Last month Nick and I spent 36 hours in the clutches of the Marquette General Hospital in the Upper Peninsula, Michigan, investigating his fleeting episode of chest pain, which turned out to be nothing more than a flush of heartburn.\u00a0 As we left, the nurse practitioner handed Nick a copy of his medical records to give to his home town physician.<\/p>\n
The first line on the history and physical read, \u201cThe patient is a pleasant man in no acute distress who appears his stated age of 63.\u201d\u00a0 Yes, it is a hard reality to look as old as you are, but after glancing in the mirror, Nick had no quibble with the assessment.\u00a0 However, the next sentence was startling.<\/p>\n
\u201cThe patient states that he was the dumbest player on his college hockey team.\u201d<\/p>\n
We hooted until our stomachs ached, but then a sobering reality set in.\u00a0 This physician had permanently etched this into his medical record, certain to follow him for the rest of his life.\u00a0 This conversation was worthy of a meticulous dissection, I thought.\u00a0 What were the steps that lead to this gross misrepresentation?\u00a0 What possessed the physician to add this irrelevant detail?<\/p>\n
I was on my way to the ER when the physician interviewed Nick, so over the next several weeks I questioned him extensively on the 10-15-minute interaction, trying to plumb the depths of the conversation and gather the slightest nuances in the exchange. I wanted to reconstruct the steps that had traversed the vast gap between a pleasant gentleman and the dumbest hockey player.<\/p>\n
Nick reported that the ER physician was an athletic-looking man who appeared his stated age of 40.\u00a0 He interspersed his cursory physical exam with simple questions, like where are you from, what are doing up here in the Upper Peninsula? \u00a0Nick felt that this was nothing more than the type of killing-time, blah, blah, blah conversation you have at a cocktail party with someone you will never see again.<\/p>\n
I countered that any conversation in an emergency room is saddled with the unintended consequences of the patient physician-relationship.\u00a0 \u201cNick, remember you were sitting on the examination table, feet dangling, wearing one of those demeaning paper outfits.\u00a0 And you were talking to a physician who could be making life or death decisions, could whisk you off to an emergency angioplasty.\u00a0 This was a man who could snap his fingers and send you down the rabbit hole of the health care system,\u201d I said.<\/p>\n
\u201cWell, okay,\u201d said Nick.\u00a0 \u201cThis was the third physician that had done an identical history and physical.\u00a0 My EKG and lab tests were entirely normal, and I was ready to leave.\u00a0 I thought that if I established a rapport with him he would let me go, maybe come back as an outpatient if I needed a stress test.\u00a0 The last thing I wanted was to stay overnight.\u00a0 So yes, I was trying to be nice, but what about him?\u00a0 What was in it for him?\u201d<\/p>\n
\u201cRemember that both the hospital and physician are constantly rated on social media.\u00a0 Your power was that you could have given him a crummy rating, saying that he was brusque and impersonal, no bedside manner, that sort of thing.\u00a0 I just want to establish that that there was probably an implicit agenda on both sides of the examining table.\u00a0 Okay, what happened next?\u201d<\/p>\n
\u201cThe physician saw scars on my knee and asked me how I got them.\u00a0 I told him that I had blown out my knee playing hockey.\u00a0 Then the guy turned around to fiddle with the computer.\u00a0 He wasn\u2019t even looking at me when he asked, \u2018did you play in college?\u2019\u00a0 I thought it was a weird question.\u201d<\/p>\n
\u201cIn what way was that weird?\u201d I asked. \u201cWouldn\u2019t this still be in the realm of idle conversation?\u201d<\/p>\n
\u201cYes, but I had already told him that I regularly worked out on the elliptical and played a lot of tennis.\u00a0 So I had established myself as a reasonably fit athlete.\u00a0 And this guy was very athletic looking, and it just seemed like he was setting up some sort of competition as to who was the best.\u00a0 I don\u2019t know, maybe in retrospect I am reading too much into the remark, but it was just a weird vibe.\u201d<\/p>\n
\u201cWhat did you tell him?\u201d<\/p>\n
