Under My Skin




Many interesting things happen in a medical office, most of which don’t merit a full column. Here are some from my own past few months:

Endocrine Knee? I was hard put to explain the calluses on both my patient’s knees. As I tried to formulate a question, he rescued me by saying, “I’m an endocrinologist. I spend a lot of my time on my knees, trimming the toenails of elderly diabetics.”

Dr. Alan Rockoff

Dr. Alan Rockoff

Who knew? At least bending the knee to insurers and regulators doesn’t require keratolytics ...

You can get anything online. My patient was about to graduate with a degree in psychoanalysis. “I have to set up my office,” she said, “drapes, analyst couch, and so forth.”

“Where do you buy an analyst couch?” I asked.

Analyticcouch.com,” she explained. “Available in a variety of colors.”

What a country!

No I’m not, Officer! Many patients consider removing facial red spots that make them self-conscious, but Harriet’s reason was unique. “I got pulled over by a cop for an illegal change of lanes,” she said. “When he saw the red spot under my eye, he assumed I was a drunk. ‘Get over there, punk,’ he said.”

The other bathroom is upstairs. Stan listed his occupation as “muralist.” Picturing him sneaking up to blank walls on street corners in the middle of the night with a can of Benjamin Moore to ply his trade, I asked where he draws his murals.

“Most of my work is residential,” he said. “For instance, last year I did a bathroom in Framingham. The motif they wanted was ancient Egypt. I had to do a lot of research on the 18th dynasty, to get the details exactly right.”

That made sense. You wouldn’t want a dangling hieroglyphic participle in your downstairs lavatory. I asked him how it worked out.

“The client was delighted,” he said, “only there was one problem. Whenever guests came over for a dinner party, there was always a long line, because whoever was in the bathroom wouldn’t come out.”

There are always alternatives. By now I am used to hearing patients extol the virtues of exotic treatments: Vicks VapoRub for toenail tinea, tea tree oil for most anything. Apple cider vinegar for everything else.

Then the other day Marcy surprised me with this:

“I stopped the minocycline,” she said, “Instead I started using celery, which I ground up and boiled and then froze and then applied to the face.”

A little bit of a production, perhaps – grinding, boiling, freezing. As long as it works ...

You need a different kind of doctor. “I see I won’t be able to shower for 3 days,” said the new patient.

My jaw dropped, but no words came out.

“It’s that sign you put up,” he said, “right on the exam room door.”

As I don’t usually read my own signs, I turned to look. The sign read:

“If you have no-showed without notice three times, we reserve the right to reschedule you at our convenience.”

“It says, ‘No-Showed,” I said. Not ‘No Showers.”

I resisted the urge to refer him to an optometrist.

This reminded me of another episode some time ago, when a patient listed his Chief Complaint as, “I want Lasik Surgery.”

“Forgive me,” I said, “but why would you ask a dermatologist for Lasik surgery?”

“Doesn’t the sign on your door say, “Boston Ophthalmology?” he asked.

“Upstairs,” I said. “Seventh floor.”

Negotiating with Father Time. We suspected porphyria, and ordered a 24-hour urine collection. “I’m a busy executive,” said the patient. “I haven’t got time to collect it for that long.”

“But it has to be a whole day ...”

“Fifteen hours,” he said. “I’ll give you 15 hours.”

“But we need ...”

“Eighteen hours. OK?”

“Well, not really. You see, the test has to be a whole day ...”

“All right, 21 hours. That’s my best offer.”

Maybe if I could get him to spend the day in that Egyptian bathroom ...

Dr. Rockoff practices dermatology in Brookline, Mass, and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His new book, “Act Like a Doctor, Think Like a Patient,” is now available on amazon.com and barnesandnoble.com. This is his second book. Write to him at dermnews@frontlinemedcom.com.

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