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. As we left, the nurse practitioner handed Nick a copy of his medical records to give to his home town physician.
The first line on the history and physical read, “The patient is a pleasant man in no acute distress who appears his stated age of 63.” 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. However, the next sentence was startling.
“The patient states that he was the dumbest player on his college hockey team.”
We hooted until our stomachs ached, but then a sobering reality set in. This physician had permanently etched this into his medical record, certain to follow him for the rest of his life. This conversation was worthy of a meticulous dissection, I thought. What were the steps that lead to this gross misrepresentation? What possessed the physician to add this irrelevant detail?
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.
Nick reported that the ER physician was an athletic-looking man who appeared his stated age of 40. He interspersed his cursory physical exam with simple questions, like where are you from, what are doing up here in the Upper Peninsula? Nick 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.
I countered that any conversation in an emergency room is saddled with the unintended consequences of the patient physician-relationship. “Nick, remember you were sitting on the examination table, feet dangling, wearing one of those demeaning paper outfits. And you were talking to a physician who could be making life or death decisions, could whisk you off to an emergency angioplasty. This was a man who could snap his fingers and send you down the rabbit hole of the health care system,” I said.
“Well, okay,” said Nick. “This was the third physician that had done an identical history and physical. My EKG and lab tests were entirely normal, and I was ready to leave. 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. The last thing I wanted was to stay overnight. So yes, I was trying to be nice, but what about him? What was in it for him?”
“Remember that both the hospital and physician are constantly rated on social media. 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. I just want to establish that that there was probably an implicit agenda on both sides of the examining table. Okay, what happened next?”
“The physician saw scars on my knee and asked me how I got them. I told him that I had blown out my knee playing hockey. Then the guy turned around to fiddle with the computer. He wasn’t even looking at me when he asked, ‘did you play in college?’ I thought it was a weird question.”
“In what way was that weird?” I asked. “Wouldn’t this still be in the realm of idle conversation?”
“Yes, but I had already told him that I regularly worked out on the elliptical and played a lot of tennis. So I had established myself as a reasonably fit athlete. 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. I don’t know, maybe in retrospect I am reading too much into the remark, but it was just a weird vibe.”
“What did you tell him?”
“Well, all I said was that yes, I did play in college and then he said that he also played college sports. Then he asked me where I went to college. Now I felt trapped.”
I understood because Nick had played hockey at Harvard. 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 “I went to college back east,” in hopes of deflecting the issue. 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 “Born to Succeed.” Maybe the doctor was jealous. And then there was the added issue of playing hockey there. Maybe the doc thought that hockey was Nick’s way into Harvard, a jockish work-around to GPAs and SAT scores, obscuring the truth that he had worked his ass off.
Nick went on. “I was so tired I just said it. ‘I played at Harvard.’ Then it got really strange. The doctor said, ‘What it was like to play on a hockey team with such a smart group of people?’ That put me at a complete loss.”
I nodded agreement. If 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. Say no, and he might create the impression that the hockey team didn’t deserve the cachet of a Harvard education.
“I tried to finesse the issue,” said Nick. “I told the guy that there were plenty of dumb guys on the team, and then we got interrupted. 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. I just quit the team, but he never heard that part.”
“Well, I guess that gets us to the launching pad for his fateful statement, but still what prompted his final leap?”
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. The only possibility I could imagine was that the physician had dictated, “The patient reports that he WASN’T the dumbest player on the team,” but this is damning with faint praise. “That doctor must have been carrying a lot of psychological baggage,” I said. “You were just collateral damage.”
“Like what?” said Nick.
“Okay, I’m just brainstorming here. Maybe you unwittingly prompted some deep-seated resentment. 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. 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.”
Nick was surfing the internet as I prattled on. “Unbelievable. Look at this. Here’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.”
“Wow, how about that – you were in the presence of greatness,” I said. “Now don’t take this personally, but the doctor probably thought you were a boring patient. Rule/out heart attack is a routine protocol that wouldn’t require his brilliance. 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.”
Nick’s eyes widened as I gathered momentum. “Your ER physician just got stuck with you. Now imagine him at the end of the day, droning on as he dictates his dreary, repetitive cases – heartburn, sprained ankles, ear infections. His eyes flutter, his head wobbles, and in this weakened state he uses a history and physician to exact revenge. He wouldn’t remember saying it and would be shocked to see it in print, but here it is, forever more.
“The patient states that he was the dumbest player on the hockey team.”
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