The computer generated routing slip on the exam room door said he was there because of a knee injury. That turned out to be only partly true.
When I entered the room, he was sitting comfortably on the exam table. I introduced myself, we shook hands, and as I sat down at the computer to open the EHR to his chart, I started with my usual fairly open-ended question:
Me: So, what brings you in today and how can I help?
Him: I hurt my knee this past weekend. (Note: this was a Wednesday.)
Me: Tell me about it.
Him: I was in the garden helping my wife and I got tangled in the hose and tripped. I think I twisted my knee.
Me: And then?
Him: What do you mean?
Me: What did you do next?
Him: Nothing, I mean, I stayed in the garden and helped my wife.
Me: Did your knee bother you? Did it swell up? Did you do anything like ice or elevation?
Him: No. It was pretty sore, but I ignored it. It was a bit better but it still hurt yesterday morning so I called and they gave me this appointment this afternoon.
Me: OK. Lets take a look at the knee. Can you take off your shoes and jeans?
(He hops off the exam table, takes of his shoes and jeans with no evidence of discomfort, and hops back up on the table. I look and see no bruising, redness, or swelling in either knee.)
Me: Which knee is bothering you?
Him: Oh, it feels fine today. It doesn’t bother me now.
Me: Great. Which knee did you hurt?
Him: (Pause. He looks down at his knees, straightens and bends them individually and then together.) I don’t remember.
Me: (Struggling silently to figure out what his agenda is.) OK, lets examine your knees and make sure they both seem ok. (Both knee exams are fine.) So, the knees seem great.
Him: Thanks. Can I have a note for work?
Me: I don’t know. What does it need to say?
Him: That I missed work today because of a doctor’s visit.
Me: Sure. I can write a note saying you were seen here today. But I’m curious. If your knee is fine, why are you here? Why didn’t you call and cancel the appointment. (I was wondering if he was worried about long term problems, a prior knee issue, a family member with incorrectly diagnosed knee issues, or perhaps a family member had insisted he come.)
Him: Well, yesterday when I got up, it was still pretty sore, so I called called in sick and then made an appointment here for today. It got better during the day yesterday and was fine this morning.
Me: I understand. But was there something else you were concerned about that kept you from canceling your appointment this morning when your knee seemed fine?
Him: No. I had already called out from work and had this appointment. My co-pay is only $10, so I figured, what the hell. I’d come in and see if I could get a note to stay out of work today.
I gave him his note, saying only that he had been seen in our office. It was an easy visit, a nice break in the middle of an otherwise pretty tough afternoon, so I should have been grateful, but I was irritated that the appointment time was not available for someone with a bigger medical need. And frustrated at understanding that this was something I couldn’t fix or change without being inappropriate and unprofessional.