“One More Thing”

Sheila’s visit was one of the funniest. I came out of the room, giggling uncontrollably. It ended with her telling me: “Now, sit your ass down; let me tell you another funny story.”

It started as just another mundane visit, talking about the skin. A spot here, a spot there. Sheila was funny. But almost too funny, like she was using humor to hide her nervousness. I do the same, sometimes, when I am uncomfortable. Sheila’s sense of humor, with her being an older, not-well-educated woman, was not at the least polished or sophisticated. She would joke about herself being a “grumpy old woman,” wink, and sometimes laugh out loud at her own jokes before she even finished her punchlines. She had a smoker’s laughter — the kind that always ended with a wet cough.

I did my best to make her more comfortable. I didn’t look at my computer more than a few times, only when confirming things on her record was necessary. I turned my body toward her and sat close to her to talk. I let her finish her (sometimes) bad jokes, and I laughed cooperatively. Still, I had a feeling we were beating around the bush. But I could be wrong, I thought. Maybe the spots were all she wanted to talk about.

After the visit, I got up to leave. “Sheila, it was so nice to meet you. My nurse will come back in to give you your next appointment.” I put my hand on the doorknob.

“Um…Just one more thing.” Sheila said.

There it is. I thought to myself.

We all get frustrated with the “doorknob question” in healthcare: the “by the way, I also have chest pain and may be having a heart attack” kind of comment that WILL delay your day by a long time and ruin the rest of the schedule; or the “my daughter also has a rash like me, can I show you a picture before you leave” kind of request that often irritates you when you couldn’t even find time to finish the charts for the patients who are in the office, let alone worrying about someone who is not on the schedule. Yes. Those.

But Sheila’s “one more thing” was different, as I could sense it. So when she finally brought it up, it wasn’t irritating. Instead, it felt like a victory. It was like when I went to the morning markets with my mother in Beijing and bargained with the vendors. When all efforts failed, we would pretend to be leaving, so the seller would say, “Ok, Ok! You win. You can have it for $2 less!” Before we turned around, we would share a mischevious smile with each other, a smile I had on my face now before I turned around to face Sheila again in the exam room.

“Ok. Tell me.” I tried to hide my grin, and sat back down.

“Alright. I was too damn embarrassed to tell you. I have a really bad itch down there. And it’s driving me nuts. I spend all day and all night scratching. My son is too embarrassed to take me to even the grocery store, cuz I’d be sittin’ there scratchin’!” Sheila admitted, but this time without her usual jokester punchlines.

“Ok, Sheila. I’d better take a look, then.” I said, closing the exam room curtain.

“Do you have to?” She bargained.

I gave her a look that said c’mon now, and she gave in. “Ok. Ok. I guess we are all women here.”

“Oh my goodness, Sheila. You’ve scratched yourself raw! It must have been so miserable!” It wasn’t the worst case of lichen simplex chronicus (LSC) I’ve seen. But I wanted her to know that I would take it seriously.

“This is actually what I came in for. I was just too embarrassed to tell you at first. So I was just bullshittin’ you with all the other stuff earlier.” Sheila’s crude sense of humor returned. This confirmed my suspicion, too. She was bullshitting me before! Her “one more thing” was actually “the” thing she needed.

We decided to take a biopsy to confirm the diagnosis of LSC. It didn’t take much time. After the visit, I got up to leave again, or at least I attempted to. “Ok Sheila, I will call you with the result. We will figure this out. But no more ‘one more thing’ today, OK?”

“Oh, come on, doc! I gotta tell you one more funny story.”

“No more stories. I have to get going to my next patient.” I wagged my finger at her playfully and “warned” her. She giggled.

“Now, sit your ass down; let me tell you aother funny story!”

My medical assistant burst out laughing after she heard Sheila’s sassy command. She looked at me and said: “Dr. Z, you’d better sit down for this one!”

Image almost unrelated to topic, but in solidarity with Maui, Hawaii.

I don’t remember the joke now. It was not particularly funny. But all three of us laughed our heads off. “You know what I like the most about you?” My medical assistant asked me later. “I bring you food?” I speculated. “Haha. No. You don’t let that ‘doctor’ shit get to your head.”

