I recently had an appointment with my dermatologist to examine a small lump on the back of my right knee. I arrived exactly at the scheduled time of 1:45pm. When I stepped up to the receptionist, rather than be asked my name, I was abruptly questioned, “Do you have an appointment?”
I was then told to take a seat and wait. Fifteen minutes later, a woman who failed to introduce herself or offer up her credentials called me into an exam room. I assumed by her colorful scrub top that she worked in the office, but I had no way of differentiating her as a nurse or a serial killer.
During the walk to the exam room, her eyes remained fixated on an iPad, which had an equal chance of containing my medical history or her top score on Candy Crush. I was impolitely told to have a seat on the exam table and wait.
Another 15 minutes passed before the door was abruptly opened without a knock. In walked the dermatologist and an individual he introduced as “Karen.” Karen looked to be somewhere between 20-30 years old, nervous, and wore a white coat. Without proper presentation I placed her as either a medical student, an intern, or his daughter.
Dr. Dermatologist asked to see the lump, and he bent down to take a look. He palpated the back of my knee for about three seconds and then turned to Karen and asked, “What do you think?” Karen looked terrified, but stooped to take a feel.
Several seconds of awkward silence passed before Dr. Dermatologist repeated his question, “Karen, what do you think?” More silence. “Superficial or deep?” he prodded in a bored monotone. More silence. “You have a 50/50 chance of a correct answer,” he said.
“Well, it’s kind of superficial, but it’s also kind of deep,” was Karen’s confident, yet completely non-committal, answer.
“Nope, it’s completely superficial,” Dr. Dermatologist responded.
I found it reassuring to know his brusqueness wasn’t reserved for only his patients.
Dr. Dermatologist informed me the lesion was consistent with a scarred cyst. Without eye contact, he said, “We can do one of several things: we can leave it alone, we can inject it, or we can cut it out.” He then returned to his own iPad and resumed typing (or possibly, resuming his own game of Candy Crush).
“Um, well, you see, I’m a big runner, so if we cut it out, would I need to restrict my activity, because…”
His irritated voice interrupted my stammering, “Yes, you would have to refrain from running or exercise for ten days.” More silence. More typing.
“Um, okay. Well then we can try and inject it?” I said, not really sure what those words meant or what I was about to subject myself to.
Dr. Dermatologist reached into a cabinet and retrieved a bottle of a milky white substance I immediately recognized as an injectable form of a steroid.
I tensed up, just prior to his poorly timed warning that “this will burn.”
The syringe was withdrawn, deposited in a medical waster container, and as he walked out, Dr. Dermatologist said, “Karen, can you put a Band-Aid on that?”
Karen started awkwardly opening random drawers and cabinets before she found an adhesive bandage, which she gently applied to my skin. She exited unassumingly, and I was left to show myself out of not only the exam room, but also the office.
I could have called out the poor bedside manner of the dermatologist, or asked him to more clearly explain his surety for what my lesion was, or to go over the pros and cons to each of the options he provided me, but it was exceedingly clear that I was not the priority — his time was. As such, we both moved on with our day.
I couldn’t help but contrast my experience at the dermatologist’s office to what would happen if an owner booked a similar appointment with me to examine a lump on their dog or cat.
In such an instance you would (at minimum!):
- Enter our hospital and be immediately greeted by your name and your pet’s name
- Be offered coffee or tea and a comfortable seat
- Meet one of our outstanding oncology technicians, who would take you to one of our exam rooms within moments of your arrival
- Arrive at the exam room and see a sign on the door specifically welcoming your pet (by name) to the hospital
- Be guaranteed eye contact and a compliment about how cute Fluffy or Fido is, even if they are growling or barking right at the doctor's face
- Have a complete physical exam performed on your animal, not just a quick look at the lump you are worried about
- Undergo a thorough consultation with me personally, where I will present several options for how we can proceed, including a discussion of the pros and cons of the diagnostic and treatment options, including associated costs.
Rather than dwell on the shortcomings of my dermatologist, I left the office thinking, “What can I do better?” My experience forced me to look at myself and wonder: in what ways am letting my patients and their owners down? What can I do better to make owners feel their experience is personalized and their time is valuable? I actually felt bad about myself professionally after a relatively miserable medical experience.
The ironic part is that Dr. Dermatologist probably left thinking he did a pretty good job that day.
And he would also be the first one to complain about the high price of veterinary care if his own pet became sick.
Next time, maybe I’ll see if my pet’s dermatologist has an opening for me…
Dr. Joanne Intile