The One Where We Almost Didn’t Talk About It

“So… how have you been lately?” I begin, fingers lingering over the keyboard in anticipation.

“Pretty good,” she responds.

I breathe a sigh of relief and continue with my agenda for her annual physical exam: Do you want a flu shot? You know, you’re due for your Pap smear. Any new medical problems you’re aware of, for you or your family? How’s your diet been? What kind of exercise are you getting? Are you smoking? What about alcohol? Your blood pressure looks great today! 

All of her answers thus far qualify as “boring,” that is, lacking in any detail that could fully engage a medical student.

Until I tackle the review of systems, a method we often use to unveil symptoms that the patient may have forgotten to mention or that we forgot to ask: Fevers lately? What about chills? Change in appetite? Headaches? Cough? Chest pain? Trouble breathing? Do you ever feel your heart beating fast or funny?

“Oh, actually…” Laura begins.


“Actually what?” I prompt.

“So I’ve just been feeling really anxious. I start shaking and my palms sweat and I can feel my heart beating really quickly,” she continues.

“How often?”

“Oh, I don’t know. Like 4-5 times a week, maybe?”

I pause, looking up at her for a second, evaluating in my head: Is this problem life-threatening? Is it imperative to treat right now? 

No, not really. I’m going to have to go there.

“I’m really sorry, but I have to ask you something kind of silly. Do you have a deductable insurance plan?” I interrupt.

She looks at me quizzically. “Yeah, I think so.”

I sigh. “So this is really stupid, but I’ve been told to ask: your physical exam is free with your insurance plan. But if we’re going to talk about this anxiety today, we have to bill it as a separate visit, and you might receive a bill for it. Knowing that, do you still want to talk about this today? Or would you like to save it for another time?”

Laura shrugs. “I’m already here.”

I nod. “Okay. Let’s talk about this more.”


A friend recently asked my roommate and me for our opinions on the problems within the healthcare system, and this was among the stories that popped into my head.

You always read in The Reader’s Digest or hear on the news that you should record all of the issues you want to bring up with the doctor. And yet my preceptor has warned me that often the patients choose to discuss these issues not realizing that they may have to get billed for them at an appointment they thought was free health maintenance. So I’m forced to evaluate if the issue MUST be discussed immediately, and if not, I have to ask.

Though I realize that there is always a charge for visiting the doctor, it irks me that I have to stop a patient in the middle of their explanation to remind them that if we’re going to bring this up with the doctor, she has to be willing to foot the bill. Otherwise, we’re not going to even open that door… and that to me, seems kind of wrong.

So that, among dozens of other issues that would take hours to articulate, is what is wrong with the healthcare system.

Just don’t ask me how to fix it.


2 thoughts on “The One Where We Almost Didn’t Talk About It

    • You and me both. My preceptor is a medical director for an insurance plan, so she’s actually spent quite some time teaching me some insurance quirks… and it’s all just really annoying…

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