A Bird in the Hand

I will preface this story with a disclaimer: I am not exaggerating the following.

On one short-handed urgent care shift right before Christmas, wait times to see the doctor (me) stretched to four hours, at which point people started a light riot.

The urgent care where I was working normally has two providers at once: an MD and either a nurse practitioner or a physician assistant. That day, the nurse practitioner called out sick with COVID, leaving me alone.

I ended up seeing about twenty patients more than usual and was working my butt off, drowning in the sea of COVID. Partway through the shift, some of the patients who had been waiting started getting upset. A group of about 10 climbed over the shrubs separating the parking lot from the building, walked around the corner to where the glass-enclosed lab was located down the hall from me, and began BANGING ON THE GLASS. “HEY! WE’VE BEEN WAITING FOUR HOURS!”

It was 11am. Urgent care had been open since 8am. You do the math.

After realizing that the shaking walls wasn’t the Big Earthquake We Fear but rather a very mild mob, I called security to shoo them away.

The shift traumatized me, as much as working at an urgent care can be traumatizing. Of course, instead of filing a complaint or notifying a superior of the awful experience, I went home and drank a pathologically-sized bourbon and ate a pint of ice cream, like the professional with 100+ coping strategies modules under his belt that I am.

So. I absolutely despise urgent care with a white-hot ragepassion. I hate working there. I try to convince myself that I don’t care, that I don’t mind, that it’s easy, that there’s an intellectual challenge there sometimes – and I fail. I would be perfectly happy never setting foot inside one of those places ever again.

With that in mind. There are basically three classes of urgent care patients right now, all of whom have COVID, and each of whom fall into one of three subcategories:

  • “I got exposed and want/need a test…”
    • To go back to work
    • For my own peace of mind
    • For attending the 40,000-person warehouse rave tomorrow
  • “I have a cough and chills…”
    • There’s no way it’s COVID though
    • Could this be COVID?
  • “I’m not vaccinated because…”
    • I don’t care
    • I don’t care
    • I don’t care

This last group deserves special mention. I think it is important to say up front that I should care if my patients are vaccinated – part of being a physician is advocating for the health of my patients, providing gentle education, meeting them where they are, etc. etc. – but I do not. I am way past being angry with these people or the talking heads they follow, beyond frustrated, and past any kind of empathy. I do not want to argue with them, or provide education, or try to have a conversation about their barriers to vaccination.

I have to ask about their vaccination status because it impacts how I risk stratify them, but I simply do not care why.

Unfortunately, the patients do! Invariably, the ones who are unvaccinated feel compelled to explain their reasoning, despite the interaction going like this:

Me: are you vaccinated?

Patient: no

Me: Okay. Do you ha-

Patient: You aren’t going to ask why?

Me: No

Patient: I just think that the government–

[two minutes later]

Me: Anyway, do you have allergies?

I don’t understand it. These people come in, usually with active COVID, and insist on explaining to me why they are unvaccinated despite the giant “I DO NOT CARE” written on my forehead.

The explanations run the gamut of vaccine hesitaters and deniers, from the do-your-own-research varietals to the more exotic 5G-towers-government-conspiracy nutcases. In an effort to skip this part of the conversation, because all I want at this point is to go home and drink cope heavily, I have been experimenting with a new method of redirection that I call the Incomplete Aphorism Technique.

Here’s how it works: when a patient either a) complains about the wait, or b) starts explaining why they are unvaccinated, I shrug my shoulders and throw out a total non sequitur.

The key is to use an incomplete saying, like “When in Rome, do as the Romans do,” but you only say the first half out loud.

<shrug> “Well, you know, when in Rome!”

Then, silence. And you wait.

Invariably, the patient stops talking to consider the extreme curveball I have just thrown their way. They always expect me to say more and explain myself, but I don’t. After a few seconds of thinking, most of them sort of cognitively seize up, like an engine that runs out of oil, and wait for me to restart the conversation. This is ideal because it usually leads to my prompt exit from the room, saving time and sanity.

The key is in the incomplete utilization of a wholly inappropriate saying. At the start of each horrible urgent care shift I go to the Wikipedia page, “List of Proverbial Phrases,” which sorts hundreds of aphorisms alphabetically, and pick a letter. I then try out sayings until I find one that either freezes my patients or makes me snort with laughter.

The best ones I’ve found so far have a 100% success rate of inducing confusion, and more importantly, stopping any discussion of vaccination or wait times:

<shrug> “well, as you know…”

  • “When in Rome!”
  • “A bird in the hand!”
  • “Haste makes waste”  
  • “Eat breakfast like a king”
  • “For want of a nail”
  • “The best-laid schemes”

Most patients then undergo a visible Windows XP computer freeze in front of my face, which is uniformly hilarious. The hardest part is not laughing, as the effect is maximized if I maintain benign, but interested, eye contact during this crucial time.

After that, the patient usually decides that the doctor is completely insane and is as eager to get the hell out of urgent care as I am. See? There’s always common ground, or so my modules tell me.

After all, you know what they say: fish always rots.

3 thoughts on “A Bird in the Hand

  1. Congratulations!!!!

    This is terrific. I’m sorry people are like that in the urgent care but you have figured it out. It almost like having a MAGIC WORD. But it is. a disgrace that the patients in that clinic behave like that. I hope the nurse was of some help. Love,grandma


  2. ended better than it began. I feel your pain and frustration but ranting about it isn’t clever. highlighting the idiocy with your coping technique is.

    other than that how are you??

    Sent from my iPhone

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