My patient and her older sister greeted me with profuse gratitude when I brought them into the examining room at the Wills Eye emergency room at Thomas Jefferson University. "We need your help," the sister said. "We're so worried."
The patient was a teenager who had lost vision in one eye. She had been seen at another eye center and diagnosed with optic neuritis, an inflammation of the optic nerve that can be associated with multiple sclerosis. They wanted a second opinion.
Second opinions are often challenging because they involve complicated cases, or the patients themselves can be inherently difficult.
This patient's story had already raised eyebrows. The two had just gotten off a plane from the other center, had no records with them and no name of their prior doctor, and were going to California the next day.
Once I started taking a look, her sister asked me for my opinion. "Will she see again? Do we need another MRI?"
I told her I needed to finish the exam and would then be able to assess the need for more tests.
A few minutes later, another flurry of questions came, and I tried to answer. Then more. At that point, I tried to tune out her questions and finish the exam quickly.
"You're not listening to me," she said.
"I'm sorry," I said. "I can't tell what's wrong with your sister until I finish my exam. Please give me a moment here."
That much set her off. "You are a terrible doctor. You don't even care. You're ignoring me and you haven't answered any of my questions."
"Ma'am, I'm sorry. . . . " I began to escalate. "Your sister has a serious problem and. . . . "
"You're the worst. I want another doctor right now."
"But . . ."
At that point, the director of our emergency room, Michael DellaVecchia, came in. One of our nurses, Sheila Starr, had summoned him from his office in the back and told him of the ensuing melee.
Eventually our white-haired director calmed them down.
I walked out and felt like crying. Sheila followed me into the back break room and comforted me. But then she gave me the bottom line, which she had come to realize after 36 years in the trenches.
"You stand up for yourself and don't let them walk all over you. When a patient is being unreasonable, you let them know."
