persistent phone caller and a somewhat less-frequent visitor to the practice. She was a bit matronly and spoke with a monotonously loud alto voice. Her signature outfit was a print dress with an inch of her slip showing and sneakers. Her modus operandi was always the same — a pile of indefinable paperwork and a barely intelligible chronology of events accompanied each new pet. She spent a lot of time worrying about her animals and seemed to always pick up an additional pets with obscure backgrounds. When she worried, she always passed this along at inopportune times to the front desk. Janet, the receptionist, thought that Mrs. Erickson's ancestors had invented the game "Twenty Questions."

The records, in conjunction with the fractured dialogue that Mrs. Erickson presented, had slowly been pieced together from the cryptic collage of information available. There were scraps of paper, various "health records" and vaccination records from the original breeder. There were also what looked like second-generation fax records from three previous veterinarians. Each facsimile bore a striking resemblance to an overdeveloped X-ray.

Milo was approximately 18 months old and apparently had been given various rounds of prednisolone and a merry-go-round of antibiotics during the past several months. It finally was deduced that Milo was given to Mrs. Erickson by her daughter's boyfriend's neighbor in Ohio.

Mrs. Erickson had come to the practice fully expecting to take home another round of antibiotics.

Dr. Fremont knew what was coming next. When Mrs. Erickson would come in, he would always patiently explain what his approach was going to be. Each explanation was not met with any real resistance but with a barrage of questions that the veterinarian felt compelled to answer. Frequently Amanda would move the questioning onto every tangent she could think of. Eventually when Amanda would finally tire or the explanations seemed sufficient, Dr. Fremont would begin his detective work.

In this case, after the ensuing 15-minute verbal rodeo and a two-minute skin scraping, the diagnosis was simple enough—demodectic mange with a possible genetic background. The explanations and the subsequent tug-of-war that followed the diagnosis were more complicated. Mandy was unconvinced.

Dr. Fremont patiently explained the situation. Again, Amanda felt compelled to interrupt and, on occasion, complete the doctor's sentences for him.

Just when Dr. Fremont thought he was working his way through the final explanations, Missy suddenly appeared to whisper in his ear that there were several clients backed up in the waiting room. Dr. Fremont's anxiety was palpable.

At the same time, Mandy Erickson sat in the corner of the room and listened. As Dr. Fremont turned readying to make his final recommendation, she interrupted with another question while he was talking. This time she nimbly changed the subject in order to query the doctor concerning her other existing pets and those of distant relatives. She was desperate; she felt her time could be running out. She turned and deftly pulled something from behind her chair.

Without missing a beat she opened a folder and presented new information that she had purposely sequestered for this very moment. It could help him shed light on the situation. She pulled out a pile of printouts from her home computer concerning a myriad of maladies and conditions that she thought Milo could possibly have. Her full intention was to ask the doctor what he thought of each of these potential diagnoses.

"Dr. Fremont would you look at these and tell me what you think?" she boomed.

There was a pregnant silence.

"Well if you don't have time now can you just call me with your thoughts after work tonight?"

Dr. Fremont shoulders slumped. He was completely spent. He really didn't answer; he just proceeded. He knew the marathon had to end sometime, and then he could collapse at the finish line. He answered the final dying gasp of questioning with mock enthusiasm hoping against hope that the never-ending office visit would finally come to a close.

Dr. Fremont neatly piled the papers from the Internet into a corner of the room and punched the intercom to set up treatments for Milo.

At last Dr. James Fremont closed the door and looked up at the ceiling. He felt a tap on his shoulder. Missy's mystical smile had returned.

"You're done for the day, Dr. Fremont," she chirped.

"Done, what do you mean? I have a least four more patients waiting."

"Not any more."

Dr. Lane is a graduate of the University of Illinois. He owns and manages two practices in southern Illinois. Dr. Lane completed a master's degree in agricultural economics in 1996. He is a speaker and author of numerous practice management articles. Dr. Lane also offers a broad range of consulting services and can be reached at david.lane@mchsi.com.