\u201cWell, all I said was that yes, I did play in college and then he said that he also played college sports.\u00a0 Then he asked me where I went to college.\u00a0 Now I felt trapped.\u201d<\/p>\n
I understood because Nick had played hockey at Harvard.\u00a0 Outside of Boston, the mention of Harvard always prompts a response, typically negative. In fact, Nick has learned to drop the H-bomb very sparingly, often saying something like \u201cI went to college back east,\u201d in hopes of deflecting the issue.\u00a0 People often assume Harvard students are too brainy for their own good, or belong to an elitist society whose members have birth certificates stamped with \u201cBorn to Succeed.\u201d\u00a0 Maybe the doctor was jealous.\u00a0 And then there was the added issue of playing hockey there.\u00a0 Maybe the doc thought that hockey was Nick\u2019s way into Harvard, a jockish work-around to GPAs and SAT scores, obscuring the truth that he had worked his ass off.<\/p>\n
Nick went on.\u00a0 \u201cI was so tired I just said it.\u00a0 \u2018I played at Harvard.\u2019\u00a0 Then it got really strange.\u00a0\u00a0 The doctor said, \u2018What it was like to play on a hockey team with such a smart group of people?\u2019\u00a0 That put me at a complete loss.\u201d<\/p>\n
I nodded agreement. \u00a0If Nick said yes, everyone was really smart, he might set up an IQ battle with the physician and potentially alienate the very person he was trying to ingratiate.\u00a0 Say no, and he might create the impression that the hockey team didn\u2019t deserve the cachet of a Harvard education.<\/p>\n
\u201cI tried to finesse the issue,\u201d said Nick.\u00a0 \u201cI told the guy that there were plenty of dumb guys on the team, and then we got interrupted.\u00a0 I was going to add that I got tired of dumb jocks and precious preppies asking me for help in classes that they never went to.\u00a0 I just quit the team, but he never heard that part.\u201d<\/p>\n
\u201cWell, I guess that gets us to the launching pad for his fateful statement, but still what prompted his final leap?\u201d<\/p>\n
I looked over the hospital transcript to see if there was any way the statement could have been the result of a typo or a glitch in a voice-activated transcription.\u00a0 The only possibility I could imagine was that the physician had dictated, \u201cThe patient reports that he WASN\u2019T the dumbest player on the team,\u201d but this is damning with faint praise.\u00a0 \u201cThat doctor must have been carrying a lot of psychological baggage,\u201d I said.\u00a0 \u201cYou were just collateral damage.\u201d<\/p>\n
\u201cLike what?\u201d said Nick.<\/p>\n
\u201cOkay, I\u2019m just brainstorming here.\u00a0 Maybe you unwittingly prompted some deep-seated resentment.\u00a0 Perhaps the guy had been rejected by Harvard, his grades, athleticism or both were not enough, perhaps his brother or sister had gone to Harvard and he was the only one in his family without an Ivy League pedigree.\u00a0 Here he is in Marquette, logging hours in the emergency room far from the elitist East Coast that he aspired to, and now his conceptual nemesis shows up, vulnerable and anxious in his examination room.\u201d<\/p>\n
Nick was surfing the internet as I prattled on. \u00a0\u201cUnbelievable. Look at this. \u00a0Here’s a profile says that he is an outstanding physician, had brilliant grades at Michigan State and does brilliant work and is one of the most reputed specialists.\u201d<\/p>\n
\u201cWow, how about that \u2013 you were in the presence of greatness,” I said. \u00a0“Now don\u2019t take this personally, but the doctor probably thought you were a boring patient. \u00a0Rule\/out heart attack is a routine protocol that wouldn\u2019t require his brilliance.\u00a0 On the other hand, if you had shown up with a fish hook embedded in your eyeball, well that might have piqued his interest, required some deft heroics on his part.\u201d<\/p>\n
Nick\u2019s eyes widened as I gathered momentum.\u00a0 \u201cYour ER physician just got stuck with you.\u00a0 Now imagine him at the end of the day, droning on as he dictates his dreary, repetitive cases \u2013 heartburn, sprained ankles, ear infections.\u00a0 His eyes flutter, his head wobbles, and in this weakened state he uses a history and physician to exact revenge.\u00a0 He wouldn’t remember saying it and would be shocked to see it in print, but here it is, forever more.<\/p>\n
\u201cThe patient states that he was the dumbest player on the hockey team.\u201d<\/p>\n
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