When I posted about Sheila’s story on Twitter (now called X), it resonated with many people. Two million viewed it in just the first 24 hours. Hundreds of people commented. Turns out, this doorknob “one more thing” being the actual thing people want to talk to their doctors about is not an uncommon phenomenon. And judging from the comments, this “one more thing” shouldn’t be ignored.

“My mother’s ‘one more thing’ turned out to be stage III breast cancer.” One commenter said. “I often find the most deeply important confessions about pain and trauma at the very end of sessions,” one psychotherapist said.

If the doorknob thing is often the most significant thing, why wait until the last minute to mention it? Don’t people know that doctors are busy?

Well. The thing is: people have tried.

In the past two years Sheila had suffered from the itch “down there”, she had seen many different doctors in different departments. A few of them insisted on performing a vaginal speculum exam. “I kept telling them it wasn’t my vagina. It’s on the outside! Then kept telling me to ‘scoot down, scoot down’ on the table. If I scooted down more on that damn table, I’d fall off the bed and break my hip!” She complained. Sheila walked with a cane, she had a hip problem already. One time, during a speculum exam, her hip hurt so much that her blood pressure shot up. The doctor looked up from the speculum exam and asked her: “Are you having a heart attack?” Sheila was simultaneously angry that someone would ask a patient that and bemused that a doctor could be so clueless about the pain they were causing.

So, after being forthcoming about her problems, being thrown antifungal creams at, or being told everything was “normal,” Sheila had given up. She was done telling people her real problem until she could be sure they would hear her.

After confirming the correct diagnosis, I treated Sheila accordingly. The day when she came for her follow-up appointment a few weeks later, I was running behind.

“I’m so sorry for the wait!” I apologized.

“Don’t you worry! I won’t take long today. I just came to tell you my itch is gone! Two years, many doctor’s visits, finally!” Sheila almost jumped out of the chair with excitement. (Then she remembered about her lousy hip and stopped.) I celebrated with her and hugged her. We got up and started to walk out of the exam room together.

“One more thing!” She turned to me suddenly. It was now our inside joke. “My faith in the medical system was way down before you. You restored my hope for them doctors.”

That was simply one of the nicest things anyone has ever said to me. And it came as a doorknob comment. Of course.

Sheila, in her usual joking fashion, didn’t give me time to respond: “I’d better go catch the bus back! Now that I don’t have to scratch myself silly anymore, I have other hobbies to entertain. You take care!”

We laughed some more.

According to the 2022 Merritt Hawkins survey, the average wait time for a patient to see a primary care doctor has been getting longer in the past two decades. On average, in large cities, the wait time for a new physician’s appointment is 26 days. For other specialties, this could be much longer. In rheumatology or dermatology, for example, it’s not unheard of that it takes months for a patient to be scheduled.

Once a patient finally comes in to see a doctor, the waiting time in the exam room or waiting area can range from minutes to hours. Many of my patients bring with them a book to keep themselves entertained. Some watch a movie while sitting in the exam room to prepare for a long wait. Patients spend so much of their lives waiting for us. It’s a big problem in our healthcare system in the United States and many other countries — a much larger problem than what we can solve in our individual exam rooms.

But we can treat people like how we’d like to be treated.

When I was trying to tell Sheila’s story to a colleague, without letting me finish, she said: “She can keep her doorknob question to herself and make another appointment!” The rest of my story was cut off by her kneejerk response to just the preface. That’s not fair. I wanted to say but didn’t want to start an argument.

It’s unfair because a clinic visit isn’t just a business transaction, no matter how much today’s healthcare system wants us to believe that. People aren’t coming to see us to buy a pair of shoes or a cabbage. They come in need of help for something they are at a total loss of. They come in vulnerable, scared, and embarrassed. They rehearse what they would say in order for us to take them seriously. They joke to hide their fear. They ask about our days and talk about their kids to remind us they are, like us, human too. A transitional model, like at the bank or a grocery store, doesn’t work to take care of fellow humans.

And here is my punchline:

If we ask people to wait for months to see us, then hours in our offices, we can hear them out for their “one more thing".

*The story of the above patient was based on a true story, but the details and name were significantly altered to protect confidentiality.*