white flower with water drops on the petals 

She glanced away sheepishly.

“You haven’t been checking your blood sugars?” This surprised me. She always checked. She was one of those patients you wished you could clone.


“What about your blood pressure?”

“No. But I have been taking all of my medications.”

I looked at her vital signs. Her weight had gone up 6 pounds. She had lost 39 pounds over the past year and now she was gaining.

“Are you exercising?”

“Not for the past couple of months.”

“How has your diet been?”


“Well, we’ll check your bloodwork and see where those numbers are. You know what to do from a diet and exercise standpoint, so try to get back to it. I’d rather not increase your meds if we can help it, OK?”

“Sure.” She shrugged. “Ok.”

I stood up to go. 

There was a nagging feeling that she was hiding something. People don’t just DO this kind of stuff without a reason. I always struggle with patient privacy, how far do I delve into their personal life before it is considered intrusive? How much do I need to know, anyway? And once I know, what can I even do about it?

“There is something else going on, isn’t there? You look different…. sad.”

Tears welled up and over flowed. 

I passed her the box of tissues and sat back down.


83 thoughts on “Moist

  1. Please, Doctor, please ask. It is not a privacy issue, it’s a health issue.

    When I was an investment manager, my clients often would apologize for talking about family concerns, as if that wasn’t related to their financial needs. Indeed it is! Please ask.

    Liked by 3 people

  2. Well done Victo. When I managed a department, it was a given that if behavior changed negatively that it was time to inquire about home issues. As far as privacy is concerned, my philosophy was always that as soon as behavior impacts my responsibilities then the causes are no longer private because the results are not private. It was a lot easier for me because I saw my employees daily and in fact, i initiated a 15 minute shift meeting daily to go over daily targets, issues and I encouraged them to speak up if they had non-work issues (or they were free to come to my office, the door was always open). These meetings greatly increased productivity and safety and yet my boss (who had been an air force brat) forbade them as a waste of time. So,we just found new places to hide and have our little meetings.

    Anyway, your inquiring into your patients’ personal issues is professional and very justified Victo. I applaud a doctor who is willing to ask patients about their lives vs their illnesses or organs.

    Liked by 2 people

  3. Hey Victo,

    Does a good Physician, like you are, already possess an innate predisposition for ‘intuitive reasoning’, or is this a faculty (?) learnt solely through experience? Often when reading your more patient-centred posts, the reach of your ‘sense of knowing’ impresses me as to your holistic approach to a patient’s whole care.

    Enjoyed the quality of the photograph…great to see spring’s flush of colour flash from the page.

    Enjoy your evening 🙂


    DN – 10/03/2016


    • I think some people are born with an innate knowledge. But before you think I am too wonderful and awesome, remember I have been practicing for over ten years and much of what I understand now has been gleaned from much trial and error. I am so glad you liked the flower! Smart phone cameras are just so powerful nowadays. 🙂

      Liked by 1 person

      • I appreciate what you are saying, yet in the small amount of time you have available for each appointment, it still takes a considering mind and experience of life to look wisely beyond the symptoms and see the root cause. Healers are unique in that way, I think.

        I’m going to have to invest in a Smart phone 🙂


        DN – 11/03/2015

        Liked by 1 person

  4. If only there were more docs like you. Having said that I finally saw a specialist yesterday who was amazing. 2 Rheumies, an ENT, a pain clinic and my GP numerous times over the last two years have missed some very major things. In one visit with the Internist yesterday, I’ve been told I have what I suspected all this time, and have being trying to tell all the others. There’s a mixture of relieve and total with that. Thanks for being one of the good ones. 🙂

    Liked by 1 person

  5. Sometimes you just need to trust your instincts. You not only knew there was something else going on, but in your heart, you knew she wanted to unload on someone. Good call. I hope you were then able to guide her to whatever help she might need.

    Liked by 1 person

  6. I literally went “awwWWWwww” out loud at the end of this! Such a nice, caring doctor. It’s nice to know there are still people out there who genuinely care (even though I assume most still do, but so many doctors express how overworked and tired they are instead of doing things like this). Great post!

    Liked by 1 person

  7. I’m sure it helped. Even if you only have a little time to listen, and you can’t fix the problem, it can still help. It takes courage to ask and your instincts were on target. I bet your instincts (observation skills) have gotten better over the years so you don’t get cussed out as much. But even if you do sometimes, just being asked the question presents the opportunity for a patient to take a closer look. And we all get it wrong sometimes. What’s that saying?…about the person who never made a mistake, didn’t make much, or something like that.

    Liked by 1 person

  8. Thank you for pressing further!
    I can relate to this. My mother has similar health issue and went through a phase similar to this – eventually she said she was tired of meds and limited diet choice.
    Thankfully we found a doc who shared his mother’s story with my mom in the language my mom understands, review her meds and diet. She is happier now (touch wood)

    Meds can be great, but having a doc with a ‘working’ heart makes a huge difference!

    Liked by 1 person

  9. One of the things I love about the doctors I trusted “back home” in South Africa is that they get personal. They look you in the eye, gently ask the hard questions, invite you to trust, welcome your confidences. It took me years to find someone like that after I moved to Washington … and I know, from talking to friends, that she’s not the norm. I’m telling you this because I think it’s great that you went ahead and delved. Privacy is important … but dang it, once you’ve been naked in front of someone, and especially someone who knows what you weigh and the dark secrets of your wobbly bits … well, maybe at that point privacy really isn’t what it’s about.

    Liked by 1 person

  10. You are such a good doctor. We always teach our visiting staff to ask at the near end of their visit time, ” is there anything else I can do for you today?” And that is when they get down to the real issues.

    Liked by 1 person

    • For routine physicals and follow-ups I always start the appointment off saying, “Is there anything you want to talk about before I get down to my stuff?” And then I close with, “Is there anything else you want to talk about before I step out?” It is amazing how many people say no but when my hand turns the door handle, something finally comes out. I completely understand it, too. I am the same way. I have to have the turmoil and angst build up to a level high enough to bring me to mention it. That peaks out at the door handle. 🙂


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